Having the human immunodeficiency virus is no longer the death sentence it was decades ago when Donna Sweet, M.D., of KU School of Medicine-Wichita began treating patients with the disease. Today, although HIV is not curable, treatments can suppress the disease and allow patients to live long and healthy lives. Similar progress has been made with hepatitis C, the liver infection that’s now curable.
The challenge is detecting the diseases early and the problem is that too few Kansans receive the screening that guidelines recommend for all Americans of certain ages. In fact, less than half of people ages 16 to 64 are tested for HIV, and about a quarter of those ages 18 and up are tested for hepatitis C.
Project ECHO, the telehealth education offering from KU Medical Center, is trying to change those numbers and improve care with a recently concluded series of sessions focusing on HIV and an upcoming series on hepatitis C. The pair of programs, funded by the Kansas Department of Health and Environment, are a follow-up to one in 2021 that covered both diseases. Sweet, a board-certified and nationally recognized HIV specialist, has been involved in all of them.
“With improved treatments, there can also be complacence about testing because providers think medication can take care of the disease,” Sweet said. “But early detection is critical to outcomes and to obtaining proper care, which is why primary care providers need to be testing patients for HIV and offering PrEP (pre-exposure prophylaxis) medications to prevent infections.”
And in Kansas, with distances far and specialists few, that care can fall on primary care providers who are uncertain they have the expertise to provide it. Project ECHO is designed to close the gaps, giving providers the tools and confidence to tend to patients in their own practices and providing them access to specialists as needed for more difficult cases.
“The message that Dr. Sweet shares is that you do not need to be an expert to diagnose and even treat this condition. She’s seen the evolution of treatment and intervention for HIV and AIDS,” said Shawna Wright, Ph.D., director of KU Center for Telemedicine & Telehealth, which is based on the Kansas City campus. “She’s seen it move from nonexistent to very difficult treatment protocols to today, where not only can we treat it but also can help prevent it if we’re willing to have conversations with patients about sexual health.”
Sharing expertise with a team-based approach
Each Project ECHO series — others this year and next include overdose prevention, oral health, and pediatric and school-based mental health — consist of four or five 60- to 90-minute sessions and involve a combination of didactics and case consultations. The programs are framed and carried out by a specialty team, and participants can earn continuing education credits.
Sweet was one of seven members of the team assembled for HIV 2023 ECHO: Strengthening Statewide HIV Prevention and Care in Kansas. She was joined by Julie Stewart, M.D., of southeast Kansas, a pharmacist, an epidemiologist and two KU School of Medicine-Wichita nurse practitioners who work alongside Sweet and specialize in HIV care, Kayla Del Rio, APRN-C, and Mary Gonzales, DNP, APRN.
More than 150 providers attended one or more of the sessions, which covered such topics as screening and testing, using data to inform care, effective treatment and intervention strategies, treatment for patients with multiple conditions, and addressing mental health and combating stigma. Participants can submit cases ahead of time and questions via chat during sessions.
Sweet has been educating about HIV and AIDS — the virus’ third and most severe stage — nearly as long as she has been treating patients with the disease.
“Part of our mission as a school is serving rural and underserved Kansas and the providers working there,” Sweet said. “With HIV, we are working to improve care and reduce stigma.”
Susan Tusher, LMSW, of KU School of Medicine-Wichita works with Sweet on another longstanding effort, the Midwest AIDS Training and Education Center.
“The ECHO fits well with the work MATEC does to educate and prepare health care professionals to care for those with and at risk of acquiring HIV,” said Tusher, MATEC’s Kansas/Nebraska program director and an adviser on the fall ECHO series. “These types of learning and technology share best practices, new information and resources, and are particularly helpful for providers in rural and underserved areas, and for providers who can’t get to in-person conferences or training.”
Confronting stigma and having difficult conversations are part of the ECHO message.
“Even in this day and age some primary care providers are uncomfortable talking with patients about sexual health or find it difficult to sit down with a patient and tell them they’ve tested positive for HIV,” Wright said. “Dr. Sweet can walk health care professionals through how to have that conversation. And she told participants that the reality is good news can follow the hard news because we can treat this and you can live as long as anybody else.”
“Dr. Sweet is very person focused,” Wright said. “Treating people with dignity and respect and honoring their choices does so much to address and erase stigma.”
Taking the leap and improving care
Family physician Megan Seidl, D.O., is medical director of Konza Prairie Community Health Center, a federally qualified health center with Junction City and Manhattan locations. She participated in the 2021 series on HIV and hepatitis C and from that program and Sweet’s assurances that primary care doctors can provide the care, she began treating hepatitis C patients in her clinic.
“Dr. Sweet was very encouraging on the access front, in that the more people who are competent and treating certain conditions, the better it is for the whole state and for everyone,” Seidl said. “And, quite honestly, there are not enough specialists to treat everyone with some of these conditions. Her perspective really has a public health focus of encouraging and empowering people to do the things they can to really make an impact in the patients’ lives.”
“We’ve had a handful of patients who have been successfully cured of hepatitis C, and most of those patients have been uninsured patients who were turned away or unable to get a specialist referral in the past. I am really proud of that,” Seidl said. “I’m just so glad Dr. Sweet gave that encouragement. It was just the nudge in the right direction that I needed.”
Above, portrait photos from top to bottom: Shawna Wright, Ph.D.; Susan Tusher, LMSW; and Megan Seidl, D.O.
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