Division of Infectious Diseases

Breaking the Stigma: Zero HIV Stigma Day at the UNMC Specialty Care Clinic

UNMC’s Specialty Care Clinic is committed to providing compassionate and inclusive care for all patients, especially those with and at risk for HIV. In honor of Zero HIV Stigma Day (celebrated on July 21^st), we reflect on the importance of breaking down the barriers of stigma that continue to affect individuals and communities.

Understanding HIV Stigma

HIV stigma refers to negative beliefs, feelings, and attitudes towards people with and at risk for HIV. The stigma surrounding HIV is intersectional because it intersects with various forms of discrimination based on race, gender, sexual orientation, socioeconomic status, and other identities, compounding the marginalization experienced by individuals. This layered stigma creates unique challenges for different groups, such as gay men, people of color, and those in low-income communities, exacerbating health disparities and barriers to accessing care. Furthermore, this stigma can lead to discrimination, social isolation, and a reluctance to seek testing and treatment. As healthcare providers, we have a critical role in combating these harmful stereotypes and ensuring our patients feel supported and respected.

Our Commitment to Reducing Stigma

Education and Awareness: We strive to educate our staff, patients, and the community about HIV in order to dispel myths and misconceptions. By promoting accurate information, we can reduce fear and discrimination. Let’s Stop HIV Together (Together) provides additional support here so you know what to do when you witness HIV stigma.
Compassionate, Equitable, and Culturally Sensitive Care: Every patient deserves dignity and respect. We strive to ensure our interactions are empathetic and non-judgmental and work hard to create a safe environment for individuals to discuss their health concerns openly.
Confidentiality: Protecting patient privacy is paramount. We adhere strictly to confidentiality protocols to ensure that personal health information is secure and only shared with authorized personnel.
Support Services: We offer comprehensive support services, including case management and mental health counseling for patients and their families. These services help individuals cope with the emotional and social challenges associated with HIV.

Join Us in the Fight Against Stigma

On Zero Stigma HIV Day, we encourage everyone to join us in fostering an environment of acceptance and support. By working together, we can create a community where no one feels ashamed or isolated because of their HIV status.

Let’s stand united against stigma and continue our mission to provide exceptional care for all.

Together, we can make a difference.

This post was written by the following authors on behalf of the entire Specialty Care Center and our allies.

Sara Hurtado Bares, MD, FIDSA, Associate Professor and Let’s Stop HIV Together Clinical Ambassador

Nada Fadul, MD, Professor and Medical Director of the UNMC SCC

Jennifer Davis, MD, Assistant Professor

Josh Havens, PharmD, Associate Professor and Clinical Pharmacist

Nichole Regan, APRN, FNP, MSN, Director of HIV Programs

Samantha Jones, CSW, Program Manager for the UNMC SCC’s Medical Case Management and Community Health Worker Programs

Our Fellowship Leaders can’t wait to review your applications!

The following content was provided by Dr. Abbas (R) and Dr. Van Schooneveld (L), UNMC ID fellowship program directors. Read on to learn about our great program and please share with those who may be interested!

Fellowship application season is open, and as the leaders of our ID fellowship, we wanted to highlight some of the exciting aspects of our program. Our program and our division are growing. We began in 2011 with 2 fellows, grew to 4 in 2017, 5 in 2020, and our full complement now includes 6 fellows. Our faculty also continues to grow, as we now have 31 physician faculty and 4 full-time ID pharmacists with diverse expertise. Dr. Trevor Van Schooneveld is the Program Director and Director of the Antimicrobial Stewardship program and Dr. Anum Abbas is the Associate Program Director. This year we are looking forward to meeting you on our remote interviews via Zoom!

