SUD/Syringe Exchange

The first needle exchange program in Florida, the Infectious Diseases Elimination Act (IDEA Exchange) was signed into law in 2016 by Governor Scott. This program works to provide health equity by increasing access to the tools necessary to keep people healthy, especially those who are most vulnerable.

By educating individuals on harm reduction and technical skills, IDEA Exchange empowers the South Florida/Miami community to reduce the spread of HIV, Hepatitis C, and other blood-borne diseases to achieve a healthier life. IDEA Exchange works closely with the Infectious Diseases Division and the Florida Department of Health to implement new research and techniques in harm reduction services for overlooked and at-risk communities.

There are over 1,700 PWID currently enrolled and 10% of PWID enrolled are living with diagnosed HIV. Miami-Dade County is a high priority county under the EHE plan and has a high prevalence of injection drug use. IDEA Miami is housed within the University of Miami Miller School of Medicine in partnership with the county safety-net hospital, Jackson Health System. IDEA Miami exchanges up to 10,000 syringes weekly and currently operates 3 fixed and 5 mobile sites within Miami-Dade County.

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Born out of the service gap to reach marginalized populations most affected by HIV and SUD during COVID-19, Drs. David Serota and Hansel Tookes’ Tele-Harm Reduction (THR) program is a telehealth-enhanced, harm reduction intervention, delivered within an SSP venue. It aims to facilitate initiation of care and achieve rapid HIV viral suppression among people who inject drugs (PWID) living with HIV while also overcoming stigma and meeting PWID where they are.

As a marginalized and stigmatized population since the beginning of the AIDS epidemic, PWID’s have not benefitted from the advent of antiretroviral therapy as others, and therefore have had suboptimal health outcomes in HIV patient care and have been disproportionately impacted by Hepatitis C and opioid use disorder (OUD). In addition, injection drug use has been linked to multiple outbreaks of new HIV cases in the U.S. since 2015. As the HIV professionals at the University of Miami strive to meet the Ending the HIV Epidemic (EHE) goal of a 90% reduction in HIV infections by 2030, Drs. Serota and Tookes understood the crucial role THR could play in the community.

In addition to implementing THR, Drs. Serota and Tookes pilot tested THR intervention to generate preliminary data on HIV outcomes at 6 months post study enrollment. Preliminary results between January 2020 and June 2020 showed 35 PWID living with HIV were enrolled in the THR pilot study with at least 6 months of follow up per participant. The majority were male (57.1%), experiencing unstable housing (59.4%), and injected heroin (77.1%), cocaine (37.1%), speedball (25.7%) or fentanyl (14.3%). Of participants, 25 (78.1%) were virally suppressed (i.e. HIV RNA <200) at six months, the end of the pilot period.

Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality.

To address this issue, Dr. David Serota, MD, in partnership with Jackson Health System, developed the SIRI Team to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, our 1550-bed public hospital in Miami, Florida. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder, and utilizes a variety of infection and addiction treatment modalities to suit each individual patient.