Celebration of Our Physician Assistants

Earlier this month, was Physician Assistant Appreciation Week and we definitely appreciate our PA's. Pictured (from left to right) are Daisy Rivera, PA-C and Carmen Rocha, PA-C. (Maria Garcia-Bulkley, PA-C is our third PA, but not pictured here.) The theme this year is "I'm a PA-- Ask Me What That Means". Despite PA's having been around since the mid-1960's out of a class of Navy Corpsmen returning from Vietnam, the public is less familiar with PA's than with nurse practitioners.
PA's are trained in a medical model to work collaboratively with physicians to provide care to patients in a wide variety of settings-- from remote primary care settings in rural areas to operating rooms in large university hospitals. They attend rigorous training programs with the majority these days graduating with a master's day and then take a national certifying exam-- hence the PA-C after our PA's names. In most states, PA's can prescribe medications and perform most of the same duties as a physician.
There are 151 PA Programs nationally-- locally there are programs at Drexel, Philadelphia University, Arcadia, Philadelphia College of Osteopathic Medicine, and University of the Sciences.
In 2006, Money magazine ranked PA's as the 5th best profession in the US. We like to think that our PA's are in the first best PA's in Philadelphia. Our celebration included this lovely cake, made by Pamela Hadley-Thornton.

DMC Staff Present at Family Planning Council Conference

The Dorothy Mann Center was well represented during the Family Planning Council (FPC)'s Conference as Roberta Laguerre, MD was the opening speaker - her talk topic: Routine HIV Testing in Family Planning Settings (Opt-Out Testing in Healthcare Settings). Daisy Rivera, PA-C was among the closing speakers - her talk topic: Best Practices to Engage HIV+ Adolescents & Young Adults in Care, Treatment and Family Planning.

In the photo (from left to right):
Tracy Graham, PA-C (FPC), Daisy Rivera, PA-C (DMC), Kathy Nixon, CRNP (FPC), Roberta Laguerre, MD (DMC), Barbara L. Bungy, MPH (DMC) pictured

Poverty and Heterosexual HIV - CDC Issues a Report

In the August 12, 2011 issue of the Mortality and Morbidity Weekly Report (MMWR), the CDC outlines results of a study examining heterosexual HIV in 25 metropolitan areas-- Philadelphia included. The study was done as an anonymous survey, asking people in areas with known high rates of HIV about various demographics facts and their HIV status. What they found were HIV rates:
- twice as high in those who hadn't completed high school (2.8% vs. 1.2%)
- twice as high in unemployed (2.6% vs. 1.0%)
-twice as high when living in poverty (2.3% vs. 1.0%)
-similar among men and women
-by race/ethnicity were not as different as it is in the general population
It was NOT associated with different levels of crack cocaine use, exchanging sex for drugs or money, or rates of STDs once the statistics were controlled for differences in poverty.
The editors, in tying together HIV and poverty as the most important factors noted that "Low SES and other adverse social conditions can increase the risk for HIV infection through sexual exploitation, marital instability, unstable sexual partnerships, poor mental health, substance abuse, and limited access to health care and preventive services. In addition, socioeconomic segregation confines low-SES persons to sexual networks with high underlying rates of HIV and other STDs, thereby further increasing their risk for HIV infection". Their conclusions were that future prevention efforts need to especially focus on those who live in poverty in areas with high rates of HIV.
Philadelphia's own, Dr. Kathleen Brady and Althea Kirkland, of AACO are cited at the end of the report as contributors.

August Star Employee - Marie Spencer

This month's star employee is Marie Spencer. Hailed by her colleagues as being: lovable, hard working, team player, helpful, always smiling, a breaker of barriers. Marie works at the DMC as an HIV tester. She is well known by staff at area homeless shelters in particular for her efforts in HIV testing there.

Summer Newsletter Now Available

Your summer newsletter should soon be in your email box. For a preview click here.

Treatment Impacts Prevention

In a New England Journal of Medicine article, published on July 18, 2011, Dr. Myron Cohen of the University of North Carolina, Chapel Hill and his colleagues make the case for "early" treatment of HIV as a means of HIV prevention. In their study, they looked at nearly 2000 serodiscordant couples (one partner HIV+, one HIV-), predominantly from Africa. HIV medication was given to half of the HIV positive partners while treatment was deferred in half until the CD4 count dropped or development of HIV related symptoms-- the standard of care in these areas without enough medication for everyone. The goal of the study was to see if this "early" treatment would result in fewer infections among their HIV negative partners (while also monitoring them to see if early treatment made a difference in the positive partners' health).
The result was that of the 28 infections that were proven to be transmitted from one partner to the other, only 1 was in the treatment group. Individuals on treatment also had fewer HIV related clinical problems.
In a companion editorial in the same issue, Dr. Scott Hammer of Columbia University makes the case for expanded access for medications, "this is precisely the wrong time to limit access to antiretroviral therapy in resource-limited settings, since we have the tools in hand to maintain or restore health in infected persons and reduce transmission to their sexual partners."

