Addressing Barriers to Care

This video is part of the NIDA series At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs.

Innovations in harm reduction are needed to effectively reach people who use drugs with vital HIV services and other lifesaving support. This video describes the work of Dr. Hansel Tookes and his team at the IDEA Exchange in Miami, Florida, where strategies are informed by and developed alongside the people IDEA serves. From community outreach to medication lockers, to telehealth-enhanced services that aim to meet people where they are, Dr. Tookes and others share how these innovations are improving the health of their community.

Addressing Barriers to Care

Video length: 6:19


[Sarah] There's a place right on the corner of 7th Avenue. And inside are a group of people. Half of them are recovering addicts, half of them not. But all of them care. So, why don't you go and let somebody care about you.

[Voiceover] Here on 7th ave, right under the sun in Miami, Is Florida’s pioneering syringe services program, the IDEA Exchange, where tools like harm reduction, advocacy and compassion are being used to save lives.

At the Intersection: Stories of Research, Compassion, and HIV Services for People who Use Drugs

[Dr. Hansel Tookes] Everything that we do is informed by our participants, so we asked them, what are the barriers, we mapped it out, we had our participants in the room and we said, how do we overcome the barriers? 

[Dr. Eddie Suarez] "Hey, we can't just give somebody experiencing homelessness meds. Not because they're irresponsible, but because homelessness comes with a few variables that can lead to you losing your medications." So in one of these trailers, you're going to see that there's a locker system that holds HIV medications, Suboxone medication for opioid use disorder in there.

[Dr. Tookes] Each patient is assigned a number, it's anonymous, but each person has a locker where they can access their HIV meds, their PrEP, their Hep C treatment, their Suboxone. This helps because it gives us the opportunity because we know how much the patients have taken. The whole thought is to combine everything, combine antiretrovirals with the provision of Naloxone, with the provision of syringes, have a really appealing package. So they get everything in a one stop shop.

All right, Ken, so when you enroll in IDEA for the first time, one of the members of my team, whether that be a peer or one of the other staffs, we bring the client in here, we can offer rapid HIV and Hepatitis screening. And the reason that, that's so important in Miami is because people have been using substances and having sex for years in the absence of a public health home, like the IDEA Exchange. So it would be one thing if we were doing these tests and we didn't have the ability to treat, but we not only test, but we also treat. So we encourage people to get their rapid screenings, 10% of the people test positive for HIV.

I think that's probably higher than most syringe services programs, but this is Miami, this is the city with the highest rate of HIV in the country. Now, when we did our investigation of the outbreak, it seemed that a lot of that risk was sexual, and so handing out condoms is a major part of our operation. 

[Ken Williams] So you come here, you get your equipment, you get what you need over here, you get your cotton, you get your alcohol swabs, you get your cookers and you also can come here and get your condoms as well?

[Dr. Tookes] Absolutely. And hygiene products, anything you need, these programs are here, and we adapt dynamically just to meet the needs of the people that we serve...we diagnosed the HIV outbreak in the homeless encampment in 2018, had to forge a pathway to care for people who inject drugs who are living with HIV, out of nothing because there was no pathway. All of the requirements were insurmountable for somebody who does not inject drugs.

[Dr. Suarez] Today you can get into HIV treatment within an hour of testing positive for HIV with Dr. Tookes if you're a person who injects drugs. Back then, it took the entire day. 

[Dr. Tookes] What tele harm reduction does is it builds upon those decades of evidence, that it is important to meet people where they are physically, mentally, and treat them with dignity and respect and just brings medical care into it. So it's a telehealth enhanced intervention delivered via a peer with lived experience. They're able to have on-demand visits. If it's been a while since they've had a visit, the peer will go out and see them. We're able to initiate antiretrovirals, we're able to do labs in the field. We're able to set the traditional healthcare system aside and bring care to the people, just like old house calls.

So, can one of you go to his house with the iPad and the hotspot and just connect him with me so I can talk to him because his mom died. His real goal was to not use before his mom died, to stop using, but he was not able to. And I think he's really beating himself up about that 

[Sarah Wallace] All of my care comes under Dr. Tookes. He has a team. I have three social workers that bring me my meds. They get me to my appointments.

[Dr. Tookes] It's fantastic, people feel safe and once they are taking their medications and I tell them you're undetectable, you can just see they're so excited. 

[Voiceover] A person living with HIV can get and keep an undetectable viral load by taking HIV medication every day as prescribed. If you are undetectable, you cannot pass HIV through sex.

[Dr. Tookes] They have this sense of relief that there aren't at risk of transmitting HIV to their partners and their loved ones. But also it's an accomplishment,like  I was able to do this quickly, take this medicine and get this under control. And it leads to other things like, oh, maybe now we'll treat the Hep C if I can take Antiretrovirals, maybe I can take Suboxone. And it just grows from there. I really feel that the most appropriate place to deliver HIV care to people who inject drugs is via a syringe services program, via this trusted institution. The one place in this great city where they don't experience judgment. These ideas. These ideas that my patients have given me. Ideas of how to help them. They're working.