“This is stigma-free and judgement-free integrated care for the needs of the population we’re trying to serve in locations they can easily access,” said David Goodman-Meza, MD, an infectious disease specialist at the University of California-Los Angeles (UCLA) David Geffen School of Medicine.
Dr. Goodman-Meza serves as principal investigator for the Los Angeles site of the HPTN 094 INTEGRA study. (“HPTN” is short for HIV Prevention Trials Network.) Preventing deaths from overdose is also part of the study. Medication to prevent HIV (PrEP, or “pre-exposure prophylaxis”) will be offered. In addition to the medical care in the van, peer navigators will help participants access harm reduction and other services throughout the area. As a randomized controlled clinical trial, HPTN 094 represents the highest standard there is for a study.
Psychologist Steven Shoptaw, PhD, INTEGRA protocol co-chair and director of the Center for Behavioral and Addiction Medicine at UCLA, says that, “People who inject drugs and are not taking medication for opioid use disorder, or MOUD, face the nearly impossible task of trying to get care with limited or no financial resources from brick-and-mortar clinics that provide separate, siloed services for opioid addiction, HIV, and primary care. Breaking down structural barriers to accessing health care is essential to improving outcomes.” He made his comments as the new clinics prepared to launch over last summer. The other cities are Houston, New York, Philadelphia, and Washington, D.C.
“It was actually difficult to roll out our mobile unit, especially during the peaks of COVID for us in L.A. in the last winter, because of all the uncertainty and the risks to the staff and the public, but now we’re fully operational,” said Dr. Goodman-Meza. The UCLA INTEGRA clinic operates in the nearby city of Long Beach.
The clinic, in its large beautiful van, launched in the fall of 2021, with special precautions taken for COVID, such as wearing masks and special cleaning procedures between participants, and having a telehealth component added. Once people are determined to be eligible for the study and go through a few visits where information and labs are taken, a lot of the continuing work can be done over the phone or through videoconferencing.
Because of this new reality, INTEGRA helps people obtain smartphones. “Being on the streets, especially for those who are experiencing homelessness, means that having their stuff stolen or their stuff lost is of a way of life,” says Dr. Goodman-Meza. “But that’s the beauty of having a mobile unit near where they are living or where they’re sleeping. That makes it easy for them to stop by.”
Dr. Goodman-Meza says the study team was energized by the support for this innovative work from the HIV and substance use professionals, community members, and government officials and agencies in Long Beach. But there’s even more work to do.
“One of the biggest difficulties for me is that the project is very specific in the people we’re trying to recruit, so we’re really only able to engage with people who are injecting drugs, particularly opioids,” said Dr. Goodman-Meza. “Whereas at least here in L.A., a lot of people are still using methamphetamine and other substances. They might not necessarily be using opioids or injecting drugs and so it’s just heartbreaking to not be able to provide them services.”
Those services could be part of the future if the INTEGRA study can show that bringing the clinic out to the people can improve their health outcomes when they already have so many medical vulnerabilities.
Godspeed. —Enid Vázquez
Go to hptn.org/research/studies/hptn094.Watch videos about the study from the different sites on YouTube.