The DMC "Hearts" Dr. Laguerre

Dr. Roberta Laguerre is our July Star Employee of the Month. As the sign she is holding says, she is fabulous, dedicated, and beautiful. Chosen by popular vote of our staff, our employee of the month gets to enjoy a month's worth of honors.
Dr. Laguerre is the Clinical Director of the DMC so is no stranger to our patients and is becoming increasingly well known by physicians in the area as she travels for her infamous lunch discussions about the importance of routine HIV testing for teens.

Our Video Now Available on Vimeo

The documentary video about the DMC, produced for our opening reception is now available on Vimeo here. For those of you who may have tried to view it in the past, the technical issues have been resolved. In the video, Dorothy Mann talks about her first experience with the program at St. Chris and with families affected by HIV. Also interviewed are Dr. Sue Willard, now at the Elizabeth Glaser Pediatric AIDS Foundation, Carol Treston, RN MPH now the Executive Director of the AIDS Alliance for Families and Children, Dr. Ellen Tedaldi of Temple University School of Medicine, and staff and family from the DMC. The video was directed by Alfredo Sosa of Mighty Head Entertainment.

First Ever National Prevention Strategy Unveiled

On June 15th, the US Department of Health and Human Services unveiled its first ever National Prevention Strategy. The prevention strategy is a required component of the implementation of the Affordable Health Care Act, aka Health Reform. Underlying the strategy is a plan that reducing illness will ultimately pay off not only in quality of life, but in less money being spent on disease care. Why should we in the HIV care about this?
Key points put forth by Maria Alvarez, the Director of Health Policy in the Office of Health Policy Reform at DHHS here at HealthCare.gov's blog :
1) Making healthy choices easy and affordable will result in more Americans having access to prevention services such as HIV testing, breast exams, blood pressure checks, etc. Having health care providers focus on prevention in general should result in broader prevention efforts in general.
2) Access to health care in underserved communities will be improved -- having a large impact on illnesses with health disparities such as hypertension, heart disease, and HIV. This will be for both HIV care and for issues around primary care as well.
3) Programs will be better targeted through advance scientific knowledge and innovation through creation of electronic systems to better monitor what is working and what isn't-- we already do this in Ryan White funded clinics through CAREWare.
4) Create a fairer and easier way to understand the health care system - by 2014, insurance will be easier to obtain and there legally cannot be any discrimination against anyone with a pre-existing condition-- opening many options for those with HIV.

DMC Director a Top Doc

Jill Foster, MD, Director of the DMC was named in the Philadelphia Magazine May Issue as a Philadelphia Top Doc in the category of Pediatric Infectious Diseases. This honor results from voting from local physicians who are her peers. Inclusion in this also qualifies her as a Castle Connolly America's Top Docs. Dr. Foster is coming up on her 10th anniversary as program director this fall. She wants to congratulate her entire team for the joint effort that led to this honor for the Center.

New Feature - Follow Us By Email

If you're interested in getting an email every time we make a new posting, just enter your email into the box in the "follow us by email" section in the left column and you're all set. We won't have access to these email addresses, so of course would never use them. If you would like us to know who you are and would like to be on our mailing address, just send an email to stchrisrapidtesting@gmail.com.