^{Dr. Casey Zelus teaching medical students about blood cultures}

Fellows at UNMC enjoy a robust clinical experience that includes not only the typically complex patients seen at a tertiary referral center, but also includes extensive experience caring for immunosuppressed patients. In addition to our General ID service, where our fellows gain experience in teaching medical students and Internal Medicine residents, we have two separate immunocompromised services that care for oncology and solid organ transplant patients. We also have an orthopedic infectious diseases rotation where fellows gain experience managing these complex patients and work with faculty who have extensive experience in this area. We have expanded our ambulatory offerings with the creation of a non-tuberculous mycobacteria (NTM) clinic and a travel clinic. Fellows have the opportunity to spend time in the microbiology laboratory, learn infection control and antimicrobial stewardship, and rotate on Community ID, which occurs at a nearby community hospital site, providing them with a more diverse clinical experience. Fellows also gain practical experience with inpatient telehealth. The faculty at UNMC are nationally recognized experts in their field and are also very approachable and devoted to the education and success of trainees. They have created extensive educational opportunities, covering topics from opportunistic infections in solid organ and hematopoietic stem recipients to emerging global pathogens and biopreparedness. Fellows gain knowledge in HIV/AIDS management working in our multidisciplinary HIV clinic, which cares for over 1200 people with HIV. In addition to having access to world-class ID expert antimicrobial stewardship, OPAT, and HIV pharmacists, our division also includes an ID pharmacy residency program and opportunities for research collaboration and rounding with pharmacy students, residents, and faculty.

As new career opportunities develop for ID physicians, we have worked to provide our fellows with the skills to engage in these fields. UNMC ID fellows receive extensive experience in the area of infection control and antimicrobial stewardship as well as dedicated biocontainment training. UNMC also offers the opportunity to stay for an optional third year to further develop a research portfolio or pursue additional clinical expertise in subspecialty areas.

_{Graduate Dr. Raj Karnatak presenting his research}

An important part of fellowship is developing skills in interpreting and performing research, and we provide our fellows with 4-6 months of mentored research experience centered on their career goals. A research committee assists fellows in mentor identification and project development. Fellows also participate in a week-long UNMC sponsored research training program, and typically present their work at national conferences like IDWeek and SHEA.

Our goal as program directors is to provide fellows with an educational experience that provides them with skills and knowledge to make them successful in whatever career path they choose. The opportunities available to ID physicians continue to expand and we hope you will consider UNMC ID. If you are interested in more information, please feel free to visit our website where you can check out a video to learn more about us. You can also contact us at the following:

Dr. Trevor Van Schooneveld
Program Director, Infectious Diseases Fellowship
Medical Director, Antimicrobial Stewardship Program
University of Nebraska Medical Center
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: tvanscho@unmc.edu

Dr. Anum Abbas
Associate Program Director, Infectious Diseases Fellowship
Assistant Professor, Division of Infectious Diseases
985400 Nebraska Medical Center
Omaha, NE 68198-9400
Email: anum.abbas@unmc.edu

Top Tips for Acing Fellowship Interviews

It is July, and fellowship application season is upon us once again. Watch the UNMC ID blog in the coming weeks for fellowship application content. We begin with a practical guide to fellowship interviews. If you know someone gearing up for this important step, please share this post. A refresher on these skills can always be useful!

Multiple ID faculty contributed to this list, and thus, the credit goes to the entire UNMC Division.

As faculty, we have the amazing opportunity to both mentor and interview residents applying for fellowship in Infectious Diseases, and we have seen it all. From the great, well-prepared interviewee to the one who had the institutional information completely incorrect. We wish we could mentor every resident in person, but since that is not possible, we decided to do the next best thing and offer our tips and tricks to acing the ID (or any other) interview! Tips and tricks are in no particular order.

