It was late March and about a week before Miami-Dade would implement its stay-at-home order when Tookes mandated that his staff at the state's only needle-exchange program wear personal protective equipment and forgo in-person appointments. The Miami-based IDEA (Infectious Disease Elimination Act) Syringe Services Program, which Tookes founded, operates under the auspices of the University of Miami's Miller School of Medicine and is primarily run by medical students.
IDEA's bread-and-butter offering is a needle-exchange program whereby drug users can exchange used syringes for clean ones. Though the needle exchanges have continued, IDEA was unable to offer in-person consultations and other services, such as HIV testing and drug-treatment consultations, for more than a month. Testing and in-person appointments were halted March 16 and only resumed earlier this month, Tookes says.
When coronavirus forced IDEA to discontinue in-person appointments, the team concentrated its efforts on developing a fully online telehealth program to connect patients with opioid-use issues with prescription treatments like Suboxone and Narcan.
Now, a recently announced $50,000 donation from the MAC Cosmetics Viva Glam campaign will support the expansion of IDEA's new telehealth offerings, says Nancy Mahon, a senior vice president for MAC's parent company, Estée Lauder. Sales from the Viva Glam cosmetics line are donated annually to local organizations — primarily those caring for individuals with HIV/AIDS — that serve vulnerable communities.
As a result of the pandemic, Mahon says, she anticipated that many of the programs supported by Viva Glam would take a financial hit. She's hopeful the IDEA program can use the $50,000 donation to alleviate some of the financial pressure so the team can focus on caring for its patients.
IDEA's program director, David Forrest, says the money will help fund salaries for certain positions and allow the staff to continue treating patients without disruption.
Before coronavirus, IDEA was primarily using its telehealth capabilities to help fill gaps when a patient was unable to come for an in-person appointment, Forrest says. When shutdowns began, it was an all-hands-on-deck effort to quickly develop the new telehealth program specifically for opioid-use disorder.
"What COVID did was push us to do that — very quickly," Forrest says. "What it made us do is force everyone, all of our services, toward [telehealth] overnight. Like: We don't have a choice."
Tookes says those telehealth offerings have been crucial in staying connected with some of the community's most vulnerable patients at a time when many either cannot leave their homes or are afraid to visit the clinic.
"You know, the thing about people who have severe opioid-use disorder, a lot of times the only people that smile at them, care for them, hug them, treat them with dignity and respect, it's the people on my team," Tookes says.
For all of the restrictions and limitations the pandemic placed on public-health entities, Tookes points out, it has also eliminated certain barriers for underserved populations to access his agency's services.
"So all of the things that are manmade that prevent people from getting HIV care — like you must be present [in a physician's office], you must sign this piece of paper, this and that — that's all gone now," Tookes tells New Times. "I don't even have to be there. My team can pull me up on an iPad, and we can have a visit remotely. This rapid evolution into telehealth and remote technology hopefully is here to stay."
Founded in late 2016 when Tookes was a resident at Jackson Memorial Hospital, IDEA is the only entity in Florida that offers a needle-exchange program. After Tookes spent three years lobbying Florida lawmakers, the state finally gave the green light to the program, which typically operates out of a mobile unit or from its main location on NW Seventh Avenue. In Miami-Dade, where more than 26,000 people live with HIV, the program has received a confounding amount of pushback from local officials, many of whom have accused the program of enabling intravenous drug users.
The program is funded entirely by private donors and grants and costs upward of $500,000 annually to remain afloat. The Viva Glam campaign was the initiative's first donor, back in 2016, Tookes says. According to Mahon, the campaign has contributed a total of $375,000 over four years.
Over the next year, Forrest anticipates the IDEA staff will conduct roughly 750 visits, which translates to the exchange of 15,000 used syringes and the distribution of about 300 boxes of Narcan.
As it relates to needle-exchange programs, Forrest says, "We're the place that is going to develop the models for the whole state of Florida. And that's what MAC is contributing to, in addition to that number of syringes that we're going to give out and the number of Narcan we're going to give out and all that.
"The bigger picture is about changing the way things are done in Florida."