World AIDS Day is Dec. 1

Nov. 27, 2013 College News - World AIDS Day is held every year on Dec. 1 to unite people worldwide in the fight against HIV, show support for people living with HIV and commemorate people who have died with HIV.  We wanted to use the opportunity to highlight some of the things being done by members of the MCW community to stop the spread of AIDS and help people who have HIV.

“AIDS remains a major health concern in the United States and across the world,” said Lee Biblo, MD, Chief Medical Officer for Medical College Physicians and Froedtert Hospital. “Unfortunately, infection with HIV continues to bring with it significant social and financial discrimination. The equal and compassionate care of all patients regardless of socio-economic status, gender, or sexual orientation remains a foundational element to the delivery of health care at Froedtert/MCW. Every person deserves excellent health care.

“World AIDS Day serves as a reminder that infection with HIV remains a devastating diagnosis on many levels,” Dr. Biblo added. “Efforts to prevent HIV infection and improve the treatment of those infected with HIV must continue with local, national, and international commitment.”

Some of MCW’s efforts to help slow/reduce the spread of AIDS and treat/assist people who have it:

Center for AIDS Intervention Research

The MCW Center for AIDS Intervention Research (CAIR) is one of five HIV prevention research centers in the country supported by the National Institute of Mental Health (NIMH) and the only center between the country’s east and west coasts. CAIR has been a federally-designated Center at MCW for nearly 20 years.

CAIR’s missions are the development, conduct, and evaluation of strategies for HIV prevention; the development of interventions to improve the health and well-being of persons affected by the disease; and the rapid dissemination of the Center’s research approaches to health service providers on a national and global scale so they directly benefit from CAIR’s research. CAIR’s work is carried out by an interdisciplinary team of nine fulltime investigators who hold appointments in the MCW Department of Psychiatry and Behavioral Medicine; a larger group of CAIR-affiliated investigators drawn from multiple MCW departments and other institutions in our area; and a team of approximately 25 fulltime research and support staff. CAIR also holds an NIMH-supported T32 postdoctoral research fellowship program, continuously funded since 1996, to train the next generation of HIV prevention researchers.

CAIR’s research is nearly equally divided between projects being undertaken in the United States and international HIV prevention studies in world regions highly impacted by the disease. CAIR’s currently funded domestic studies include:

  • A project undertaken by a research team led by Julia Dickson-Gomez, PhD, which identifies factors associated with substance abuse, violence, and HIV risk behaviors among young gang members in Milwaukee, with the aim of developing a multi-level intervention for reducing risks by addressing multiple and interrelated health and social problems
  • An intervention trial led by Jeffrey Kelly, PhD, and Yuri Amirkhanian, PhD, that uses social network approaches to reach African American men who have sex with men (MSM) in the community and to deliver HIV prevention messages to reduce high-risk sexual behavior and improve treatment uptake among those already living with HIV infection
  • A line of research being carried out by a team headed by Carol Galletly, JD, PhD, that examines the effects and possible unanticipated negative consequences of laws enacted in some states that criminalize nondisclosure of positive HIV status to sexual partners
  • Research co-led by Steven Pinkerton, PhD, that explores how community health agencies adapt and tailor evidence-based HIV prevention interventions for disadvantaged women and also examines the “real world” effectiveness of these interventions when carried out by service providers rather than researchers.
  • A project conducted by Andrew Petroll, MD, MS, that investigates the readiness of U.S. healthcare providers to prescribe PrEP (pre-exposure prophylaxis) to individuals at risk. Dr. Petroll’s study focuses on those U.S. metropolitan areas hardest hit by HIV, including Chicago, New York City, and San Francisco.

Because more than 96% of the world’s HIV infections affect people living outside North America, CAIR has an active international HIV prevention research program and serves as a resource to the global AIDS field. Center initiatives have long been focused in post-Soviet countries of Eastern Europe and Latin America. Examples of CAIR’s international projects include:

  • Yuri Amirkhanian, PhD, and colleagues have established an Interdisciplinary Center for AIDS Research and Training (ICART) in St. Petersburg, Russia. Linked with CAIR, the initiative brings together MCW and Russian social, behavioral, and medical researchers to collaborate in HIV prevention and care initiatives including prevention through behavior change, mental health among people in Russia living with HIV, and improved health care through HIV testing, linkage to care, and antiretroviral treatment adherence.
  • Drs. Kelly and Amirkhanian, working with their Russian team, are conducting several studies aimed at using social networks to overcome different barriers to antiretroviral (ART) regimen adherence and maintenance of health care appointment keeping in persons living with HIV (PLH) in St. Petersburg. Adherence to ART regimens and linkage/maintenance in care are important factors in improving the lives of PLH and of preventing further spread of HIV.
  • Dr. Dickson-Gomez and her team have a longstanding record of research collaboration with public health agencies in El Salvador. In its present phase, this research led to the development of community-wide, multi-level interventions to reduce HIV risk, increase voluntary HIV testing, and improve care linkages for crack users in the country. The work brings together CAIR researchers, academic partners in El Salvador, community-based service agencies, and the country’s public health system to develop innovative and sustainable HIV prevention models.

Over the past several years, important new tools for HIV prevention have become available. These include the potential for early antiretroviral therapies to not only improve the health of persons living with HIV but also, if undertaken on a wide scale, to reduce disease transmission and HIV incidence. CAIR’s work in the future will be strongly focused on meeting the implementation science challenges needed to apply these new developments on a public health scale in Wisconsin, the United States, and the world.