Be yourself and relax.
Articulate why you are interested in this fellowship program, what your ID interests are and where you think you would like your career to go (even if you acknowledge that might change or be a little vague at this time).
Have an idea of how the program works and ask specific questions to help deepen that knowledge regarding the education you will receive. What are the strengths, weakness and unique aspects of the program you want to know more about?
Remember that you are interviewing the fellowship program as much as they are interviewing you. Do your research and come prepared with questions about everything from how the fellowship will prepare you for your career as an ID physician to where you will park.
- Need suggestions on how to curate your list of questions?
  - Look up the program and Division on their website.
  - It is helpful to know a little about the faculty you are interviewing with, so if you get a schedule ahead of time find out what their clinical/research interests are and ask them about it – you can check out their publications on PubMed or Google Scholar to focus questions on specific topics. If you don’t get a schedule ahead of time, ask them what their interests are or what their role is during your interview.
  - Formulate questions important to you about the program, the institution and the local area regarding resources, lifestyle and more.
Be prepared to talk about your successes and the challenges you have encountered. For example, if you have an unexpected break in training, use that as example to illustrate what you learned from that experience. We do not expect perfection, but value honesty and clarity.
If you have something on your application that might be viewed negatively (academic difficulties, etc.) take the initiative and explain how you have overcome it and why you are a good candidate now before we have to ask you about it.
Consider a “highlight” reel handout for faculty on an updates to your CV since you submitted your application in ERAS. This can be incredibly beneficial if you have had a new publication, presentation or other activities demonstrating your interest in ID and future potential as a fellow.
Be friendly and treat everyone, including program coordinators and other office personnel kindly and with respect. Your interview starts from the moment some first meets you (a current fellow, administrative assistant or staff) and ends when you say goodbye to the last person. ALL opinions count. If you are rude to anyone, trust us, we will find out.
Be truthful and be yourself. Don’t answer questions with what you think the interviewer wants to hear (e.g. don’t say you want to do academic medicine if you are interested in private practice). This is the only way for both you and the program to determine whether or not you are truly a good fit.
Tell us something interesting about yourself, even if it doesn’t relate to ID. It is important to be well-rounded, and hearing about hobbies, experiences and interests helps keep the interview conversation fun and flowing.
Thank the faculty for their time; the emails and cards with a personal comment regarding a specific detail of the interview are both appreciated and noticed.

PharmtoExamTable (Part 2): Why should sulfamethoxazole/trimethoprim (Bactrim) be used with caution in patients with renal impairment or those on dialysis?

This #PharmToExamTable post was authored by Eric Hiatt, PharmD Candidate (2025) at the UNMC College of Pharmacy, and explores Bactrim’s use in those with impaired renal function.

(Content reviewed by Jenna Preusker, PharmD, BCPS, BCIDP)

Recall from Part 1:

Impact of sulfamethoxazole/trimethoprim on Renal Function	In patients with renal impairment, administration of sulfamethoxazole/trimethoprim has been shown to have a significant incidence of acute kidney injury (AKI)
Mechanism of sulfamethoxazole/trimethoprim-Induced AKI	Sulfamethoxazole’s metabolite, N-acetyl-sulfamethoxazole (NASM), may form crystalline structures in acidic urine, causing renal damage in the form of AKI.

In addition to increased risk of AKI, patients with renal impairment are more likely to experience electrolyte abnormalities while taking sulfamethoxazole/trimethoprim, particularly hyperkalemia and hyponatremia. The electrolyte abnormalities are believed to be attributed to the trimethoprim component of sulfamethoxazole/trimethoprim through an amiloride-like effect.^4,5 Trimethoprim is structurally like amiloride, a diuretic known to retain potassium and excrete sodium in the kidneys. Furthermore, trimethoprim has been shown to inhibit the same sodium transport channels that amiloride inhibits reversibly. In animal studies, intravenous trimethoprim was shown to decrease potassium and increase sodium urinary excretion by 40% and 46%, respectively.⁴These electrolyte abnormalities are reported to be more common with high doses of sulfamethoxazole/trimethoprim in non-renally impaired patients indicating these effects are dose dependent.⁵

