Points of Impact: Okeoma Mmeje

Can you describe your current research? Internationally, I’ve been involved in work related to reproduction in HIV-infected couples in Kenya and Ethiopia since 2011. More recently, I’ve focused on expanding my work in STI treatment and prevention here in the U.S., primarily through what’s known as Expedited Partner Therapy, or EPT.

How does EPT work? This is an STI treatment and prevention strategy that allows healthcare providers to write a prescription for their infected patient as well as those patients’ sexual partners – without an in-person visit when the sexual partner may be unlikely to access care in a timely fashion due to lack of health insurance, limited access to healthcare and cost. Providers can either dispense medications directly from their clinic if that’s allowed, or they can provide a prescription for the sexual partners to fill at a pharmacy. Allowing providers to treat both patients and their partners through this strategy has been proven effective in preventing reinfection and the spread of new infections, primarily chlamydia and gonorrhea. Our team’s research has found that sexually transmitted infection (STI) rates have risen significantly higher in states that do not permit EPT. STI rates have risen for the third year in a row in the U.S., particularly among young people ages 15-24 (who account for half of all new infections), and we need to make sure we’re doing everything we can to prevent this given the long-term complications related to persistent or recurrent STIs.

What are some barriers to implementing EPT, and how can they be overcome?
Although EPT is currently permitted in 41 states and supported by the Centers for Disease Control and Prevention (CDC), our research is finding that lack of awareness about this strategy among healthcare providers is one of the biggest barriers to its success. Our colleagues at the Michigan Department of Health and Human Services are currently working with pharmacy professional associations to spread the word about EPT and how to offer and support EPT. There are also systemic barriers that can make it cumbersome to dispense prescriptions to sexual partners, and we’re studying ways to improve that process within different healthcare settings.  

What is your role with the CDC?
Along with a group of other physicians from across the U.S., I work as a consultant on special topic areas related to STI treatment and prevention. One critical area has been the rise in recent years in cases of congenital syphilis, which happens when a pregnant woman infected with syphilis pass the infection along to her fetus.   Most cases of congenital syphilis have occurred in women who were not screened properly during pregnancy. Although it’s recommended that all pregnant women should be screened for syphilis infection during pregnancy, some fall through the cracks because they have suboptimal or inconsistent prenatal care, or no access to prenatal care at all. In collaboration with staff at the CDC, I’m looking at ways we can support states in overcoming this epidemic. One strategy is helping states with high numbers of congenital syphilis cases establish a congenital syphilis review board, modeled after the very effective maternal mortality boards that most states have to better understand the circumstances and contributing factors that may have led to maternal mortality.  Congenital syphilis review boards would work to identify gaps in care and services that may have resulted in a case of congenital syphilis because of inadequate diagnosis of syphilis or maternal treatment. Also with CDC, I’m working on reviewing some of the research gaps and priorities related to HIV pre-exposure prophylaxis (PrEP) in women, as well as HPV infection and vaccination.

In your view, what are some of the most pressing issues and opportunities in HIV prevention today?
Here in the U.S., a little over a million individuals are infected with HIV, with different population groups of course bearing a greater burden than others. Among heterosexual women, I think the biggest challenge is that they may not be seen as a high-risk population. There are certainly areas across the country, particularly in the Southeast, where minority women are disproportionately affected by HIV. And if you’re not living within those regions, you don’t really appreciate the burden of infection. A lot of attention has focused on men who have sex with men, particularly around services and promotion of PrEP, in which people who do not have HIV but are at very high risk of getting it take daily medicines to lower their risk of infection. Momentum for a more comprehensive national campaign to support the use of PrEP among all at-risk individuals now seems to be building, one that would be inclusive of women who engage in risky sexual behaviors, those who are known to have partners potentially who may be at risk for HIV infection or may have HIV infection, women who engage in transactional sex, and now with the opioid crisis, injection drug users. Our HIV infection numbers in the U.S. don’t compare to places like sub-Saharan Africa, which carries the highest burden of HIV infection worldwide – but if we don’t recognize it here, we’re going to start seeing increasing rates as well.