HIV research

The Children’s Hospital of Wisconsin HIV program, led by Peter Havens, MD, Professor of Pediatrics (Infectious Diseases), in collaboration with Janice Hand, Program Director in the MCW Department of Pediatrics Division of Infectious Disease, and Barbara Cuene, RN, MSN,  Program Coordinator at Children’s Hospital, started in 1992. The CHW HIV Program is one of nine partners in the State-wide Wisconsin HIV Primary Care Support Network.  The Network serves children, youth, pregnant women, and women with HIV infection living throughout Wisconsin.

Since 1993, one important focus of the Network has been to reduce the number of children born with perinatally acquired HIV infection in Wisconsin.  Physicians, nurses, and social workers from MCW, CHW, and American Family Children’s Hospital in Madison, collaborate with HIV specialists and obstetricians throughout the State to care for all pregnant women with HIV infection.  Through their combined efforts, they have served more than 300 pregnant women and close to 500 infants since 1993. 

In just the past 10 years, they cared for 200 pregnant women with HIV and 352 babies born to women with HIV. During this time, there was just one baby born with HIV to a pregnant woman served by the Network.  During this same time period, there were two babies born with HIV to pregnant women who did not know they had HIV.  Perinatal HIV transmission is preventable, and they continue to educate Wisconsin providers about the importance of testing all women for HIV during pregnancy.

Without treatment, 25% of babies born to women with HIV will acquire perinatal HIV infection.  On average, there have been 35 babies born to women with HIV annually; this means that there would be eight babies born with HIV per year; resulting in the birth of 80 babies with HIV during the past 10 years.  With a lifetime cost of medical care per child of approximately $1,400,000, the cost savings for the state of Wisconsin Medicaid program is $112,000,000. This is in addition to the more meaningful non-financial benefits enjoyed by the child and his or her family.

Dr. Havens serves in numerous national leadership roles related to pediatric HIV research and treatment of pediatric patients with HIV. This includes serving as Co-Chair of the U.S. Department of Health and Human Services’ Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children, which develops the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. He also is a member of the Adolescent Medicine Leadership Group of the Adolescent Trials Network (ATN) for HIV/AIDS Intervention. In this role, he is responsible for the review and approval of all grants approved by the ATN and also writes grants that will be funded through the ATN and carried out at study sites throughout the United States.

John Fangman, MD, Associate Professor of Medicine (Infectious Disease) and Medical Director of the AIDS Resource Center of Wisconsin; Mary Beth Graham, MD, Associate Professor of Medicine and Associate Chief of Infectious Disease; Dr. Havens; Christine Hogan, MD, Assistant Professor of Medicine (Infectious Disease); Michael Frank, MD, Professor of Medicine; Andy Petroll, MD, Assistant Professor of Medicine (Infectious Disease); and Janaki Shah, DO, Assistant Professor of Medicine (Infectious Disease); are active faculty in the monthly HIV Treaters Meeting, a statewide continuing education conference which was started by MCW faculty and is funded by the State of Wisconsin and the Midwest AIDS Training and Education Center (MATEC).

Current ATN projects for which Dr. Havens is principal investigator include studies of the metabolic complications of long-term treatment for adolescents and young adults with HIV infection, and potential interventions to prevent HIV treatment-related toxicities. 

Froedtert Hospital Infectious Diseases Clinic and the Veteran’s Affairs Medical Center

The Froedtert Hospital Infectious Diseases Clinic provides comprehensive and state-of-the-art HIV treatment to approximately 620 clients annually.  The team consists of MCW faculty, four full time registered nurses, an Infectious Diseases Pharmacist, and Social Worker.  Additionally, the clinic receives state funding from to provide onsite mental health services for clients in need of this support.

The VA healthcare system provides treatment for the largest number of HIV infected individuals nationwide, and the HIV primary care clinic in at the Clement J. Zablocki VA Medical Center in Milwaukee serves the largest population of HIV-infected veterans in Wisconsin.  In 2010, the Milwaukee VAMC initiated a program to proactively offer HIV testing for every veteran enrolled at the facility.

AIDS Resource Center of Wisconsin

The Medical College of Wisconsin and Froedtert Hospital have a long-standing affiliation with the AIDS Resource Center of Wisconsin (ARCW) that helps to ensure that HIV/AIDS patients in Southeastern Wisconsin have access to quality primary and specialty care. To this end, the affiliation agreement provides ARCW with opportunities for operational efficiencies and improvements, enhanced HIV research and the ability to staff the ARCW clinic with outstanding physicians.

As part of the affiliation, John Fangman, MD, Associate Professor of Medicine (Infectious Disease), serves as Medical Director of the ARCW medical clinic, and Christine Hogan, MD, Assistant Professor of Medicine (Infectious Disease), Janaki Shah, DO, Assistant Professor of Medicine (Infectious Disease), and Krutika Kuppalli, MD, Assistant Professor of Medicine (Infectious Disease), provide specialty care for patients at the clinic.

Another connection with the ARCW, although not part of the affiliation agreement, is that Dr. Biblo, who is also Professor of Medicine and Associate Dean of Clinical Affairs, serves on the ARCW Board of Directors.

“As ARCW continues on its trajectory to enhance patient outcomes through continual refinement of its integrated HIV medical home model of care, our strong partnership with MCW and Froedtert Hospital are critical to our success,” said Mike Gifford, ARCW president and chief executive officer. “With organizations from 16 other states and the District of Columbia looking to ARCW for leadership on how to create similar models in their communities, I cannot emphasize enough the importance of collaborations such as ours in delivering high quality, patient-centered care. It’s exciting and telling that the success of our relationship  is being used as the template for the development of a new relationship between the AIDS Resource Center of Ohio and the Ohio State University Wexler Medical Center.”

In addition to medical care, ARCW provides housing support, social service support, food pantry support, dental care, and legal services to patients with HIV. ARCW clearly provides a comprehensive medical home to their patients. MCW and Froedtert are proud to support this comprehensive approach to care with our strong affiliation.

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