NIMH Awards $3 Million for HIV Prevention

July 27, 2016—Researchers at Montefiore, Albert Einstein College of Medicine and Columbia University Medical Center have been awarded nearly $3 million from the National Institute of Mental Health to increase the use of pre-exposure prophylaxis (PrEP)—a medication that reduces the risk of contracting HIV.

The intervention will integrate PrEP into Montefiore primary care practices throughout the Bronx, a borough with one of the highest HIV rates in the nation.

“Primary care providers are essential to ending the AIDS epidemic because they regularly reach people before they are infected,” said Laurie Bauman, Ph.D., co-principal investigator on the study, director of the Preventive Intervention Research Center and professor of pediatrics at Einstein. “Our goal is to address reservations providers might have about prescribing PrEP, which include their own lack of training and their concerns about patient adherence.”

The selection of Montefiore Medical Group’s Federally Qualified Health Centers (FQHCs) for this intervention highlights Montefiore’s expertise in developing models for treating diseases on a population basis, and its ongoing collaboration with the New York City government to end the AIDS epidemic.

The randomized trial will involve six Montefiore Medical Group FQHCs; three will receive the intervention, which will address diverse barriers to PrEP by:

• Training Montefiore primary care providers to prescribe and manage PrEP;
• Developing a PrEP Eligibility Tool that will help providers identify high-risk individuals who might be eligible for PrEP;
• Making it simple for providers to use the electronic medical record to screen, prescribe, monitor and communicate with patients and other clinicians about PrEP;
• Appointing PrEP “champions” at each site to serve as role models to support provider colleagues in talking with patients about their sexual health;
• Identifying high-risk individuals in collaboration with BOOM!Health, a Bronx-based community organization that conducts HIV testing and outreach. It will link people to primary care providers who can offer PrEP.

“Increasing access to prevention methods in primary care is how you lower the viral load of a community and decrease everyone’s risk,” said Joanne Mantell, M.S.P.H., Ph.D, co-principal investigator and professor of Clinical Psychology (in Psychiatry) at Columbia University Medical Center. “The intervention will use, evaluate and enhance existing resources to achieve the greatest possible prevention impact by making programs transferable to other primary care sites.”

To evaluate the intervention, researchers will use electronic health record data to track the number of people screened and new PrEP prescriptions. They will also assess the effectiveness of each intervention component with qualitative studies of providers and patients who both embraced and opted not to initiate PrEP.

More than 1.2 million people in the United States are living with HIV, including 156,300 (12.8 percent) who are unaware of their status. The HIV prevalence rate in the Bronx is 1.7 percent, one of the highest in the United States. In 2013, more than 27,000 Bronx residents were living with HIV.