In patients with renal impairment, sulfamethoxazole/trimethoprim can accumulate, resulting in common daily doses causing these electrolyte abnormalities.⁵ In the case of sulfamethoxazole/trimethoprim, both drugs are primarily eliminated through the kidneys causing accumulation in renal impairment. In severe renal impairment, the half-life of both drugs can significantly increase from 11 and 9 hours each to 45-60 hours. The recommended dose adjustment to prevent accumulation of sulfamethoxazole/trimethoprim occurs when the patient’s creatinine clearance is <30 ml/min.⁶

CrCl	Dose
CrCl < 30 ml/min	Standard dose
CrCl 15-30 ml/min	Reduce dose by half
CrCl < 15 ml/min	Use not recommended

The FDA recommendations for the adjustment of sulfamethoxazole/trimethoprim based on renal impairment

Notably, the FDA does not recommend sulfamethoxazole/trimethoprim use in patients with CrCl < 15 ml/min; however, it may be the only option available.

CrCl	Dose
CrCl < 30 ml/min	Standard dose
CrCl 15-30 ml/min	Reduce dose by half
CrCl < 15 ml/min	CrCl <15: Adjust to 25-50% of the total daily dose for indication. Use caution and monitor.
Hemodialysis	Dose as CrCl < 15 ml/min, administer after HD on dialysis days

Nebraska Medicine renal dose adjustment guidelines⁷

Alternative dosing based on type of dialysis based off the trimethoprim component:

Dialysis	Trimethoprim Based Dose IV
Hemodialysis	2.5-5 mg/kg every 12 hours; administered after hemodialysis
CVVH	2.5-7.5 mg/kg every 12 hours
CVVHD	4-5 mg/kg every 6-8 hours
CVVHDF	4-5 mg/kg every 6-8 hours

Alternative Dialysis regimens⁸

Final Take Home Points:

Impact of sulfamethoxazole/trimethoprim on Renal Function	In patients with renal impairment, administration of sulfamethoxazole/trimethoprim has been shown to have a significant incidence of acute kidney injury (AKI)
Mechanism of sulfamethoxazole/trimethoprim-Induced AKI	Sulfamethoxazole’s metabolite, N-acetyl-sulfamethoxazole (NASM), may form crystalline structures in acidic urine, causing renal damage in the form of AKI.
Electrolyte Abnormalities from sulfamethoxazole/trimethoprim	Patients with renal impairment on sulfamethoxazole/trimethoprim may develop hyperkalemia and hyponatremia due to trimethoprim’s effect on sodium and potassium transport. These effects are dose-dependent and more likely in patients with impaired renal function due to drug accumulation.
Dosing Adjustments in Renal Impairment	Sulfamethoxazole/trimethoprim’s elimination is primarily renal, with a prolonged half-life in severe renal impairment. FDA dosing adjustments based on CrCl levels: CrCl >30 mL/min: standard dose, CrCl 15-30 mL/min: reduce dose by half, CrCl <15 mL/min: use not recommended, but may be necessary

References:

1. Fraser TN, Avellaneda AA, Graviss EA, et al. Acute kidney injury associated with trimethoprim/sulfamethoxazole. Journal of Antimicrobial Chemotherapy, 2012; 67(5), 1271–1277. https://doi.org/10.1093/jac/dks030

2. Azencot R, Saint-Jacques C, Haymann JP, et al. Sulfamethoxazole-induced crystal nephropathy: Characterization and prognosis in a case series. Scientific Reports, 2024; 14, 6078. https://doi.org/10.1038/s41598-024-56322-9

3. Perazella MA. Crystal-induced acute renal failure. The American Journal of Medicine, 1999; 106(4), 459–465. https://doi.org/10.1016/S0002-9343(99)00041-8

4. Perazella MA. Trimethoprim-Induced Hyperkalaemia. Drug Safety, 2000; 22(3), 227–236. https://doi.org/10.2165/00002018-200022030-00006

5. Mori H, Kuroda Y, Imamura S, et al. Hyponatremia and/or Hyperkalemia in Patients Treated with the Standard Dose of Trimethoprim-sulfamethoxazole. Internal Medicine, 2003; 42(8), 665–669. https://doi.org/10.2169/internalmedicine.42.665

