A Vehicle for Care, Counseling Out in the Community

The University of Miami (UM) has a community-based mobile clinic that offers PrEP counseling along with other medical services to those who might not otherwise have access to or seek clinical care.

The University of Miami’s green and orange colors add some contrast to the otherwise all-black truck, which is sitting in a parking lot in a Miami neighborhood. A visitor to the truck has come in to get information on sexually transmitted infections (STIs), and stays to get some counseling on pre-exposure prophylaxis (PrEP) from one of the education navigators working the clinic.

This truck is a mobile clinic created by the University of Miami, and it goes out into various areas within Miami-Dade County to deliver care related to STIs, HIV care, and HIV prevention to people who might be at-risk and who might not be seeking medical care.

“It provides us the opportunity to go to neighborhoods that may not have PrEP services in place,” Susanne Doblecki-Lewis, MD, MSPH, FIDSA, professor of Clinical Medicine, and director of HIV Prevention, Division of Infectious Diseases, University of Miami Miller School of Medicine. Doblecki-Lewis heads UM’s PrEP outreach.

As many urban areas across the US, Miami has been challenged with HIV incidence rates. As of 2018, Miami had the second highest rate of HIV infection in US cities behind only Baton Rouge according to the Centers for Disease Control and Prevention (CDC). In 2019, there were 25,671 people living with HIV in Miami-Dade, and 1170 people were newly diagnosed with HIV that year.

“We are hoping that based on the barriers that we have seen to PrEP—and we have studied here in Miami—our goal is to leap over some of those barriers in one step by rethinking the clinical environment entirely,” Doblecki-Lewis stated.

The mobile clinic is equipped with an exam room, phlebotomy station, a place to collect specimens, and an area for counseling. The clinic often has hours in the afternoons and evenings to accommodate people who want to come in after work.

“We try to make it welcoming and make it fast,” Doblecki-Lewis said. “Rapid is one of our main tenets. We don’t want people to spend a lot of time to get these services.”

The clinic also tries to remove the stigma associated with some department-of-health clinics, and the service is free, explained Doblecki-Lewis.

The PrEP clinic has some corporate sponsorship, and Doblecki-Lewis credits the navigators’ passion for keeping the clinic going. “They are the heart of program; they are what makes this work,” Doblecki-Lewis said.

Contagion spoke with Doblecki-Lewis recently about the genesis for the clinic, how they decide on the different mobile sites, who they are reaching in the community, and how they carry out a continuum of care for their patients they serve.