by Marybeth Kotrodimos
Featured photo by Vina Cristobal
“Our mandate is to end the AIDS epidemic by any means, to make it so that we don’t have to do this work anymore. That is our overall goal. That is why we exist.” –Dominic Chow, MD, PhD, MPH, Investigator for The Hawaii Center for AIDS (HICFA) at the John A. Burns School of Medicine (JABSOM) and Director of the University Health Partners’ (UHP) Clint Spencer Clinic
Recently we sat down with Dr. Chow and Maya Barney, BSN, RN, Clinical Operations Manager of the Clint Spencer Clinic, to get an update on what has been going on at the clinic since we last talked with them. They remain busy and committed to their cause of eradicating AIDS in our lifetime as they fight one epidemic in the midst of another.
The Clint Spencer Clinic is part of The Hawaii Center for AIDS (HICFA). It serves about 650 patients including 550 who have HIV, and 100 who are part of PrEP (Pre-exposure Prophylaxis Prep) – their AIDS prevention program for those who are at risk of contracting HIV. The majority of their patients are on Oahu, but they also care for patients on Maui and have two practices on the Big Island. They are the second largest provider for people living with HIV in Hawaii, following closely behind Kaiser Permanente in terms of the volume of patients that they see.
The clinic’s partnership with the Department of Health (DoH) has also helped “streamline referrals” for their PrEP program, which Mrs. Barney called “a really good tool and resource. We do what we call a ‘rapid-start PrEP’, whereby the DoH does a negative HIV test and with that resolved, we’re able to get them started on medications after a few questions and a quick check-in to make sure they don’t have any underlying conditions that that would prevent them from being on the meds. We’re pretty proud of that because you can’t cure HIV if you’re not taking care of those at risk of getting it, so it’s two halves of the same coin.”
Dr. Chow explained that the dedicated professionals of HICFA work “both on the clinical stage and in the research arena partnering with AIDS Service Organizations (ASOs) and medical research institutions to try to find where we can be of most use in helping patients to reach their HIV goal of being undetectable, trying to prevent other individuals from getting HIV in our PrEP Program and overall reducing HIV and its complications in our patients.”
They told us that Dr. Donah Lu, who joined the clinic last year, helped them launch a clinic in a transitional housing program. In addition to seeing patients in their facility in Kakaako, this unique clinic allows them to care for their patients in the community by setting up temporary practice sites in housing complexes where their patients live.
Instead of following “the traditional model” of patients visiting doctors in a facility, Dr. Chow said, “We’re taking the physician to the patients.”
And how attainable is that goal of ending the AIDS epidemic? “It is within our grasp to actually stop new incidents of AIDS in our state,” Dr. Chow said. “The number of newly infected people in Hawaii annually is about 100.”
“I think our state does an incredible job with working with the AIDS organizations on our Islands to make sure that once those cases are identified, they have that support network of case management and they’re in touch with the provider and doing a rapid-start for medication as quickly as possible,” Mrs. Barney said. “We’re trying really hard to get away from the days where people would get diagnosed and then be off meds for a couple of months as they are out in the community just trying to process their diagnosis on their own. [Now] people are engaging really early on, getting on meds and having a support network early on because we’ve found that in the long run, that way people will stay engaged and have better control of their [HIV] viral load. I think the DoH has done a great job of encouraging ASOs to engage and also having the medical providers ready to go. For example,” she added, “when we have a new person with a diagnosis, they either come directly to us from DoH, or they go to an ASO first, and the ASO will start them on meds and get them over to us or to another provider in the community and vice-versa: if we get them first, we can send them over to an ASO so they have a network built up early to support them.”
Services that ASOs provide for the patients (such as assistance with housing, employment, obtaining healthy food, counseling, and education) are just as important to these patients as direct medical care, Dr. Chow interjected.
“You need that support to make sure that the patient feels comfortable taking their meds between visits,” Mrs. Barney said. “We typically see patients every three to six months. We only know what happens when they get the lab work done and show up for their appointments. In the four years I’ve been working here, we’ve had increased contact with all the ASOs. We have really good collaborative energy with pretty much all the ASOs in the state so we share information. We know what’s happening because housing and job status affect what you are willing to do, how you are willing to partake in your medical care – all of that.”
Lessons learned from the AIDS epidemic have informed us of how to effectively address the spread of infectious disease and treat its victims, including how we are now addressing the current pandemic. The ASO model came from what we learned about caring for people with HIV. “A lot of things we take for granted now actually were initiated by people who had been advocating for patients suffering with HIV,” Dr. Chow said. “We have patient navigators now – that was a result of outreach done by the ASOs. HIPPA was actually started because during the AIDS epidemic, people were prying into medical records to see if someone was HIV positive. That’s a stigma piece. So, we have a lot to appreciate for what’s been done by advocates for HIV patients.”
Just as the AIDS Epidemic brought about some innovations and positive changes for the way healthcare is delivered, the Coronavirus has, by necessity, prompted us to explore and develop the use of telemedicine. According to Mrs. Barney, the Coronavirus Pandemic “has really allowed us to expand our telemedicine capabilities, which we have enjoyed doing.” She said that in acknowledging that COVID will be with us for a while, they have had to think about what that means for patient interaction. “We want to have a patient here physically for every other appointment to do vitals and make sure we’re catching up whatever is happening with them, especially since we manage so many of the patients’ primary care needs. But a lot of our patients have blossomed with Zoom. They come to appointments they wouldn’t normally come to. Our no-show rate has probably gone down from years past, because we have options to give people now. It’s really great on the Big Island because we weren’t traveling for about 18 months [due to the pandemic]. We’ve only just started to go to the neighbor islands again.”
Another positive change that has come from COVID has been the change in work place culture. “One of the things I appreciate about COVID,” Mrs. Barney said, “is that now if you’re sick, you stay home for yourself, for your colleagues, for your patients. And now we have patients recognize when they’re not well enough to do a visit rather than just showing up and being really sick.”
Dr. Chow and Mrs. Barney also talked about the launching of a new injectable medication for HIV called Cabenuva. The advantage of this drug is that the HIV patient only needs two injections a month, and both are given in one visit, instead of needing to take HIV medications daily. “The FDA just approved Cabenuva,” Mrs. Barney said, “and we have had a lot of patients expressing an interest in it and coming to appointments to see if they are a good fit for it.”
Between the continuing spirit of collaboration between the state and HIV provider community, the technological advances fostering more outreach and better communication, and the introduction of a promising new HIV medication, there is much reason for the people at the Clint Spencer Clinic to feel optimistic about reaching their goal of getting to zero new HIV infections in Hawaii. Mahalo to them and everyone engaged in research and outreach in The Hawaii Center for AIDS! We appreciate your hard work and dedication to the health of Hawaii.