6. Patel RB, Welling PG. Clinical Pharmacokinetics of Co-trimoxazole (trimethoprim-sulphamethoxazole). Clinical Pharmacokinetics, 1980; 5(5), 405–423. https://doi.org/10.2165/00003088-198005050-00001

7. Nebraska Medicine renal guidelines for antibiotics. Accessed May 2024. https://www.unmc.edu/intmed/_documents/id/asp/dose-nm-anti-infective-renal-dosing-guidelines.pdf

8. Golightly LK, Teitelbaum I, Kiser, TH, et al. Renal Pharmacotherapy: Dosage Adjustment of Medications Eliminated by the Kidneys. Springer New York; 2013. https://doi.org/10.1007/978-1-4614-5800-5

National HIV Testing Day: Let’s Stop HIV Together

Content provided by Dr. Sara H. Bares, MD, FIDSA Associate Professor, Division of Infectious Diseases | Let’s Stop HIV Together Clinical Ambassador

National HIV Testing Day (NHTD) was first observed in the United States on June 27, 1995, and has been observed every year since. Although much progress has been made in the last 29 years, we have a long way to go to successfully end the HIV epidemic. Currently, one in seven people with HIV (14%) are unaware of their status and thus at risk for disease progression and transmission to others.

This year’s NHTD theme is “Level up your self-love: check your status,” an important message that aims to emphasize the ways in which knowing our HIV status enables us to maximize our health. People who test negative for HIV can be offered HIV prevention tools such as pre-exposure prophylaxis (PrEP) and people who test positive for HIV can start antiretroviral therapy (ART) to stay healthy. HIV testing is widely available and can be accessed via Nebraska Medicine as well as community partners such as Nebraska AIDS Project, OneWorld Community Health Centers, North Omaha Area Health clinic, Charles Drew Health Center and the Douglas County Health Department. For those unable to travel to a testing site or who would like anonymity, self-testing kits such as the Together TakeMeHome kits are available at no cost.

While this year’s theme aims to empower community members to get tested for HIV as a form of self-care, I hereby call on providers to “level up” their game and screen all patients between the ages of 13 and 64 at least once during any medical encounter (and annually if they have ongoing risk factors). Nebraska is far behind the national testing goal (only 26% of adults living in Nebraska had ever had an HIV test as of 2022) but, together, we can change this.

I am proud to share that our partners in the University of Nebraska Medical Center’s Emergency Department are now offering HIV tests along with other STI testing and we look forward to expanded testing throughout our hospital and medical center as we all work towards the goal of ending the HIV epidemic together.

PharmtoExamTable (Part 1): Why should sulfamethoxazole/trimethoprim (Bactrim) be used with caution in patients with renal impairment or those on dialysis?

This #PharmToExamTable post was authored by Eric Hiatt, PharmD Candidate (2025) at the UNMC College of Pharmacy, and explores Bactrim’s use in those with impaired renal function.

(Content reviewed by Jenna Preusker, PharmD, BCPS, BCIDP)

In the world of antimicrobial stewardship, finding the right antibiotic for definite therapy against a bacterial infection can be the difference between life and death. Bacterial resistance has emerged with the use and misuse of antibiotics. The result leads to dwindling options and reliance on less-than-ideal antibiotics for specific populations. An example is sulfamethoxazole/trimethoprim in populations with renal impairment or those on dialysis.

