Acceptability, feasibility, and pilot results of the tele-harm reduction intervention for rapid initiation of antiretrovirals among people who inject drugs

Tookes, Hansel; Bartholomew, Tyler S.; Suarez, Edward; Ekowo, Elisha; Ginoza, Margaret; Forrest, D.W.; Serota, David P.; Rodríguez, Allan; Kolber, Michael A.; Feaster, Daniel J.; Mooss, Angela; Boyd, Derek R.; Sternberg, Candice; Metsch, Lisa R.

doi:10.1016/j.drugalcdep.2021.109124

Cited by 12 publications

(15 citation statements)

References 51 publications

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“…We developed a Tele-Harm Reduction intervention to help PWID overcome the psychosocial and structural burden aspects of the syndemics theoretical framework [ 35 , 36 ]. Preliminary data suggest that SSP-based telehealth for HIV care is both feasible and acceptable and pilot data showed 78.1% ( n =35) viral suppression at 6-month follow-up [ 17 ]. Our novel, white glove, concierge medicine approach to PWID health shows great promise as an efficacious model of care for a long-overlooked community.…”

Section: Discussionmentioning

confidence: 99%

“…The T-SHARP study is proposed as an efficacy trial because the study team has already demonstrated the feasibility and acceptability of rapid ART initiation via telehealth in PWID [ 17 ]. THR will be based out of SSPs due to their central role as a “home-base” in the community of PWID.…”

Section: Interventionsmentioning

confidence: 99%

“…A recent drop-in HIV clinic intervention among a cohort of housing unstable individuals with substance use disorder (SUD) and uncontrolled HIV in San Francisco reported only 44% viral suppression at 12 months [14]. Furthermore, PWID living with HIV face intersecting stigmas that affect adherence to care in the traditional healthcare setting and to antiretroviral therapy (ART), and subsequently viral suppression [15][16][17].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

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Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

Tookes

Oxner²,

Serota³

et al. 2023

Trials

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Background The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. Methods The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. Discussion The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. Trial registration ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022.

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Section: Discussionmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Background and Rationale {6a}mentioning

confidence: 99%

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Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

Tookes

Oxner²,

Serota³

et al. 2023

Trials

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“…One of our foremost lessons learned is that the engagement in care interventions tested in our studies has not always worked for PWH who use drugs and has been limited by short-term success. Dr. Hansel Tookes is currently testing an innovative new linkage to care intervention for persons who use drugs—Tele-Harm Reduction—which integrates harm reduction with patient autonomy (Tookes et al, 2021). Rather than enlisting traditional health care systems, Dr. Tookes and team are focusing on trusted services—and specifically, SSPs—to deliver on-demand, concierge-driven, telehealth-enhanced access to care.…”

Section: Lessons Learned and Future Directionsmentioning

confidence: 99%

Ending the HIV Epidemic for Persons Left Behind in the Advances of HIV: Intervention Studies Addressing the HIV Continuum of Care

Metsch

Feaster

Parish

et al. 2022

Research on Social Work Practice

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The advent of antiretroviral therapy and biomedical prevention has transformed HIV from a fatal disease to a chronic condition where people with HIV (PWH) can live long, healthy lives. Yet, there remains a subset of PWH left behind from receiving timely HIV diagnosis and care. Striking inequalities in access to resources, socioeconomic disparities, and social forces have prevented certain PWH from achieving significant health and quality of life (QOL) improvements experienced by those who secure life-saving treatment. For decades, our multidisciplinary team developed a collaborative scientific portfolio focused on helping those left behind advance along the HIV continuum of care. In this manuscript, we highlight some of our U.S.-based social interventions that have addressed the disparities and sub-optimal QOL encountered by overlooked populations with the goal of achieving timely HIV diagnosis, care, and sustained viral suppression. We then outline our many lessons learned and vision for the next crucial steps ahead.

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“…To expand and improve access to MOUD, the IDEA Miami SSP adapted and implemented the Tele-Harm Reduction (THR) intervention for buprenorphine initiation and retention. THR is a multicomponent, telehealth-enhanced, peer-driven intervention that has shown promise for PWID living with HIV to initiate HIV care and achieve viral suppression [ 32 ]. In THR, telehealth is an on-demand videoconference facilitated by a peer assisting a participant interact with their physician via tablet at the SSP or on the mobile unit so the physician can evaluate, document, and prescribe in a remote location.…”

Section: Introductionmentioning

confidence: 99%

Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study

et al. 2023

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Background: At the start of the pandemic, relaxation of buprenorphine prescribing regulations created an opportunity to create new models of medications for opioid use disorder (MOUD) delivery and care. To expand and improve access to MOUD, we adapted and implemented the Tele-Harm Reduction (THR) intervention; a multicomponent, telehealth-based and peer-driven intervention to promote HIV viral suppression among people who inject drugs (PWID) accessing a syringe services program (SSP). This study examined buprenorphine initiation and retention among PWID with opioid use disorder who received the adapted THR intervention at the IDEA Miami SSP. Methods: A retrospective chart review of participants who received the THR intervention for MOUD was performed to examine the impact of telehealth on buprenorphine retention. Our primary outcome was three-month retention, defined as three consecutive months of buprenorphine dispensed from the pharmacy. Results: A total of 109 participants received the adapted THR intervention. Three-month retention rate on buprenorphine was 58.7%. Seeing a provider via telehealth at baseline or any follow up visit (aOR = 7.53, 95% CI: [2.36, 23.98]) and participants who had received an escalating dose of buprenorphine after baseline visit (aOR = 8.09, 95% CI: [1.83, 35.87]) had a higher adjusted odds of retention at three months. Participants who self-reported or tested positive for a stimulant (methamphetamine, amphetamine, or cocaine) at baseline had a lower adjusted odds of retention on buprenorphine at three months (aOR = 0.29, 95% CI: [0.09, 0.93]). Conclusions: Harm reduction settings can adapt dynamically to the needs of PWID in provision of critical lifesaving buprenorphine in a truly destigmatising approach. Our pilot suggests that an SSP may be an acceptable and feasible venue for delivery of THR to increase uptake of buprenorphine by PWID and promote retention in care. KEY MESSAGES The Tele-Harm Reduction intervention can be adapted for initiating and retaining people who inject drugs with opioid use disorder on buprenorphine within a syringe services program setting Using telehealth was associated with increased three-month buprenorphine retention Baseline stimulant use was negatively associated with three-month buprenorphine retention

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Acceptability, feasibility, and pilot results of the tele-harm reduction intervention for rapid initiation of antiretrovirals among people who inject drugs

Cited by 12 publications

References 51 publications

Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

Project T-SHARP: study protocol for a multi-site randomized controlled trial of tele-harm reduction for people with HIV who inject drugs

Ending the HIV Epidemic for Persons Left Behind in the Advances of HIV: Intervention Studies Addressing the HIV Continuum of Care

Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study

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