Commemorating the 30th Anniversary of HIV

By Jill Foster, MD - Director of the DMC
It was 30 years ago this week that the first official account of a mysterious illness that would become known as HIV was made, in the June 5, 1981 issue of MMWR-- and the beginning of the summer when I would begin my medical career. My personal journey with HIV didn't become evident until two years later, in 1983 with my first job, as a physician assistant at Giuffree Medical Center on 8th and Girard in North Philadelphia-- a hot zone for HIV in Philadelphia. Hearing only whispers in the medical community of what was becoming known as a "gay plague", we started seeing previously healthy young people be admitted and abruptly die. There was fear from the patients as they sickened so quickly and fear from much of the staff that it was contagious. There was a lot more than whispers in the community as people saw friends taken from something ominous.
I have vivid memories of patients and friends from that time. Andre (not his real name) who was a twenty something whom I had cared for and laughed with during several dirty needle related illnesses who came in with PCP and died 2 days later. Phillip who was 2 whose mother had died and he had just been adopted and now had kidney failure from guess what, HIV. We had the "miracle cure" of AZT and ddI for him and he lasted a few years. Michael, my friend, who I begged to get an HIV test after he had a particularly nasty foot infection, but he said, "What would I do different?" The answer to a positive test for him since he was already symptomatic would have been to start preparing for the end and he still had so much life to live.
"What would I do different?" is such a different question for 2011 rather than 1985. Today, we have medications that are not a cure but in the majority of patients can get someone to having no detectable virus in their blood. Someone who knows his or her status can take risk reduction steps to protect him/herself and decrease the risk of transmission to others. Earlier this year, we heard about PrEP (Pre-Exposure Prophylaxis). PrEP from early clinical trials has the promise that we may be able to offer two medications (emtricitabine and tenofovir) and counseling to high risk HIV negative young men who have sex with men to potentially decrease their risk of HIV.
"What would I do different?" now, personally and professionally-- nothing. I remember the first time I ordered an HIV test on a patient and how glad I was to have it available. I also remember the first time I did an HIV test in a church rather than in a medical office and how magical it still seemed. I remember the first person I gave an HIV positive result to (a mother for her baby) and the most recent (a teen 2 weeks ago). I remember the first time I ordered AZT for a patient and where I was driving when I heard the news on NPR that a clinical trial giving AZT to pregnant women had been halted because of its success-- and that we would soon eliminate mother to child transmission. I am looking forward to remembering where I was when I heard there was a cure.
Here's some links to some other pieces on remembrances and other items about the 30 year anniversary. Op-Ed in the Inquirer by Dr. Marla Gold, Dean of the Drexel School of Public Health, features in the Inquirer, a New York Times Op-Ed, a piece by the Smithsonian on an exhibit commemorating the 30 year anniversary, and a message from Secretary of State, Hillary Clinton. View information and panels from the AIDS Quilt.

DMC Testing Program Results Presented at SPH Research Day

Cymara Tolbert, MPH (candidate) spent her year at St. Chris performing a program evaluation of our testing program. She presented these results at the annual Drexel School of Public Health Annual Poster Presentation and Awards Reception. Her analysis showed an overall positivity rate of 2% in our community based testing program, and that we are being successful in reaching our target populations of high risk for HIV youth in Philadelphia. We will continue to refine our testing program based on her findings.

June Star Employee of the Month - Tanya Marrow

Tanya Marrow, the DMC Clinical Coordinator, is honored this month as our Star Employee of the Month. Tanya is the one who keeps everything running at the program-- managing grants, supervising administrative staff, and just generally making sure that everything works the way it is supposed to. We've been a little short handed recently, so Tanya has been filling in for others as well, and is quite relieved that we've filled our vacancies.

Lunch In Benefits St. Chris Hunger Initiative

To support the St. Christopher's Foundation for Children Dine In Help Out Initiative, the DMC staff skipped their usual Friday ordering out for lunch. Instead, the staff hosted a pot luck lunch and donated what they would have paid for lunch to the Dine In Help Out Initiative. Dine In Help Out utilizes the Farm to Families program to ensure that families in North Philadelphia have access to farm fresh fruits and vegetables with weekly pickups of food in neighborhoods. The plight of hunger in the St. Christopher's Hospital for Children neighborhood was featured in a Philadelphia Inquirer article. Since then, St. Chris in partnership with the Foundation has hosted a holiday turkey giveaway and is now promoting the Dine In Help Out initiative. Our CEO Carolyn Jackson was featured on NBC Channel 10 discussing the initiative.

DMC Scholars Win Prevention Conference Sponsorship

Noel Ramirez, MSW and Cymara Tolbert have both been awarded scholarships to attend the CDC National HIV Prevention Conference in Atlanta in August. Cymara is the Drexel School of Public Health student who has spent the year at the DMC completing her Community Based Masters Project (CBMP). She will graduate next month and we're looking forward to hearing about her plans for the future. Noel is the Health Education Program Coordinator for the DMC and an MPH student at Drexel as well.

Did you receive our newsletter?

We're now publishing a quarterly newsletter-- also available via the web at Google docs here. If you would like to receive our newsletter via email, please email us at stchrisrapidtesting@gmail.com to be added to our mailing list.

"Don't Touch the Needle"

Dr. Roberta Laguerre went back to school on May 12 to teach 100 pre-K and K students (and their teachers) at The Lighthouse Family School about the importance of not touching needles. Every day, "dirty" needles and other medical sharps are carelessly discarded by people without thoughts of how they might end up in the hands of children who then stick themselves with them. Some of this is by adults who have medical needs such as for lancets to check blood sugars and insulin syringes, but many of these are from needles used for illegal drug use and then discarded on streets and playgrounds. Viruses such as HIV, hepatitis B, and hepatitis C can live in these syringes for many hours and then infect the person being stuck.

Dr. Laguerre says, "Stop, Don't Touch, and Tell". She also says that this is the most fun she's had in a long time and was quite impressed with how well aware the children were of needles in their environment.