A meta-analysis explored the adverse renal effects of sulfamethoxazole/trimethoprim and included patients who initially received their first dose in the hospital. The study included 573 patients, of which 64 (11%) developed an AKI. Out of the 64 with AKI, the authors noted a significantly higher percentage of patients had pre-existing chronic kidney disease. The inclusion criteria itself has a limitation; with or without sulfamethoxazole/trimethoprim, many hospitalized patients are likely to develop an AKI. To control this limitation, the authors included a comparator group with similar characteristics but who were administered clindamycin instead due to no known AKI-associated events with clindamycin. The clindamycin group consisted of 84 patients, of which none developed an AKI, with only 3 having an increase in serum creatinine and no increase in BUN. The study concluded that since there were patients who developed AKI even with no other known risk factors for renal impairment, sulfamethoxazole/trimethoprim was suggested to be an independent risk factor for AKI.¹

**_{Image 1: Example of the crystalline structure form in the urine by NASM}**

In 2024, a case series of 14 patients investigated whether sulfamethoxazole-induced crystalline structures result in AKI. The crystalline structure results from sulfamethoxazole’s metabolite N-acetyl-sulfamethoxazole (NASM). NASM has been observed to form a crystalline structure in acidic urine, potentially causing renal damage resulting in an AKI. The authors concluded that patients with sulfamethoxazole-induced crystalline nephropathy developed an AKI. They also noted that individuals at risk for crystalline structures forming from NASM include patients who have hypovolemia, hypoalbuminemia, acidic urine, high concentrations of sulfamethoxazole/trimethoprim and NASM in urine, and chronic kidney disease.²

In hospitalized patients, providers can avoid crystallization by giving intravenous normal saline for hydration and promoting diuresis with an agent like a loop diuretic. Another way would be to ensure the pH of the urine is basic (pH > 7.15), as it would increase sulfamethoxazole solubility in the urine, preventing further crystallization. If needed, sodium bicarbonate can be administered to increase urine pH. Additionally, clinicians should monitor the estimated glomerular filtration rate and monitor urine for crystalluria. In acute renal failure resulting from sulfamethoxazole/trimethoprim, the first step is to discontinue it and administer fluids to ensure the patient is euvolemic, followed by diuresis to clear any obstructing crystals within the kidney. If needed, sulfamethoxazole/trimethoprim can also be removed through dialysis.³

To be continued in Part 2 soon!

References:

3. Perazella MA. Crystal-induced acute renal failure. The American Journal of Medicine, 1999; 106(4), 459–465. https://doi.org/10.1016/S0002-9343(99)00041-8

UNMC ID Wins Internal Medicine Residency’s Best Teaching Division Award!

We are proud to announce that, earlier this month, UNMC ID was awarded the Best Teaching Division among all 12 Divisions of UNMC’s Department of Internal Medicine for this academic year! This is a huge honor for UNMC ID, which is voted on by current IM residents and awarded at the annual IM residency graduation celebration.

Dr. Jasmine Marcelin (pictured left) accepted the award on the Division’s behalf, commenting, “Thanks to all our faculty and fellows for your exceptional teaching of our residents!”

Dr. Trevor VanSchooneveld, Director of the ID Fellowship Program and Core Faculty for the Internal Medicine Residency, echoed that sentiment, saying, “The ID Division is exceedingly pleased to receive this award, and the ID faculty deserve the credit for their above and beyond effort to educate and mentor trainees.”

Dr. Andre Kalil also praised the achievement, stating, “Truly an amazing Division accomplishment that will certainly translate into more interest in following an infectious disease career.”

Lastly, Dr. Mark Rupp, Chief of the Division of Infectious Diseases, also commended the award and the work of the UNMC ID community towards training our great IM residents in ID- “What a great recognition of the effort that so many make to contribute to the positive educational environment in the Division. Great job, team!”

Great job team, indeed! A huge thanks to all our faculty, fellows, APPs, staff, and all others who assist in making resident education a great experience for all!

UNMC Specialty Care Clinic Presents Work at National HIV Conference

_{Lance (middle) and the two other co-presenters of work on HIV Telehealth Care}

Back in March, we ran this Sneak Peak post announcing that Lance L. Burwell, LIMHP, PC, behavioral therapist at the UNMC SCC, was invited to co-present an ongoing project titled “Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care” at the 2024 National Conference on Social Work and HIV/AIDS. This is a huge honor, and we congratulate Lance on a fantastic presentation and commitment to a project that has improved care for many SCC patients. Read below for Lance’s recap of the presentation and the impact of this important work.

