Every community has unsung heroes, and in the HIV-care community there are many. Cassandra Durham is a fierce advocate for the HIV workforce whose dedication is reshaping what it means to care for people with HIV. A personal experience supporting a friend with HIV in the early 1990s—seeing his food tray pushed across the nursing home floor because staff were afraid to enter his room—ignited a lifelong mission anchored in HIV education and community engagement.
Durham has worked street outreach, counseling and testing. She’s been an HIV social worker, case manager, supervisor, and a program monitor for the state. But when she came to UNC in 2020, it was to do something new—to provide training and education for the HIV workforce.
Durham is a social worker with the North Carolina HIV Training & Education Center (NCHTEC), part a federally-funded network of HIV care organizations providing tailored education and training on HIV-related topics. The team includes Christopher Hurt, MD, principal investigator, and Ben Clack, program coordinator, who help providers across the state learn about a variety of issues related to the management of HIV.
The U.S. Department of Health and Human Services created the AIDS Education and Training Center (AETC) Program in 1987 to help healthcare providers stay current with rapidly evolving HIV treatment and care. In 1996, it became part of Part F in the Ryan White HIV/AIDS Program (RWHAP). The program now includes eight regional centers overseeing state-level partners, plus national resources like the HIV Curriculum, Clinician Consultation Center, and Support Center.
“We are focused on outreach and engagement with HIV professionals across North Carolina, especially Ryan White HIV/AIDS Program-funded entities, through meetings, councils, training requests, participant networks, regular events, and continuing education credits,” explained Dr. Hurt, professor of medicine and NCHTEC Director.
“We also support providers with complex cases, help clinics develop protocols, and create tools to strengthen HIV treatment and prevention programs.”
Through workforce development, NCHTEC provides training for prescribers, nurses, pharmacists, case managers, social workers, educators. NCHTEC also supports outreach staff through workshops and case discussions, and this includes the Medical Case Manager Community of Practice. But this wasn’t always the case.
“When I started here, I wondered why the program only trained clinicians. I knew that doctors were not the only ones working with people with HIV,” said Durham, recalling the reality of outreach work—being cussed out over a hot dog at 11 p.m. while trying to get someone tested for HIV.
It is in these moments, she explains, that relationships and trust are built, one small act at a time, while asking the questions that sometimes others don’t understand. That’s because people living with HIV can sometimes experience heightened levels of emotional and psychological stress.
“If a person needs to catch three buses to get to the clinic, a breakdown can start with a clash at check-in. Sometimes it starts before then, but by the time the patient gets into the room with the doctor, a meltdown could be cataclysmic. These are the things that keep people out of care, because the first thing the patient says is, I’m not coming back.”
During her street outreach days, Durham worked to get people back in care. She’d go out and find people and re-engage them. These early days taught her that caring for people with HIV required meeting every need—the big and the small. She started blessing bags, stuffed with essentials, and enlisted local churches to help fill them.
“If you’re doing street outreach, if somebody is hungry, they won’t hear anything you say about an HIV test. But what you can do is get hot dogs from the health department, chips and sodas, and set up on a street corner in the community and talk to people walking by. “‘Hey, I’ve got two hot dogs for you. Want to get an HIV test?’”
That relentless grassroots community advocacy shapes Durham’s approach to training. It’s also what propelled the NCHTEC into the national spotlight.
The HIV Medical Case Management Community of Practice
When the COVID-19 pandemic hit, Durham’s creativity kept the mission alive. She launched virtual trainings, ensuring that case managers in even the most remote regions could stay connected, learn from each other, and share best practices—regardless of shutdowns or isolation. This became the “North Carolina HIV Medical Case Management Community of Practice”—a monthly, safe space for training and networking.
The first series drew 800 participants, who logged on and stayed on for over six hours of learning. As word spread, people from New Mexico, Florida, California and Portland began to join the training program. The series peaked with over 2,500 case managers across the country seeking tools to navigate not just patient care, but the emotional and logistical complexities of working in HIV prevention and care. Now, the training series takes place twice a month. Resourcefulness defines Durham’s training style.
“Need buy-in from a busy clinic staff? Give them some donuts, this will go a long way. Need a community partner? I have no shame. If I know your church will help pay a light bill, I’m coming to talk to your church and we’re going to be friends.”
Her passion is not just for patients and programs, but for the case managers themselves—those on the front lines, often underpaid, overworked, and emotionally stretched. Weekly, she checks in asking: “Is everybody okay? How are things going?” The community Durham has fostered isn’t just about sharing training tips and tools—it’s about sharing strength.
During COVID, Durham led self-care training for practitioners, to ensure managers had the tools to navigate their own fears with COVID. The team also started using telehealth for medical case management, funding rural agencies for electronic equipment and internet to keep them connected.
How Community Relationships Can Power Impact
The NCHTEC team not only provides essential case management and time management support—critical when some case managers are responsible for as many as 100 clients—but also specialized training that emphasizes the art of relationship-building and the ability to tap into community resources. This focus became especially vital in the aftermath of COVID, when many professionals returned to the field after nearly a year of isolation.
“How do you go back out and reconnect with those networks? You go to the church down the street and knock on the door. Ask if they have a food bank and show up on food bank day. Maybe you can volunteer for an hour because you need that relationship, because your patient may not have access to food, but Pastor Bob down the street has a food bank ministry on Tuesdays and Wednesdays.”
“It’s also about making sure we’re giving clients everything they need to be successful,” Durham said. “If a patient doesn’t have transportation to the doctor, connect with the city to see if you can get bus passes. Can you build a relationship with a local food establishment that will fund food cards? It’s doing whatever it takes to be able to make sure that the patient has access to the best services we can give them but also making sure case managers have those same skills.”
The program also invites expert guests who provide education on everything from how to collaborate with local businesses to sponsor HIV testing, to helping clients navigate health disclosure.
“We sometimes bring in people who are doing street outreach, because they are on the front lines of what’s happening, which deeply resonates with case managers.”
“I tell everyone the patient’s world is different. When a client comes to your office, they’re in your space, they’re in your zone. But you need to go to their zone. You need to go to their space, because then you can understand why they may have difficulty taking their meds every day at a certain time.”
Between January 2022 and December 2024, NCHTEC hosted 469 training events reaching nearly 13,000 attendees across professions. Social workers (3,449) and public health professionals (2,665) made up the largest groups, followed by nurses, community health workers, and administrative staff. Prescribers accounted for 11% of participants (736 physicians, 543 NPs, 173 PAs). The strong social worker turnout highlights the success of NCHTEC’s MCM Community of Practice in meeting the ongoing development needs of case managers and social work practitioners serving RWHAP-funded programs.
UNC served as North Carolina’s AETC partner from 2011–2025, first under Emory and later Vanderbilt. Leadership transitioned from Dr. David Wohl (2011–2019) to Dr. Christopher Hurt (2019–2025). In 2024, Vanderbilt re-secured the Southeast AETC regional award, but in 2025 HRSA cut funding by 51% for FY26. As a result, Vanderbilt ended subawards to UNC and other state partners (Mississippi, Georgia, South Florida, Kentucky), retaining funding only for Tennessee, Alabama, South Carolina, and North Florida.