The DMC offers evaluation services and advice about post-exposure prophylaxis for situations where there is a suspected non-occupational HIV sharps exposure.

Our Stars

We're honoring our Star Employees of the Month and here is our collection of honorees so far.
First (from left to right) is Evelyn Arroyo (April), our Lead Patient Representative who is the first person and last person people see when people come to clinic. She is always courteous and friendly and makes sure everyone's needs are met. Second is Daisy Rivera, PA-C (March), one of our physician assistants. She worked for months as the only PA while we had a vacant position, keeping us organized and surviving under a deluge of paperwork. Last but not least is Natasha Gordon (May), our medical assistant. Natasha is this month's honoree for her tireless dedication to the program and the uncanny ability to somehow be able to be in more than one place at the same time.
Honorees are given a crown to wear for the day, hand-made artwork customized to their particular star attributes to be posted on their door, a flower scepter to reign over her royal subjects, and a gift card as a small token of our appreciation.
Stay tuned for monthly updates of our Star Employees of the Month. Please join us in congratulating them when you see them.

Dr. Foster On Radio Times to Discuss Teens and HIV/STDs

STDs and HIV among Philadelphia's Teens

Dr. Jill Foster, Director of the Dorothy Mann Center, was part of a panel on Radio Times with Marty Moss-Coane on WHYY today. Go here for the podcast. She was there to discuss rates of HIV and STDs among teens in Philadelphia and potential ways to help alleviate the problems. She joined Elicia Gonzales from GALAEI and Gary Bell from BEBASHI in what turned out to be something that she hopes is as fun for viewers to listen to as it was for her to do. (And while waiting for the interview, she spied Tina Fey and her entourage arriving at WHYY for a different gig.) More pictures from today's studio session are at Radio Times' Facebook page.

DMC Staff Comment in Inquirer Article

HIV risk higher for teens who had syphilis, gonorrhea

Dr. Jill Foster, Director of the DMC, was asked to comment for a 4/7/2011 Philadelphia Inquirer article on the link between HIV and rates of STDS, specifically gonorrhea and syphilis. In her discussion, she talked about teens feeling that they can judge their HIV risk merely by looking at someone and that there is still significant stigma around an HIV diagnosis.
This article was written as the city rolls out a new campaign to combat the unacceptably high rates of youth STDs, with Philadelphia "achieving" number 1 status in the country for youth STD's. There's a second Inquirer article on this in today's paper. Part of this campaign is free distribution of the new Philadelphia Freedom condom (pictured above), more information at takecontrolphilly.com. From this website, teens can get apps for mobile phones to help them locate sites to get free condoms and can mail order free condoms. St. Chris' Adolescent Clinic (right upstairs from the DMC) is one of the sites for condom distribution and the DMC will soon be a site.

Institute of Medicine Report Highlights LGBT Health Issues

The Institute of Medicine released a report, The Health of Lesbian, Gay, Bisexual, and Transgender People today. This report was commissioned by the National Institutes of Health (NIH) so that a research agenda can be formulated to ensure that the health needs of LGBT people can be met. This is a very important development for the LGBT community because in order for health needs to be addressed, there needs to be more formal study.
This development is comparable to the movement in this country over the last few decades to ensure that women and ethnic minorities health needs were addressed separately. For years, the "standard" patient in medical research was the 60 kilogram white male. All drug development, disease progression, epidemiology, etc. used this standard patient rather than considering the unique needs of different populations. This report is an important move towards considering the unique health needs of LGBT individuals.
Highlights from the report summary are: 1) Attention needs to be focused on the chronic stress that may accompany stigmatization 2) Health status needs to be examined through the lifetime, including unique issues of adolescence (including the potential for increased rates of depression, suicide, and substance abuse), adulthood (the potential increased rates of obesity and breast cancer among lesbians), and the elder years and 3) that study needs to be made of health issues LGBT sub-populations, especially the disparately high rate of HIV among gay, bisexual, and transgender minority men.
Staff at the Dorothy Mann Center are reviewing this report in full as we continue to plan our agenda for exploring issues of the youth we serve.

Rapid Testing Team's Efforts Featured on AHRQ's Website

Our Rapid Testing Team has been featured on the US Department of Health and Human Service AHRQ's (Agency for Healthcare Research Quality) Innovations Exchange page for a couple of years now, but in the March 13, 2011 issue of their e-newsletter, we're one of the featured innovations. Congratulations go to Theresa Parrino for her innovations in starting this program, Barbara Bungy for her dynamic leadership of the team and to the testers: Marie Spence, Tira Faison, Andrea Johnson, and Joel Diaz. Keep up the good work.

We're Reviving Our Blog

After a bit of a hiatus, the the Dorothy Mann Center's blog is up again. Stay tuned for lots of good stuff, especially with the one year anniversary of our re-naming coming up in mid-April.