Six University of Miami collaborative studies to test new HIV treatment and prevention strategies have received supplemental funding grants totaling $912,000 from the National Institutes of Health as part of the nationwide initiative “Ending the HIV Epidemic: A Plan for America.”
The one-year supplemental awards were made to 17 institutions that participate in the NIH-funded Centers for AIDS Research program and six AIDS Research Centers, funded by the NIH National Institute of Mental Health.
“With existing, powerful HIV treatment and prevention tools, we can end the epidemic in the United States,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases at NIH. The nationwide plan aims to reduce new HIV diagnoses in the United States by 75 percent in five years and by 90 percent by 2030 in keeping with President Trump’s goal announced in the 2019 State of the Union Address in February. The efforts will focus on four key strategies that together can end the HIV epidemic in the U.S.: Diagnose, Treat, Prevent, and Respond.
While human immunovirus (HIV) transmission rates and HIV-related deaths are falling in most of the country, that’s not the case in Miami-Dade County, where 27,544 adults – about one in 84 – were known to be living with HIV as of year-end 2017, according to the Florida Department of Health. Unlike most U.S. communities, that number rose 1.3 percent from the prior year.
Three of the grants support projects administered through the Miami Center for AIDS Research (CFAR) and three support projects administered through the Center for HIV and Research in Mental Health (CHARM). Both CFAR and CHARM are multi-disciplinary cross-institutional centers at UM that support HIV/AIDS research, with CFAR administered through the Miller School of Medicine, and CHARM through the Department of Psychology at the College of Arts & Sciences.
The six research projects are also aligned with Florida’s public health HIV goals, which include implementing HIV screening in health care settings and priority testing in non-health care settings; providing rapid access to treatment and ensuring retention in care (“Test and Treat”); improving access to antiretroviral pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (nPEP); and increasing HIV awareness and community response through outreach, engagement, and messaging.
“Our medical school has been a leader in the fight against HIV/AIDS since the beginning of the epidemic,” said Savita Pahwa, M.D., professor of microbiology and immunology and director of the Miami CFAR. “It’s exciting to be in the forefront of a national initiative that could one day bring an end to the epidemic.”
CFAR’s Outreach Projects
With its diverse population and clusters of HIV infections, Miami-Dade County is one of the nation’s most challenging battlegrounds for preventing viral transmissions, according to Mario Stevenson, Ph.D., professor of medicine, co-director of Miami CFAR, chief of the Division of Infectious Diseases, and director of the Institute of AIDS and Emerging Infectious Diseases. “If we can find effective responses to this public health problem, we can serve as a model for the country,” he added.
The Miami CFAR supplemental grants focus on outreach strategies aimed at high-risk individuals and communities. “We need to do more than simply offer the traditional clinical model of diagnosis and treatment,” said Dr. Stevenson. “Many people lack the ability or the desire to travel to an HIV clinic. Others don’t want to be stigmatized or treated differently by their family or neighbors. That’s why outreach is so critical for preventing new infections.”
The supplemental grants support these three research studies:
- “Identifying Barriers and Building Strategies for Widespread Implementation of Rapid Linkage into Care and Antiretroviral Initiation of Individuals Newly Diagnosed with HIV in Miami-Dade County.” The principal investigator is Allan E. Rodriguez, M.D., professor of clinical medicine in the Division of Infectious Diseases and director of the Behavioral/Social Science & Community Outreach Core of the Miami CFAR. This project focuses on ways to provide rapid HIV testing to people who may have been exposed to the virus. “If they do test positive, getting them on antiretroviral therapy as quickly as possible can actually change the course of the disease,” said Dr. Stevenson.
- “Mobile Prevention Services to Respond to Expanding HIV Clusters in South Florida,” led by Susanne Doblecki-Lewis, M.D., associate professor of clinical medicine and clinical director of infectious diseases. By partnering with Sylvester Comprehensive Cancer Center’s “Game Changer” mobile clinic, Miller School clinicians can bring HIV educational, testing and treatment services to people at “hot spots” throughout Miami-Dade County.
- “Mobile Delivery of PrEP and Medication-Assisted Treatment at a Syringe Services Program – A Pilot Study,” co-led by Hansel Tookes, M.D., M.P.H., assistant professor of medicine, and Dr. Doblecki-Lewis. This project focuses on testing and treatment for intravenous drug users who are at high risk for HIV infections.
CHARM Behavioral Studies
Many Miami-Dade County residents engage in high-risk behaviors that can lead to new HIV infections. Others find it difficult to adhere to a long-term HIV treatment program – particularly if they also have mental health disorders like depression or anxiety.
“Our center focuses on these types of challenging problems, as well as mental health disparities within our community,” said Steven Safren, Ph.D., professor of psychology and director of CHARM. “Our center’s studies focus on innovative ways to reach these individuals for testing and help those living with HIV stay in treatment.”
The CHARM supplemental grants support these three research studies:
- “Implementation of Telemedicine Test and Treat for On-Site Initiation of Antiretroviral Therapy at Miami’s IDEA Exchange Service Program,” led by Dr. Tookes. The goal of this project is to link people who inject drugs and who are taking part in the UM syringe service program with HIV testing and care through a telemedicine program.
- “Finishing HIV: An HIV Protection, Diagnosis and Treatment Network for Latinos,” led by Mariano Kanamori, Ph.D., professor of public health. This is a collaborative outreach project involving area pharmacies and other organizations to connect at-risk Latinos with HIV testing and treatment services.
- “Five Point Initiative,” led by Sannisha Dale, Ph.D., assistant professor of psychology and CHARM’s scientific director for community engagement. This is an innovative outreach project focused on black communities that will be done in close collaboration with community consultants (Kalenthia Nunnally, Camille Lewis, and George Gibson) and community organizations. Individuals who come to five different venues as points of contact – corner stores, mechanics, hair/beauty salons, barber shops, and laundromats – will be given a voucher for services at that venue after completing a survey about facilitators and barriers to HIV prevention and treatment. “They will also be offered HIV/STI testing and referrals as needed,” said Dr. Safren.
All six of these pilot studies will be evaluated after one year, and projects that demonstrate a positive impact may receive additional NIH funding for further development, said Dr. Stevenson. “A key mission for academic medical schools is to make a positive impact on the health of their community,” he added. “I can’t think of a better way to do so than through these types of studies, which hopefully can make a lasting contribution to ending this epidemic.”