The USF Health Tampa Bay Street Medicine, Hillsborough County and Pioneer Foundation Needle Exchange Program is ready to hit the road as Florida’s second needle exchange or syringe service program (SSP). In conjunction with Tampa General Hospital, the Health, Equality and Linkage Project (HELP) Medical Van will offer to persons who inject drugs (PWID), a safe place to turn in used syringes for clean ones to avoid sharing blood-borne diseases like HIV and Hepatitis C, get anonymously tested for those diseases and be linked to free primary care, wound care, or drug treatment programs among other social services. Targeted locations in Hillsborough County will be those with the highest rates of HIV and opioid overdoses such as around the University Square Mall and downtown Tampa.

Representatives for the USF Health Tampa Bay Street Medicine, Hillsborough County and Pioneer Foundation Needle Exchange Program during a mock run through outside the University Square Mall.

Formed in 2014, Tampa Bay Street Medicine (TBSM) is a USF Health Morsani College of Medicine (MCOM) student-run service organization supervised by faculty that provides medical care to underserved populations. It was initially started to meet the needs of Tampa’s homeless community but continues to evolve as student leaders recognize opportunities to help elsewhere. TBSM students conduct biweekly street runs in unsheltered settings near the I-275 bypass, operate continuity clinics at First Presbyterian Church, and staff a medical van at a variety of clinic sites in partnership with Pioneer Medical Foundation.

USF Health Tampa Bay Street Medicine students talk with a homeless man during a night of biweekly street runs in unsheltered settings near the I-275 bypass. Pre-COVID photo.

“We’re going to the same locations where we’ve built that relationship, where they know that we have providers for primary care and they can trust us already,” said Asa Oxner, MD, FACP, faculty advisor for the USF Health TBSM and vice chair of the USF Health MCOM Department of Internal Medicine. “We have around 800 reoccurring customers in these locations, so we can first start by serving the people we already know well and work on marketing and growth.”

At a PWID’s first visit to the program, they can receive up to 10 clean hypodermic needles and every visit after that, it’s a 1:1 exchange. SSP volunteers will also distribute condoms, alcohol swabs, portable sharps containers and Naloxone (or Narcan), an emergency treatment for narcotic overdose. Pioneer also staffs the Lily Pharmacy free medical clinic inside the University Square Mall, adding another layer of resources along with the other community agencies partnering to offer downstream care for clients who engage in the SSP’s services. Enrollees in the program are tracked with a nickname and an ID number associated with a laminated card they’re asked to carry that identifies them as part of the SSP. If the card holder is arrested for drug paraphernalia, USF providers are working with the local police authorities to have our clients placed in drug rehabilitation instead of jail. At the same time, when PWID carry clean needles and a portable sharps container, it protects the law enforcement and first responders in return.

From inside of the medical van, Jerren Creak, MPH, patient care services research associate for Tampa General Hospital, explains the disease testing options to a mock patient, a member of the community in remission from a substance use disorder, during a mock run through of the needle exchange program.

“In communities where drug users are invited to swap out used needles without retribution, hospitals have reported major declines in the spread of blood-borne infections like hepatitis C and HIV, increased enrollment in drug treatment programs and fewer opioid-related overdose deaths,” said Khary Rigg, PhD, associate professor at the University of South Florida’s Department of Mental Health Law & Policy, in a report from the Tampa Bay Times. “As for the cost, research has shown that every $1 spent on needle exchange programs yields an average $7 savings in avoided costs for HIV-related medical treatment.”

According to the Centers for Disease Control and Prevention, more than 140 Americans die from drug overdoses every day. The U.S. Opioid Epidemic was declared a public health emergency by the United States Department of Health and Human Services (HHS) in 2017. SSPs are a key part of harm reduction strategy, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. SSPs have been legal in many other states for decades, but it was not legal in Florida until recently. Thanks to the relentless fight for legislative approval and the resulting success of the University of Miami’s IDEA Exchange, a pilot program that was approved in a 2016 exception policy, Governor Ron DeSantis signed into law the Infectious Disease Elimination Act (IDEA) on June 27, 2019.  IDEA allows county commissions to authorize sterile needle and syringe exchange programs for PWID. The law states that disease prevention must be the goal of every exchange program, they cannot use state, county or municipal funds to operate, and they are required to be funded through grants and donations from private resources and funds.

A grant already pays for prescription medications for patients of existing programs operating through partnerships with the University of South Florida, Tampa General Hospital, the Drug Abuse Comprehensive Coordinating Office and Gracepoint, and the SPP will be allowed to use that money to buy the county’s first batch of hypodermic needles and syringes.

