Bronx county has the country's fifth-highest rate of HIV diagnosis-;but the lowest rate in New York State for use of HIV pre-exposure prophylaxis (PrEP), medications that are extremely effective in preventing HIV infection. Physician-researchers at Albert Einstein College of Medicine and Montefiore Health System have received a five-year, $4.2 million grant from the National Institutes of Health to compare two strategies for improving PrEP access and use in the Bronx.
"There are severe racial/ethnic, and socioeconomic inequities in HIV infection rates and PrEP use, with people who identify as Black or African American and Hispanic shouldering the greatest burden," said Uriel Felsen, M.D., M.S., a principal investigator on the grant, associate professor of medicine at Einstein, medical director for HIV testing at the Montefiore AIDS Center, and assistant director of the clinical and translational sciences core at the Einstein-Rockefeller-CUNY Center for AIDS Research (ERC CFAR).
Rates of new infections among Black/African American people are more than eight times as high-;and among Hispanic/Latino people nearly four times as high-;as those of white people, according to the U.S. Department of Health. People in urban areas with high poverty rates are 10 times more likely to be living with HIV than those from more affluent areas. "Our goal," Dr. Felsen said "is to meet Bronx residents where they are in order to improve PrEP access and reduce HIV infection rates."
Many people at risk for HIV seek care for sexually transmitted infections (STIs) in emergency departments (EDs). But the traditional approach of focusing on acute illness in this setting is poorly suited for preventing HIV. While EDs can offer referrals to the appropriate services, "nationally, fewer than one-fourth of patients who are referred to sexual or HIV preventive care make appointments," said Viraj Patel, M.D., M.P.H., a principal investigator on the grant, associate professor of medicine at Einstein, co-director of the Montefiore Prevention Program (which focuses on HIV), and associate director of the behavioral and implementation sciences core at the ERC CFAR. "It's crucial to find more efficient ways to connect ED patients for whom PrEP is recommended to the clinicians who can provide this highly effective medicine."
The two strategies supported by the grant will be evaluated at different Bronx EDs, which are among the busiest in the nation. Participants in both strategies, totaling 1,400 people, will receive the appropriate treatment for their STI during their ED visit. One strategy will assign a sexual health navigator to contact patients after the ED visit. The navigator will provide PrEP education and attempt to enroll these patients in ongoing sexual and HIV preventive care. The second approach, called Tele-PrEP, offers people a telehealth consultation with a sexual health specialist while they're still in the ED. This specialist can provide information on and prescribe PrEP at that time and set up appointments with a care provider or facility that offers ongoing HIV preventive care.
We want to see whether the novel strategy of prescribing PrEP right in the ED can become a new national model for enrolling more people on this important tool to prevent HIV infection."
Dr. Viraj Patel, M.D., M.P.H., Associate Professor of Medicine, Albert Einstein College of Medicine
The grant is titled "ED2PrEP - patient focused, low-burden strategies for PrEP uptake among emergency departments patients: a cross-over hybrid implementation-effectiveness trial." (1R01AI169636) Sarit Golub, Ph.D., professor of psychology, Hunter College and the City University of New York Graduate Center, is co-investigator on the grant.
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