Ending HIV: Bringing Integrated Prevention and Treatment Services to People Who Use Drugs Where They Live

Project Abstract: The United States (U.S.) Ending the HIV Epidemic (EHE) plan’s primary goal is to reduce the number of new HIV infections by 90% by 2030, but this will not happen unless we develop ways to BRING the evidenced- based services to persons who use drugs (PWUD). Overdose deaths are dramatically increasing in the US,

and fentanyl and stimulants are fueling new HIV epidemics. My career and my passion revolve around integration of treatment of opioid use disorder (OUD) and other substance use disorders with HIV treatment and prevention. Through over 20-years of direct clinical care as an infectious disease and addiction medicine

physician combined with substantial clinical research expertise involving PWUD living with and at risk of HIV, I know the blind spots in the EHE plan and I can fill them in with this pioneer award. My pioneering award vision is to: 1) train persons who live in the communities affected by high levels of overdose to be community

health workers (CHWs) to provide the HIV testing and rapid diagnosis of OUD; 2) create mobile hubs that are pharmacies and clinics on wheels that can be deployed to immediately dispense pre-exposure prophylaxis (PrEP), antiretroviral therapy (ART), and medication treatment for OUD (MOUD) anywhere; 3) develop rapidly

deployable mobile rapid response teams (the mobile spokes) comprised of the CHWs and pharmacists with 24 hour access to online clinicians that deploy out from the mobile hubs to where the CHWs identify to bring the medications (PrEP/ART based on the rapid HIV testing results, and MOUD to people who have a diagnosis of

OUD) to where people ‘live’; and 4) collaborate with researchers, including modelers, to prioritize where outbreaks of HIV are most likely to occur and provide a collaboration hub for others working in the fields of HIV and substance use disorders to help inform this proposed care model. Through this award, I will also ensure

that the mobile rapid response teams continue to follow people and help them retain on the medications and address competing needs to eliminate barriers to accessing services. Thus, the overall idea in this pioneer award is providing low barrier services at multiple access points in line with the EHE plans where we would be

BRINGING the testing and treatment plans (MOUD, PrEP/ART) to PWUD and RETAINING them via non- traditional methods where THEY LIVE. Through using trained persons who LIVE in the communities (CHWs) with shared living experiences of their community members who use drugs and are at risk or living with HIV,

we can provide the testing and diagnosis services combined with pharmacists to dispense the medications in real-time to people who typically do not have access to our normal clinical or research venues including women, justice-involved persons, immigrants, the uninsured, and underrepresented minorities. I have the

experience, the passion, the work ethic and the collaborative team to help end HIV in PWUD through this pioneer award.