With this green light, TBSM and USF faculty began advocating for an SSP in Hillsborough County with the Hillsborough County Commissioner’s Office Opioid Task Force Behavioral Health subcommittee. They used the robust data from Miami’s IDEA Exchange and their program was approved. The needle exchange was supposed to kick off in April but was delayed due to COVID-19.

During a mock run through of the SSP, Heather Henderson, MA, CAS (second from left), USF Applied Medical Anthropology PhD Candidate and director of social medicine programs for Tampa General Hospital, hands a prop to mock patients, members of the community in remission from a substance use disorder, to represent the needle exchange.

In preparation for the official start of the program in December, the USF Health and Pioneer team met in the University Square Mall parking lot with two members of the community in remission from a substance use disorder serving on the SSP advisory board, to do a mock run through and receive their feedback. “This was really great,” said one of the mock patients. “You guys came across that you care and you’re nonjudgmental.”

TBSM will be joined at the needle exchange by USF Health College of Public Health and USF Applied Medical Anthropology students to create a true interprofessional effort to make life better for people in the community. “Preventing acquisition of HIV/HCV requires a complex understanding of the interconnection between biomedical and social dimensions of infectious disease,” said Bernice McCoy, MPH, USF PhD Candidate in Applied Anthropology. “These students will apply both epidemiological and ethnographic methods to contextually assess our SSP’s potential impact and further explore the drug-using habits of PWID. Through this assessment that we can and identify facilitators and barriers towards HIV/HCV risk-reduction within the Tampa Bay community.”

The Opioid Crisis in Florida          

According to the National Institute on Drug Abuse, nearly 68% of the 4,698 reported drug overdose deaths in Florida involved opioids in 2018—a total of 3,189 fatalities (Figure 1).

Figure 1. Number of drug and opioid-involved overdose deaths in Florida. Deaths may have involved more than one substance. Source: CDC WONDER

The increase in substance use has resulted in consequent increases in injection drug use across the country. This has caused not only large increases in overdose deaths, but also the transmission of blood-borne diseases. According to the CDC, the majority of new acute hepatitis C virus (HCV) infections are due to injection drug use and Florida is in the top 10 states with the highest rates of infection. According to the Florida Department of Health HIV/AIDS Surveillance Program, about 7% of the new diagnoses of HIV in Florida in 2018 were from injection drug use (IDU) (Figure 2) and 11% of persons living with an HIV diagnosis were persons who inject drugs (PWID) (Figure 3).

Figure 2. HIV modes of exposure in 2018. Source: National HIV Behavioral Surveillance System (NHBS).

Figure 3. The number of persons who inject drugs (PWID) living with an HIV diagnosis in Florida in 2018. Source: NHBS.

According to the CDC, the HIV burden in Florida is the highest in Broward, Duval, Hillsborough (Figure 4), Miami-Dade, Orange, Palm Beach, and Pinellas. It was announced in the February 2019 State of the Union Address that these counties are a part of 57 jurisdictions that are the focus of the Trump administration’s, “Ending the HIV Epidemic: A Plan for America” or EHE initiative, which aims to end the HIV epidemic in the United States by 2030.

Figure 4. Hillsborough County is one of Florida’s HIV hotspots. Source: NHBS.

The IDEA Exchange

On July 1, 2016, after years of struggling to win legislative approval, Miami-Dade became the first county in Florida with a legal hypodermic needle exchange program and on December 1, 2016, World AIDS Day, the IDEA Exchange opened its doors as a pilot program. The IDEA Exchange in Miami was started by Hansel Tookes, MD, MPH, an assistant professor at the University of Miami’s Miller School of Medicine and principle director of its harm reduction research group. NBC Miami reported in June 2019 that the Miami program has disposed of more than 317,000 used needles since it received temporary authorization from lawmakers in 2016. The program also distributes naloxone and Tookes told the Miami Herald in November 2019 that since March 2017, “the IDEA Exchange has handed out 2,871 boxes of the drug and those who have taken naloxone from the clinic to carry with them have reported 1,529 overdose reversals in that time.” Miami is the only place in Florida seeing a decrease in opioid-related mortality while death tolls spike across the state.

Video by Torie Doll, USF Health Communications & Marketing, with interview footage assistance provided by Ian Vancattenburch, Movie Magic Productions.

The University of South Florida commemorated National Peace Corps Week at the College of Public Health with its annual Peace Corps Festival, March 2.

Returned Peace Corps volunteers shared stories and experiences from abroad, while guests sampled international dishes as they celebrated USF’s role as a top producer of Peace Corps volunteers and international volunteerism.

