CIRA Talk: "Reducing HIV Transmission Among People who Use Drugs: Bridge Clinic Implementation of Low‐Barrier PrEP and MOUD"
High HIV transmission continues to impact people who inject drugs (PWID) and other people who use substances in many regions across the country. HIV pre‐and post‐exposure prophylaxis (PrEP, PEP) and medications for opioid use disorder (MOUD) are potent biomedical HIV‐prevention tools yet remain underutilized. Low‐threshold, on‐demand models are needed to deliver evidence‐based services to those at highest risk. This talk will describe experiences with the implementation and delivery of HIV PEP/PrEPand MOUD in Faster Paths, the low‐barrier substance use disorder bridge clinic at Boston Medical Center in Boston, MA. We will discuss the strategies including a standardized intake laboratory panel, changes to our provider note template to augment PEP/PrEPdecision support, and the launch of point‐of‐care HIV rapid testing to facilitate screening for people who decline phlebotomy and will review data on PEP/PrEPoffers and uptake in our program. We also discuss implementation of "72‐hour‐rule methadone" administration for opioid withdrawal management paired with rapid referral to local opioid treatment programs. Preliminary data suggest that "72‐hour rule methadone" has been successful in engaging patients at very high risk of HIV (e.g., over 1 in 7 of the first 142 patients treated had known HIV infection), and that it has been associated with high rates of successful OTP linkage (87%) and 1‐month retention (58%).
Boston University School of Medicine and Boston Medical CenterJessica L. TaylorAssistant Professor