Syringe exchange programs (SEPs) serve populations who are high risk for acquiring HIV and other infectious diseases. Adherence to offsite healthcare referrals is low. We describe a novel partnership between an academic medical center and an SEP to deliver low barrier healthcare to people who use drugs (PWUD) onsite at an SEP.
A Montefiore Medical Center clinic was opened within the drop-in center of a local SEP on February, 11, 2019. In this setting clients are able to access clean syringes, laundry, showers, group education, and psychosocial counseling. We conducted a retrospective chart review of patients seen at the drop-in center clinic from 2/11/2019-5/29/2019 using the electronic medical record. Sexual risk factors for HIV were defined: multiple sex partners, unprotected sex, sex worker, STD in the last 12 months, and/or sexual partners who are anonymous, HIV+, or currently injecting drugs.
A total of 118 patients were seen by a provider during the study period. The mean age was 43 (IQR 17). The majority f patients were female (53%) and Hispanic (44%) or non-Hispanic Black (32%). 30% of patients were homeless. 61% of patients had ever injected drugs and 61% of patients also had one or more sexual risk factors for HIV. The most common current substances used were heroin (50%) and crack/cocaine (44%). The primary reason for a patient’s first visit to the clinic was for buprenorphine treatment (32%), followed by PREP (20%), hepatitis C treatment (20%), and PEP (8%). Of those who initiated buprenorphine treatment, 50% were retained in treatment at 90 days. 27% of patients who initiated PrEP were retained in treatment at 90 days. Of the 8 patients who received PEP, 3 initiated PrEP afterward. Of the 22 patients who were HCV positive, 20 (91%) were evaluated for treatment and had fibrosis staging, 10 (50%) initiated treatment.
Through a novel SEP-academic medical center partnership, PWUD received well-established HIV-prevention services (buprenorphine and PrEP/PEP), as well as HCV treatment on-site at an SEP, demonstrating the feasibility of such initiatives. Rates of retention in buprenorphine treatment are comparable to retention rates at other low-barrier programs. PREP retention was slightly lower than reported in other populations, but few studies have evaluated PrEP engagement among PWUD. Low barrier care delivered onsite at an SEP should be further explored to improve access to care and HIV and HCV prevention for PWUD who may otherwise never receive them.