By Stephen Spotswood
WASHINGTON – When the first Infectious Disease Clinic took place at the Washington, DC, VAMC in 1985, only a handful of HIV-infected patients took advantage. In fact, the disease hadn’t even been named “human immunodeficiency virus;” that would happen the next year.
Today the clinic is a permanent part of the medical center, caring for 1,200 veterans with HIV, while the VA as a whole treats approximately 27,000 patients living with the disease.
What has occurred at the DCVAMC clinic is representative of how HIV and acquired immune deficiency syndrome (AIDS) treatment has changed across the VA and federal medicine. Spread of the disease, along with improved treatment protocols, have caused the clinic to grow and evolve during the past 30 years in ways that never could have been predicted.
The ID Clinic provides consultative services for patients suffering from the entire spectrum of infectious diseases — latent TB, microbacterial infections, STDs and hepatitis, to name a few — but HIV patients make up the bulk of the caseload.
One reason is that the clinic not only treats the patients’ HIV but also manages their primary care.
“That’s a model we’ve preferred because of the complexity of caring for these patients,” explained Debra Benator, MD, the clinic’s director, who joined as a fellow in 1992.
The decision was made to keep as much of the patient’s care in the clinic as possible because of the complexity of the drug regimens and the possibility of adverse interactions. Another is to better treat common comorbidities, such as hepatitis C (HCV).
To achieve this, the clinic has brought in specialists to cover as many aspects of patient care as possible.
“The model of our clinic has been one of the PACT (Patient-Aligned Care Team) approach,” even before the model officially existed, Benator said. The clinic’s team includes a nurse practitioner, medical staff assistant, social worker and clinician. It also includes an HIV psychologist, HIV pharmacist, HIV hepatologist and an HIV diabetologist, who provide services at least once a week in the clinic.
The clinic leverages its location in the seat of federal power by including regularly-visiting physicians who are employees of other agencies in the region — the Food and Drug Administration, the National Institutes of Health, Health Resources and Service Administration, as well as George Washington University, which has a fellowship education program with DCVAMC.
“These are infectious disease specialists who are experts,” Benator said. “They may do work in policy or drug regulation or other types of areas but are trained in infectious diseases. They’ll do a half-day a couple times a month to care for patients in our clinic.”