I attended the 2024 National Conference on Social Work and HIV/AIDS and co-presented with the lead presenter Masil Miranda, MSW, a Program Manager from AIDS United, along with Clover C. Cambell-Woods, MA, PsyD, from Georgia Harm Reduction Coalition. We presented the intervention we have been implementing- “Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care.”

The goal of Intervention to Telehealth and Text to Improve Engagement in Care (i2TEC) is to increase engagement in HIV care and viral suppression for people with HIV by raising understanding of the intersection between mental health, substance use, and HIV care. The hope is that this intervention will reduce or eliminate barriers to care, such as transportation, stigma, and insecurities related to food, income/finances, and housing, not only by connecting people with resources but also by providing an alternative that allows patients to improve their own engagement in their healthcare. The telehealth option allows patients to participate remotely, thereby minimizing attendance concerns related to transportation and stigma while also increasing patient awareness of how their mental health, substance use, and/or HIV knowledge impacts their treatment, the outcomes, and their overall health, wellness, and life satisfaction.

My portion of the presentation provided information on how our site implemented the intervention, the staff involved, the challenges we faced, and the successes we experienced to date. Our site demonstrated that, in spite of typical challenges of patient outreach & enrollment, technology, and sustainability concerns, the implementation was hugely successful. Not only were we able to meet patient enrollment goals and integrate them into the clinic using existing staff and technology, but we also provided resources & referrals to patients who utilized these to further reduce barriers and improve health, wellness, and life satisfaction. More importantly, however, the intervention decreased the stigma associated with mental health counseling as many of those previously hesitant to pursue therapy transitioned into ongoing therapy upon completion of their 12 sessions. Our site experience demonstrates the ease of implementing an intervention in an existing clinic while providing a valuable option for patients that reduces barriers to care. This translates to improved treatment consistency and adherence while also providing needed resources to patients, thereby furthering goals of minimizing transmission and improving patient quality of life.

–Lance L. Burwell, LIMHP, PC

Research Digest: The Practice of ID

Research Digest is a periodic installment that recognizes the world-class clinical research performed right here at UNMC ID. Today, we review three articles covering new developments regarding advancements in how ID professionals practice. As always, check out the linked full articles for more details.

_{Dr. Cawcutt, author of a recent paper of HIAs}

In the first article, authored by Dr. Kelly Cawcutt and others, the authors address how surveillance for healthcare-associated infections (HIAs) is performed in the medical system. Great strides have been made toward efficient and timely monitoring of invasive device-associated infections that arise from things like central lines, ventilators, and catheters. This has enabled the medical community to recognize spikes in infection rates and adjust recommended practices to keep patients safe and devices sterile. However, these devices are not the only nidus that can cause infection in a healthcare environment. Alternative devices, as well as non-ventilator hospital-acquired pneumonia and infectious complications from other conditions, can all increase the risk of HAI. Therefore, the authors discuss alternative performance metrics that can provide a more comprehensive picture of the HAI landscape and identify a wider range of infections that may require systematic intervention. Read the full details here.

_{Dr. Lawler, co-author on this paper addressing PPI}

The second article, written by many from the UNMC community including Sara Donovan and Dr. James Lawler, identifies a core need in the ID community as we face increasing rates of high-consequence infectious disease events; safe and effective donning and doffing protocols for personal protective equipment (PPI). Utilizing knowledge from an exhaustive literature review as well as their own expertise as experts in ID and PPI use, the authors identified a set of cardinal rules to keep in mind when dealing with PPI. While they note that these rules are not all-encompassing, these rules serve as a great starting point and refresher for any who would need it. Read the full text here.

