With a Clinic on Wheels, ICAP Moves Research on Opioids and HIV Into the Passing Lane

In summer 2021, a state-of-the-art mobile clinic began making rounds in the streets of Harlem and the Bronx, drawing attention with its bright graphics. But beneath the colorful exterior is a serious proposition – to address the intertwined public health crises of opioid addiction, HIV, and hepatitis C among people who inject drugs.

Drug overdose is the leading cause of accidental death in the United States, with nearly 108,000 fatalities in 2021, the highest number of overdose deaths recorded in any 12-month period. Factors such as lack of access to health care, poverty, mental health disorders, use of multiple illicit substances, stigma and discrimination combine to increase the risk of HIV transmission and acquisition and other health issues among people who inject drugs.

The mobile clinic is at the center of ICAP’s participation in the nationwide INTEGRA study (HPTN 094), which aims to determine whether using mobile health units to deliver integrated health services for people with opioid use disorder can improve addiction, HIV, hepatitis C and substance use outcomes compared to standard of care. At locations frequented by people who inject drugs, ICAP study team members engaged with individuals, provided them with information regarding the study, enrolled participants and followed up with them throughout their study participation.

Participants in the study are randomized to receive integrated care on the “van” – as the study team calls it – or to receive the services of a health care navigator who will assist the participant in finding care in the community.

“The integrated care model means they will be able to receive their buprenorphine [a medication to treat opioid use disorder] prescription from the van,” said Rashaunna Redd, NP, site clinician for ICAP’s Bronx Prevention Center, which conducts the study. “And they will also be tested for HIV, STIs, and hepatitis, and screened for routine primary care problems such as diabetes and blood pressure issues.”

After six months, all participants transition to care in the community. Follow-up after the study extends to 12 months.

“Our goal is to make it as close to one stop as a possible. Although we recognize that some people will have serious medical conditions that require them to see specialists – and we will help them with that,” said Ellen Morrison, MD, site lead at ICAP’s Bronx Prevention Center.

Since the study began, initial findings revealed a high prevalence of mental health disorders such as anxiety, depression, and post-traumatic stress disorder among participants.

“This finding is particularly important because recreational drug use may be used as a form of self-medication,” said Alan Padilla, BA, community educator at ICAP’s Bronx Prevention Center. “Our team is actively promoting the need to address these underlying factors to fully provide addiction services.”

As the van proclaims in bright lettering, ICAP is driving health forward. Mobile health units, along with this study, are providing the engine necessary to reach that mission.

Funder: U.S. National Institute of Allergy and Infectious Diseases (NIAID) with funding from the U.S. National Institute on Drug Abuse (NIDA)

Project: HIV Prevention Trials Network (HPTN); INTEGRA study (HPTN 094)