HIV: NIDA's Avenir Grant Awarded to Hansel Tookes, MD, MPH, for Tele-Harm Reduction Research

Liz Scherer

July 15, 2021

"There are no interventions that have been shown to be effective in attaining viral suppression in people who inject drugs (PWID)," 2021 HIV/AIDS Research Avenir Award winner Hansel Tookes, MD, infectious disease specialist at the University of Miami Miller School of Medicine, Miami, Florida, told Medscape Medical News.

Dr Hansel Tookes

Tookes is one of two recipients of a 4-year grant from the National Institute on Drug Abuse (NIDA) that is intended to stimulate innovation and transformative research by early-stage investigators. They will receive $2.3 million. Tookes' project — Tele-Harm Reduction for Rapid Initiation of Antiretrovirals in People Who Inject Drugs: A Randomized Controlled Trial — is a natural evolution of his work in Miami to bring to the streets essential care for patients with HIV, hepatitis C virus (HCV), and addiction.

"We piloted tele-harm reduction last year during the pandemic to make sure that our patients remained in care and remained engaged with us during a highly challenging time," Tookes explained. The result? "Patients achieved viral suppression rates as high as 78% under duress, which highlights that given the right support, PWID can be successful."

A New Model of Care

The Avenir Awards ("avenir" is French for "future") were born from NIDA's Avant-Garde Awards with a goal of extending much-needed funding to less-established, early-stage HIV/AIDS and substance use disorder researchers whose work has the potential to open new areas of care and who represent the future of addiction science.

"This year, we selected two Avenir rewards that reflect the diversity of field and perspectives that are not always well received," explained Nora Volkow, MD, director of NIDA.

In general, harm reduction programs have been known for incentivizing people to reach out for treatment — whether for HIV or substance abuse — when they are ready. "Dr Tookes is proposing a new model of care that takes advantage of syringe exchange programs to provide integrated services, leading to initiation of antiretroviral therapy and at the same time treatment for substance use disorders in PWID," noted Volkow.

Meeting People Where They Are

Current estimates suggest that almost 50% of new HIV diagnoses are made among PWID. Yet a majority of these patients are never tested for HIV or HCV. There is a variety of reasons for this, including stigma, access, homelessness, and mental health problems.

"Tele-harm reduction is rooted in harm reduction, which is meeting people where they are and respecting their autonomy," explained Tookes. This means taking healthcare out of traditional systems and leveraging trusted services (specifically, syringe services programs [SSPs]) to deliver telehealth-enhanced access to care.

In a study published in 2020, Tookes and colleagues showed that one of the most effective interventions for reducing HIV transmission among PWID is to provide sterile syringes through SSPs, especially when combined with other prevention methods. Tookes' new study, which is slated to begin in 2022, will randomly assign 360 PWID recruited from three SSPs in Miami, Tampa, and West Palm Beach, Florida, to receive on-demand, concierge-driven interventions or standard care (linkage to a traditional HIV clinic) over 12 months. The primary outcome is viral suppression.

PWID who receive tele-harm reduction will have on-demand access to Tookes or one of his colleagues who specialize in harm reduction. These contacts may occur where PWID reside, in person at the SSP, via a mobile unit, on street outreach, or over Zoom. Participants will have access to phlebotomy, personal medication delivery and storage, and harm-reduction counseling. Control patients will be offered tele-harm reduction services at the end of 12 months.

"I don't know of any other program that has been developed with these characteristics, and I definitely think that it's worth testing,'' said Volkow. "Ultimately, the research will let us know the extent to which this model is sustainable and how efficacious it is at bringing [care] to patients that otherwise would not receive any."

Medscape Medical News reached Tookes just as he was ending a consultation with West Virginia and Centers for Disease Control and Prevention (CDC) public health experts. They called him for assistance with an emergent HIV outbreak. "The reason that CDC, the physicians, and Ryan White providers in West Virginia reached out to us was the way that we investigated and responded to our 2018 HIV outbreak amongst PWID," explained Tookes. "It was really our outbreak response and removal of barriers to care that spurred this entire tele-pharm reduction phenomenon in HIV. I'm really hopeful that we can move the needle."

Volkow has disclosed no relevant financial relationships. Tookes receives research funding from Gilead Science.

Liz Scherer is an independent journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology, and women's health.

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