Bronx County has the fifth highest rate of HIV diagnosis in the nation, but the lowest rate in New York State for the use of HIV pre-exposure prophylaxis (PrEP), drugs extremely effective in preventing HIV infection. Physician-scientists from the Albert Einstein College of Medicine and the Montefiore Health System have received a five-year, $4.2 million grant from the National Institutes of Health compare two strategies to improve PrEP access and use in the Bronx.
“There are serious racial/ethnic and socioeconomic inequalities in HIV infection rates and PrEP use, with people who identify as black or African American and Hispanic bearing the greatest burden” , said Uriel Felsen, MD, MS, principal investigator of the grant. , Einstein Associate Professor of Medicine, Medical Director of HIV Testing at the Montefiore AIDS Center, and Associate Director of the Clinical and Translational Sciences Hub at the Einstein-Rockefeller-CUNY Center for AIDS Research (ERC CFAR).
According to the US Department of Health, rates of new infections among Black/African Americans are more than eight times higher and among Hispanics/Latinos nearly four times higher than those of whites. People in urban areas with high poverty rates are 10 times more likely to be living with HIV than those in wealthier areas. “Our goal,” Dr. Felsen said, “is to meet Bronx residents where they are to improve access to PrEP and reduce HIV infection rates.”
Many people at risk of contracting 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 ill-suited to HIV prevention. While emergency departments can offer referrals to appropriate services, “nationally, less than a quarter of patients who are referred to sexual or HIV preventive care make an appointment,” said Viraj Patel, MD, MPH, Principal Investigator of the grant, Einstein Associate Professor of Medicine, Co-Director of the Montefiore Prevention Program (which focuses on HIV), and Associate Director of the Behavioral and Implementation Sciences Hub at the ‘ERC CFAR. “Finding more effective ways to connect ER patients for whom PrEP is recommended to clinicians who can provide this highly effective drug is crucial.”
The two strategies supported by the grant will be evaluated in different emergency departments in the Bronx, which are among the busiest in the country. Participants in both strategies, totaling 1,400 people, will receive the appropriate treatment for their STI when they visit the emergency department. One strategy will designate 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 are still in the emergency room. This specialist can provide information about and prescribe PrEP at this time and schedule appointments with a provider or facility that offers ongoing HIV preventive care.
We want to see if the new strategy of prescribing PrEP directly in the emergency department can become a new national model for enrolling more people in this important tool for preventing HIV infection.
Dr. Viraj Patel, MD, MPH, Associate Professor of Medicine, Albert Einstein College of Medicine
The grant is titled “ED2PrEP – patient-oriented, low-burden strategies for adoption of PrEP in emergency department patients: a hybrid implementation and efficacy crossover trial.” (1R01AI169636) Sarit Golub, Ph.D., professor of psychology, Hunter College and the City University of New York Graduate Center, is a co-investigator on the grant.
Albert Einstein College of Medicine