New Study Brings Mobile Clinics to Populations at High HIV Risk

The NIH is putting the rubber to the road in a new study that will involve mobile clinics deployed to test and treat opioid users who inject drugs intravenously, government website HIV.gov reports.

The study, called INTEGRA, will "determine whether delivering integrated health services through mobile clinics can improve HIV and substance use outcomes among people with opioid use disorder who inject drugs," HIV.gov detailed. "If effective, mobile clinics could serve as an innovative strategy for expanding access to care."

HIV.gov cited CDC numbers that suggest that "approximately 1 in 10 new HIV diagnoses in the United States are attributed – in whole or in part – to injection drug use."

The website added: "While injection drug use is not limited to injecting opioids – a drug class that includes heroin and fentanyl – these drugs have a high rate of use among key populations in this new study."

The mobile clinics will be used in five cities around the United States: Houston, Los Angeles, New York, Philadelphia, and Washington, D.C.

AIDSVu offered snapshots of how HIV and injectable drugs interfaced in each of these cities in 2018. In Houston, 27,057 people were known to be living with HIV that year; 75.6% of them were male, and 24.4% of them female. 4.5% of the men had acquired the virus through injectable drugs, compared to 10% of women.

In Los Angeles County, 49,449 people were known to be living with HIV in 2018, 88.7% of which were male and 11.3% female. 3.2% of the men and 19.9% of the women had acquired the virus through injecting drugs.

In New York the numbers were: Men, 10.9%; women 15.3% (out of a total of 100,644 people know to be living with HIV that year, 72.2% of them male and 27.8% female).

In Philadelphia, it was 18.1% of men and 25.8% of women out of a total of 18,380 people known to be living with HIV (72.2% of them male and 27.8% female).

And in Washington, D.C., 9.8% of men and 23.7% of women known to be HIV positive (out of a total of 14,194 people, 72.8% of which were male and 27.2% female) contracted HIV through injecting drugs.

A report on HIV rates in Los Angeles County in 2019 underscored the link between continuity of care and use of injected drugs, noting that "Populations with lowest achievements in linkage to care" included "persons with injection drug use."

Mobile clinics could help close that gap. "If effective, mobile clinics could serve as an innovative strategy for expanding access to care and providing uninterrupted treatment in this underserved population that addresses the linked public health crises of addiction and HIV," text at HIV.gov noted.

An article titled "The opioid crisis and HIV in the USA: deadly synergies," published earlier this year in medical journal The Lancet, noted that "Demographics of new HIV diagnoses among people who inject drugs are... changing, with more new HIV diagnoses occurring among White people, young people (aged 13–34 years), and people who reside outside large central metropolitan areas."

In one recent example, a surge in new HIV cases in Kanawha Country, West Virginia, put a spotlight on data that showed that in "2014, only 12.5% of HIV cases in West Virginia were the result of intravenous drug use. By 2019, 64.2% were," as the Associated Press reported this past April.

But large cities, too, have been affected, the Lancet article said, noting that there have been recent HIV outbreaks "among marginalized people in urban areas with robust HIV prevention and treatment services."

The Lancet article noted that "Multiple evidence-based interventions can effectively treat opioid use disorder and prevent HIV acquisition," but pointed out that "considerable barriers exist precluding delivery of these solutions to many people who inject drugs."

The mobile nature of the clinics could help overcome some of those barriers, as could the comprehensive way in which they are equipped to test and treat patients, providing "safe and effective medication for opioid use disorder (buprenorphine) and overdose reversal (naloxone, or Narcan), syringe services where available, HIV testing, ART for HIV treatment, PrEP for HIV prevention, testing for hepatitis and sexually transmitted infections (STIs) and primary care services," HIV.gov noted.