Christopher Hurt, MD, loves live wires. Not the electrical kind, the kind that comes in the form of providers eager to increase their knowledge of HIV.
Hurt is an assistant professor of medicine in UNC’s Division of Infectious Diseases and co-directs the North Carolina AIDS Training and Education Center or NCATEC. The federal government, through its Ryan White HIV/AIDS Program, supports eight regional AIDS Education and Training Centers around the country. The NCATEC, based at UNC since 2011, is part of a group of similar training centers serving the Southeast region. NCATEC is tasked with providing all HIV professionals – from clinicians to allied health providers to advocates – with the latest information to prevent, diagnose and treat the virus.
“The purpose of the training centers is to bring HIV out of the shadows and help providers understand the disease,” says Hurt. “This is especially important in the South because we have more people living with HIV than any other region in the country.”
Professor of Medicine David Wohl, MD, co-directs the NCATEC with Hurt. He says the training center seeks to increase provider knowledge in three areas:
- HIV, especially pre-exposure prophylaxis (or PrEP) to prevent the spread of the virus;
- Hepatitis C virus diagnosis and treatment; and
- taking an accurate and culturally appropriate patient sexual health history.
Providers – including physicians, nurses, physician assistants, nurse practitioners, dentists and pharmacists – can receive on-on-one training, attend an NCATEC educational event or join a weekly webinar. The goal is to make the trainings accessible to as many providers as possible, especially those in rural parts of the state. Once Wohl or Hurt have made a connection with a practice, they keep in touch regularly through email and phone calls.
“It’s like being a tennis coach,” Wohl says of his and Hurt’s relationship with trainees. “Whether you are just starting out or you’re playing at Wimbledon, you have a coach. You need coaching early on, but also when you are pretty good. We serve as those coaches for HIV providers so they always have a resource to turn to.”
Closing the Gap
LeShonda Wallace, FNP, PhD, is a nurse practitioner at New Hanover Regional Medical Center in Wilmington who frequently collaborates with the training center. She has experience providing HIV care at the bedside to inpatients. But over the years, her role has changed and she now finds herself the primary care provider to many people living with HIV in Wilmington and the surrounding rural counties.
“The opportunistic infections associated with HIV are not taught in nursing school,” Wallace says. “I wanted to learn more so that I could provide the best care for my patients.”
Wallace traveled to UNC’s Infectious Diseases Clinic to shadow Wohl and Hurt, and attended two HIV trainings in Atlanta and Chapel Hill. She keeps her skills current through the weekly webinars. Most recently Wallace helped coordinate Wilmington’s first “Port City Pride” event in August. Thanks to her close relationship with the training center, NCATEC exhibited at Port City Pride, sharing vital information with consumers about prevention.
“I now know the vital questions to ask to take an accurate sexual health history. I also learned what other factors increase a person’s risk for acquiring HIV like substance abuse and homelessness,” says Wallace. “You learn so much hands-on, and it is also extremely helpful to now have an infectious diseases consultant like Drs. Wohl and Hurt accessible by phone or email because we do not have one at our clinic. Their mentoring closed the gap in my knowledge of HIV.”
Aregai Girmay, MD, agrees with Wallace. He is a provider at Gaston Family Health Services outside of Charlotte. He completed his residency in New York City in the 1990s just as antiretroviral therapy was being developed to help control HIV. But he wanted to learn more about the complexity of the virus, especially for the patients he treats who develop a resistance to their current regimen of medications.
“Shadowing David Wohl has transformed my practice,” Girmay says. “HIV is really an evolving field. And patients are living longer. All primary care providers need to become familiar with the latest treatment options to provide the best quality care for our patients. I recommended the NCATEC training to all of my colleagues.”
The NCATEC was the first group in the nation to create a map of PrEP providers, says NCATEC Program Manager Michele Bailey. Approved by the U.S. Food and Drug Administration (FDA) in 2012, the once-daily PrEP pill is a powerful HIV prevention tool. Bailey says analytics from the NCATEC website show the map is being accessed by people from around the country. She even received a call from a provider in Illinois for information about implementing PrEP there.
Locally, Hurt says one of the most common questions he fields from HIV providers is how they can launch a PrEP program at their site. That’s where people like JT Williams come in. Williams is an NCATEC regional liaison in the Sandhills region of North Carolina. He facilitates PrEP trainings and the creation of new sites to prescribe the potent prevention pill.
“At NCATEC, we know talking about sexual health can be uncomfortable. We give providers the blueprint for starting the PrEP conversation,” Williams says. “The most common question we get from patients is whether they still need to use condoms if they are taking PrEP. We tell them that condoms and PrEP are the dynamic duo. PrEP protects against HIV and condoms guard against other sexually transmitted infections. We only want you to catch feelings.”
Interest in learning about PrEP in the region has been so strong not even Hurricane Matthew nor a visit from President Obama could disrupt attendance at two trainings in Fayetteville last fall, Williams says. He credits these successes with the NCATEC’s inclusive approach to PrEP. The center’s staff have approached churches, corporations and youth centers about hosting PrEP trainings.
“This is a universal message,” Williams says. “PrEP is for everyone. It doesn’t matter what your gender, ethnicity or sexual preference is. That’s why we are working all angles to get the word out.”