_{Dr. Van Schooneveld, co-author on a recent paper exploring ID fellowship training}

In the final article, authored by Dr. Trevor Van Schooneveld and others, considerations for ID fellowship training are explored. Training ID fellows unavoidably involves a balance between delivering great patient care and managing a high caseload while also protecting the educational environment for trainees. Recently, consult volume has been identified as an area of concern, which has a large effect on the educational environment. To characterize this concern, the authors performed a survey of ID fellowship programs in the United States to assess consult volume trends and any mitigation strategies implemented. This effort was able to quantitatively describe ID program daily new consult and total census rates, which rose as high as 12 and 30, respectively. It also identified shared strategies used to protect trainees and other ID professionals from burnout. The authors conclude that “as we navigate the challenges posed by the consultation surge, it is crucial to strike a balance between ensuring quality patient care, preserving educational opportunities, and safeguarding the well-being of both faculty and fellows.” Read the full article here.

Specialty Care Clinic HIV Team to Share Work at National Conferences

A huge congratulations to our Specialty Care Clinic (SCC) HIV team, who have been hard at work implementing quality improvement programs and clinic implementation efforts and will be sharing updates on their accomplishments with the national ID community throughout the summer. The team will be represented at no less than 6 conferences this summer, with 12 abstracts currently accepted for presentation. We are proud of our SCC team for many reasons, among them their tireless effort to improve the quality and implementation of care for their patients. See below for the details of those who will be sharing their work this summer, and keep an eye on this blog throughout the summer for updates and summaries from presenters. Congratulations, SCC team!

Professional Association of Social Workers in HIV/AIDS Conference in Orlando, FL, May 2024:

Bridging HIV Care Gaps through Telehealth: An Evidence-Informed Intervention to Support Engagement in Care (Miranda, M; Burwell, L; et al)

SYNC2024 in Alexandria, VA, in May 2024:

RWHAP Best Practices Compilation: Sharing Successes in Telehealth and Addressing STIs (Hook, J; Flaherty Dore, K; Regan, N; Nelson, J.)

IAPAC Continuum Conference in Puerto Rico in June 2024:

Determining Capacity and Desire for Age-Friendly Healthcare at a Midwest HIV Clinic (Regan, Essam Nkodo, Fadul, along with colleagues from geriatrics: Jenkins and Porter)

Medicaid insurance expansion and its association with HIV outcomes in Nebraska, USA: An observational prospective cohort study (Essam Nkodo, Arroyo, Fadul, Furl, Lyden)

Data-driven Strategies Towards Case Management Utilizing Tableau Dashboard Reporting and Automation (Glassman, Arroyo, Jones, Fadul)

Leveraging Implementation Science to Address HIV Disparities (Fadul, Essam Nkodo, Furl, Regan)

25th AIDS 2024 Conference in Munich, Germany, in July 2024:

Medicaid insurance expansion and its association with HIV outcomes in Nebraska, USA: An observational prospective cohort study (Essam Nkodo, Arroyo, Fadul, Furl, Lyden)

Ryan White National Conference in D.C. in August 2024:

Bridging the Gap: Multi-Specialty Collaboration to Bring Age-Friendly Care to a HIV Clinic (Regan, Essam Nkodo, Fadul, along with colleagues from geriatrics: Jenkins and Porter)

Telehealth 2.0: Revitalizing a Previously Successful Telehealth Program with Updated Process Mapping (Regan, Cramer, along with colleague from Ohia Advisors: Wetherhold)

Screening is Believing: Increasing Depression Screening in a HIV Primary Care Clinic (Regan, Arroyo, Burwell, Furl)

Data-driven Strategies Towards Case Management Utilizing Tableau Dashboard Reporting and Automation (Glassman, Arroyo, Jones, Fadul)

GLMA as WORKSHOP in Sept/Oct 2024 in Charlotte, NC:

Meeting them where they’re at: Implementing telehealth services in a HIV clinic to increase LGBTQ+ patient engagement (Cramer, Carr, Burwell, Regan)