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Intervention Recognized in CDC Compendium a Milestone for HIV and Hepatitis C Testing

University of Miami Miller School of Medicine faculty Tyler Bartholomew, Ph.D., led the intervention aimed at increasing HIV and Hepatitis C (HCV) testing among people who inject drugs which has officially been included in the Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention by the Centers for Disease Control and Prevention (CDC). This groundbreaking intervention, termed Opt-Out HIV/HCV Screening, is the first of its kind designed specifically for syringe services programs (SSP) and holds significant promise for addressing testing barriers in this population.

Tyler Bartholomew
Dr. Tyler Bartholomew

The CDC Compendium serves as a comprehensive resource that compiles effective interventions and strategies rigorously evaluated and proven successful in preventing the transmission and spread of HIV. It offers valuable guidance to public health professionals, researchers, policymakers, and organizations working in the field of HIV. 

Included in the Compendium are evidence-based and evidence-informed interventions that encompass a wide range of approaches, including behavioral, biomedical, and structural interventions. 

"These interventions have undergone a thorough evaluation and have demonstrated positive outcomes in preventing HIV transmission, promoting testing and counseling, and addressing the underlying social determinants of health," said Dr. Bartholomew, assistant professor in the Division of Health Services Research Policy in the Department of Public Health Sciences. 

Innovative Approach to Testing 

The Opt-Out HIV/HCV Screening intervention focuses on providing convenient and acceptable access to HIV and HCV testing within the SSP setting. It replaces the opt-in testing policy with an opt-out approach, where participants are informed during enrollment that HIV and HCV testing are routine components of their care within the SSP. 

"While individuals have the option to decline testing, if they accept, both HIV and HCV tests are conducted using point-of-care tests with immediate result reporting. Post-test counseling and education are provided, along with active linkage to care for those who test reactive," said Dr. Bartholomew. 

The intervention effectively addresses a crucial need for increased testing among individuals who engage in drug injection practices. By focusing on the unique context of SSPs, it offers a targeted and comprehensive approach to HIV and HCV testing within this vulnerable population.

Structural interventions play an essential role in addressing the underlying social and environmental factors that contribute to the spread of HIV and HCV among at-risk populations. These structural interventions focus on addressing the underlying determinants of health by targeting social and structural factors that influence health behaviors and access to healthcare services. 

By targeting the SSP setting, this intervention offers a unique opportunity to reach individuals who inject drugs and provide them with the necessary testing and support services. 

The intervention yielded positive outcomes during its evaluation study conducted in Miami, Florida between December 2016 and January 2020. The findings demonstrated significant increases and sustained testing rates for both HIV and HCV among the study participants. Notably, acceptance rates for testing were substantially higher during the opt-out testing period compared to the opt-in period. 

The recognition of the Opt-Out HIV/HCV Screening intervention in the Compendium affirms the intervention's efficacy and its potential to make a significant impact on HIV prevention efforts among individuals who inject drugs. 

"As the first intervention specifically designed for SSPs to increase testing among people who inject drugs, it represents a significant advancement in addressing the unique challenges of this population," said Dr. Bartholomew. 

Its inclusion in the Compendium also underscores the importance the structural intervention in combating the

Hansel Tookes
Dr. Hansel Tookes

spread of HIV and HCV among vulnerable communities. "This recognition opens doors for further advancements in HIV prevention strategies and testing initiatives," said Dr. Bartholomew. 

Dr. Bartholomew implemented this intervention as part of his doctoral studies with Dr. Hansel Tookes, associate professor in the Division of Infectious Diseases in the Department of Medicine. Together, they are now embarking on the next phase of their work. They are in the process of designing a proposal, slated for submission later this year, for an R01 study. This study aims to test various implementation strategies to scale up the Opt-Out HIV/HCV Screening intervention and explore its effectiveness in different settings. "The proposed research holds the potential to further enhance HIV and HCV testing efforts and contribute to improved public health outcomes," Dr. Bartholomew said.

Written by Deycha Torres Hernández
Published on June 26, 2023