Dr. Paul Drain
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Over half of the 37 million people worldwide living with HIV are receiving antiretroviral therapy (ART), yet only half of those people have suppressed replication of HIV with appropriate ART. A new project led by Dr. Paul Drain, an Associate Professor in the Departments of Global Health and Medicine at the University of Washington, aims to provide insight into the acceptability, feasibility, and impact of scaling-up the delivery of ART among adolescents and young adults living with HIV in community-based settings. Dr. Drain and his fellow investigators are exploring alternatives to deliver HIV care and treatment outside of the traditional, brick and mortar settings, which may improve access to care for patients and alleviate the congestion within clinics.

“In decades of providing HIV care and treatment, we’ve learned that attending a clinic is burdensome for many people and often carries some perceived stigma for receiving HIV care,” Drain said. “We have now established a model to provide community-based care among adolescents and young adults in Cape Town, South Africa.”

The proposal for this project was submitted to the National Institute of Health (NIH) as an R34, a planning grant to provide support for the an initial clinical trial or research project. The parent application for this proposal is titled “Standing Tall - A Pilot Randomized Controlled Trial of a Community-Based Intervention to Improve Health Outcomes for Newly Diagnosed HIV-Positive Young Adults in South Africa”. As Drain describes it, the trial may be critical to create a more efficient model for delivering HIV care, and the long-lasting implications of this project could extend beyond the field of HIV.

“In this project, we are understanding how the delivery of care can be optimized to help achieve the goals of HIV treatment,” Drain said. “However, the treatment model could then be applied for other conditions and diseases that are prevalent in resource-limited settings, including sexually transmitted infections and non-communicable diseases.”

Along with Drain, the group of five investigators on the project also includes Jane Simoni, an adjunct professor of global health, and Dr. Michalina Montano, a post-doctoral fellow in DGH. Simoni’s past work includes research focused on behavioral aspects of HIV treatment in locations around the world. This behavior, which often times includes not seeking treatment at all, is part of the focus of this proposal.

“We haven’t yet developed appropriate systems to deliver HIV care in an optimized manner that meets the needs of adolescents and young adults in resource-limited settings,” Drain explained. “As a result, many adolescents and young adults who are living with HIV still do not seek HIV testing and/or care within the traditional medical systems of clinics and hospitals. In this project, we have developed a model to deliver HIV care and treatment in a community setting.  As part of that model, we are also exploring how we can use newer testing technologies, called point-of-care tests, to monitor a person’s adherence to HIV treatment in the community.”

Over the last two decades, Drain has been conducting translational, clinical, and implementation science research in sub-Saharan Africa. He and his team are now applying their experience and knowledge to use cutting-edge technologies to improve the health of adolescents and young adults of Cape Town living with HIV.

“When I [previously] treated people living with HIV who arrived in our clinics, it became clear that two of the largest barriers to their care were needing to spend a full day at the clinic for a routine visit and then sending a patient home before knowing the results of their blood test,” Drain said. “With this project, we hope to provide timely, efficient care that is more accessible to our patients. So far, this model of care has been very well-received by both the adolescents living with HIV, as well as their providers.”

Read more about Drain’s previous work in HIV treatment here.