As the United States continues to grapple with the HIV and substance use epidemics, clinicians are exploring new ways to reach people who face persistent barriers to care. Those efforts will be highlighted in “Dual Crises, Shared Solutions: Novel Care Delivery Models at the Intersection of HIV and Substance Abuse,” at 10:30 a.m. ET Friday, Oct. 23.
Moderator Yussef Bennani, MD, MPH, FIDSA, FACP, associate professor at Virginia Commonwealth University, will introduce presentations by Sandra Springer, MD, professor of medicine at Yale School of Medicine; Ayesha Appa, MD, an infectious diseases and addiction medicine fellow at the University of California San Francisco; and Hansel Tookes III, MD, MPH, a physician at the University of Miami.
Dr. Appa will focus on addressing stimulant use care in HIV care, while Dr. Tookes will address tele-harm reduction at a syringe exchange services site for rapid initiation of antiretroviral therapy in people who inject drugs.
Dr. Springer’s presentation, “Using a Mobile Pharmacy and Clinic to Deliver Integrated HIV/SUD Prevention and Treatment,” will focus on a model designed to meet patients where they are, both geographically and medically.
An infectious diseases and addiction medicine physician, Dr. Springer has spent more than 25 years working to integrate HIV, hepatitis C and substance use disorder care. Her latest effort grew out of research examining ways to improve access to HIV prevention and treatment among people who use drugs and individuals involved with the criminal legal system.
“One of the major issues we found was that you could have all the best interventions that you have,” she said. “But if people can’t get access to those medications ... . Access to the medications is absolutely critical.”
That realization inspired In Motion, a mobile pharmacy and clinic program created through a National Institute on Drug Abuse award. Unlike many outreach programs, the model combines clinical care, laboratory services and an operational retail pharmacy in a single mobile unit.
Making that vision a reality required more than clinical innovation. Dr. Springer and colleagues helped develop Connecticut legislation allowing retail pharmacies to operate as mobile pharmacies. The law took effect in 2023, and the In Motion unit began serving communities later that year.
The 38-foot unit now travels throughout Connecticut, providing services for individuals who cannot or choose not to access traditional health care settings. Patients can receive HIV testing, hepatitis C services, vaccinations, chronic disease management and medications during the same visit.
“It looks like a little CVS on wheels,” Dr. Springer said. “We partner with another pharmacy, and it has over 400 different medications, injectable orals, all vaccines.”
Early experience suggests the demand extends far beyond HIV-related services. The program has served more than 1,300 individuals and dispensed more than 4,000 prescriptions. Many patients seek help for hypertension, diabetes and other chronic conditions that have gone untreated because they cannot reach pharmacies or clinics.
“The big takeaway is whole person health care,” she said. “Don’t silo disease states. Don’t assume you know what people want.”
That broader approach also creates opportunities to engage people in HIV prevention and treatment. The program has identified new HIV infections, reengaged individuals previously lost to care and expanded awareness of pre-exposure prophylaxis, or PrEP, among populations that may not realize they are eligible.
“If you provide people what they want, and help them with those needs, then if not the first time, maybe they’ll accept the second time,” Dr. Springer said.