USF System President Judy Genshaft highlighted USF’s recent ranking in the Peace Corps 2017 Top Volunteer-Producing Colleges and Universities list.

The Peace Corps currently ranks USF third in the nation for the most graduate alumni volunteers and in the top 18 among large colleges and universities for the most undergraduate alumni who volunteer worldwide.

USF celebrated National Peace Corps Week at the USF College of Public Health’s Peace Corp Festival on March 2. (From left, front row): Returned Peace Corps volunteer Kevin Orner, College of Engineering; USF World’s AVP for Research Innovation and Global Affairs Kiki Caruson; College of Engineering Dean Robert Bishop; USF System President Judy Genshaft; returned Peace Corps volunteer and USF Peace Corps recruiter Wilnie Merilien; Patel College of Global Sustainability’s Peace Corps Program Director Kelly Gaskell; and College of Public Health Peace Corps Program Director Jesse Casanova. (From left, back row): College of Public Health Dean and College of Nursing Interim Dean Donna Petersen; Patel College of Global Sustainability Interim Dean Richard Berman; College of Arts and Sciences Dean Eric Eisenberg; and College of Arts and Sciences Peace Corps Program Director Christian Wells. (Photo by Zachary Murray, USF College of Public Health)

“It’s another recognition of our great success and inspiring our students to help their communities across the world,” Genshaft said.

In addition, USF has been ranked by the Chronicle of Higher of Education as the number one producer of Fulbright Scholars in the U.S. for 2016-2017, according to U.S. Department of State and Institute of International Education data.

Genshaft also announced four new Paul D. Coverdell Fellowship Programs at USF in public health, civil and environmental engineering, applied anthropology and global sustainability.

“Paul D. Coverdell Programs offer financial assistance to graduate students who return from the Peace Corps volunteer program and it gives our service-minded volunteers great incentive to enroll in graduate studies at the best place ever, the University of South Florida,” she said. “Coverdell Fellows share the passion for world experiences across university and help to inspire others to advance to the Peace Corps and take advantage of this great program that we have.”

Returned Peace Corps volunteer Valerie Rojas speaks about her experiences abroad in Cambodia. (Photo by Anna Mayor, USF College of Public Health)

USF has also launched a Peace Corps Prep program, designed to enhance the experience of undergraduate students by preparing them for international development fieldwork and potential Peace Corps service, according to Genshaft. This new program will be implemented in concert with the Global Citizens Project, a university-wide initiative that aims to enrich undergraduate education through curricular and co-curricular experiences.

The Diversity Abroad Network, a professional consortium of educational institutions, government agencies, for-profit and non-profit organizations dedicated to advancing diversity and excellence in international education, named USF the recipient of the 2017 Excellence in Diversity and Inclusion in International Education (EDIIE) and Global Student Leadership Award on March 2.

“Thank you for all you do,” Genshaft said. “Thank you for making this a top tier school in global issues in every way possible.”

Dr. Joseph Dorsey, an adjunct faculty member at the USF Patel Center for Global Sustainability, speaks about his time as a volunteer in the Ivory Coast. (Photo by Anna Mayor, USF College of Public Health)

Peace Corps program directors and deans from the Colleges of Arts and Sciences, Engineering, Public Health and the Patel College of Global Sustainability also spoke on the importance of the programs in their respective colleges.

“The distance between public health and peace in the Peace Corps is not a long one,” said Donna Petersen, ScD, dean of the College of Public Health and interim dean of the College of Nursing. “We know that health is absolutely critical to people having hope, and hope is absolutely critical to people pursuing peace, so this has been a great partnership for us.”

Guests were invited to sample food from across the globe during the festival. (Photo by Anna Mayor, USF College of Public Health)

“What we all share, all of us, is a passion for healthy people, for healthy communities and for a healthy environment,” said Eric Eisenberg, PhD, dean of the College of Arts and Sciences. “It makes me feel great to know that we are all pulling in the same direction and that a common language is the language of the experience of the people who live in the world, not the language of our disciplines or the language of theory or method. It’s a beautiful thing,”

USF’s Peace Corps recruiter and returned Peace Corps volunteer, Wilnie Merilien, also a master’s student in the College of Public Health, gave closing remarks.

Wilnie Merilien, returned Peace Corps volunteer and current USF Peace Corps recruiter (Photo by Anna Mayor, USF College of Public Health)

“Peace Corps has definitely confirmed my passion for the field of public health,” she said. “This week we are celebrating 56 years of friendship, service and peace, so thank you for coming out and joining us as we celebrate our local Peace Corps community.”

Story by Anna Mayor, USF College of Public Health