Infectious Diseases and HIV Medicine |
CLINICAL PROGRAMS
|
ID Clinic
Special Immunology Unit
Travelers' HealthCare Center
Infection Control
ID Clinic
Medical Director: Robert A. Salata, M.D.
WHAT: Patients are seen as a referral or a follow-up after hospitalization,
(HIV infected individuals are seen in the Special Immunology Unit). Areas of
interest include: Orthopaedic infections, transplant-associated infections,
chronic infections, nosocomial infections, pulmonary and enteric infections
WHERE: University Hospitals of Cleveland (UHC), Mather Pavilion Suite 1600
and Chagrin Highlands at Orange Place.
WHEN: University Hospitals of Cleveland, Mather Pavilion Suite 1600
Tuesdays - 8:00 am to 12:00pm
Fridays - 8:00am - 12:00 pm
Chagrin Highlands at Orange Place
Fridays – 8:00 am –12:00 pm
Referrals or urgent consultations can be scheduled at any time during the week
if necessary.
WHO: Keith Armitage, M.D., Dave Bobak, M.D., Michelle Lisgaris, M.D., and Robert
A. Salata, M.D.
APPOINTMENTS: (216) 844-8500
John T. Carey, M.D. Special Immunology Unit
Medical Director: Barbara Gripshover, M.D.
The Special Immunology Unit was established in 1985 to address the growing need in our community to provide
primary medical care to persons with HIV infection. From the outset, the SIU agreed to provide primary
medical care to all persons regardless of ability to pay. In 1987, the NIH awarded funding to CWRU and
University Hospitals of Cleveland to establish an AIDS Clinical Trials Unit - membership in a national
consortium of medical centers (the AIDS Clinical Trials Group) dedicated to the development and testing
of new treatment strategies for management of HIV infection. The success of the CWRU ACTU is in large
part attributable to its close relationship to the Special Immunology Unit with which it shares space.
This relationship provides to SIU patients access to the very latest and potentially most promising
treatments for HIV infection and its complications. Moreover, as the ACTU physicians are also SIU
physicians, the latest research findings are rapidly translated into patient care in the SIU.
In 1989, Dr. John Carey assumed leadership of the SIU and his excellence as a physician and HIV educator
helped establish the SIU as the premier facility for HIV care in our community. Dr. Carey remained the
director of the SIU until his untimely death in September 1995. The SIU was renamed The John T. Carey
Special Immunology Unit in his honor. In January, 1997 Dr. Barbara Gripshover assumed the role of director.
The SIU is staffed by 3 Registered Nurses, 2 Medical Assistants, an Office Coordinator, 3 Social Workers,
a Pharmacist, a Financial Coordinator and a Dietician. Seven full time faculty members
(trained in infectious diseases) provide primary care in the John T. Carey SIU and medical students,
residents and fellows may opt for rotations in the Unit. Twenty-eight children also receive care in the
SIU, provided by a Pediatrics Infectious Disease Specialist. As noted above, the SIU shares space with
the NIH-funded AIDS Clinical Trials Unit and both are staffed and are a part of the Division of Infectious
Diseases in the Department of Medicine of Case Western Reserve University School of Medicine.
The SIU/ACTU facility occupies a total of 5,500 square feet of space on the campus of University Hospitals
of Cleveland on Cleveland's east side. The facility comprises a small waiting room, a central nurses'
station, eight examining rooms, a 2-bed, 2 recliner treatment room for infusions of blood, chemotherapy
and sick patient examinations and a UV-irradiated, high volume air exchange room specifically designed for
administration of aerosols. In addition, there is a small laboratory, an office for the nurses, an office
for a social worker, and a small conference room.
The SIU is open Monday through Friday from 8:00 am through 4:30 PM, with Tuesday evening clinic until 8pm,
and a physician is available on call 24 hours a day, 7 days a week.
In the SIU patient care is addressed by a team that includes a physician, nurse, medical assistant and
social worker. A full time dietitian, pharmacist, and financial coordinator are also available to all
patients based on their needs.
To schedule an appointment, please call Lynell Davis, Intake Coordinator at 216-844-2649.
Current Services Provided in the SIU
1. HIV screening (anonymous or confidential) is now provided on site since 8/98. Free counseling and
testing are provided. Persons who test HIV-1 seronegative are offered counseling regarding risk reduction.
Persons who are HIV-1 seropositive are referred to the SIU for continuity of care. In addition, HIV testing
is done at the Free Clinic, J Glenn Smith and McCafferty clinics.
2. HIV Primary Care includes:
a. completion of a comprehensive HIV care intake form, which includes risk assessment, medical history, and immunization records.
b. clinical evaluation by SIU nurses and physicians
c. laboratory monitoring of HIV-1 disease progression - including routine chemistries, blood counts, serologies for syphilis, toxoplasmosis, cytomegalovirus, hepatitis A, B and C, G6P-D screening, CD4 and CD8 subset enumerations, plasma HIV-1 RNA determinations, placement of tuberculin skin tests and anergy panel. Comprehensive radiographic services including magnetic resonance imaging, CT scanning and radioisotope scanning (including PET scanning) are available on site. Funds for our self-pay patients to receive radiographic studies are now available through Title III funds.
d. immunizations with pneumococcal polysaccharide vaccine, hepatitis A and B vaccine, influenza vaccine, and other routine immunizations as indicated.
e. treatment with state of the art antiretroviral therapies as indicated and prophylaxis against opportunistic infection. SIU faculty are recognized leaders in HIV clinical care and research and offer patients optimal strategies for management of HIV-1 infection and its complications.
f. pharmaceutical education including adherence counseling, side effect management, and assistance obtaining medications provided by an on site Pharm. D.
g. ambulatory treatments include infusions of blood, blood products, chemotherapies, intravenous antibiotics and aerosolizations to limit need for hospitalization.
h. risk reduction counseling regarding safer sex and reduction of exposure to opportunistic pathogens (e.g. cryptosporidium, toxoplasma) are provided by SIU nurses, physicians and literature.
i. subspecialty referrals are available on site for all indications including but not limited to: neurology, psychiatry, gastroenterology, pulmonary, renal, oncology, dermatology, all surgical specialties, ophthalmology, and obstetrics/gynecology.
j. women's health services are provided on site by SIU staff and this includes routine PAP, gyn and breast examinations. Mammography is provided by the Department of Radiology and GYN referral is provided for colposcopy or other indications as needed. We have Title III funds to pay for gyn visits, colposcopy, and mammography. HIV screening is encouraged for at risk pregnant women and HIV-1 seropositive persons are provided antiretroviral therapy to reduce maternal to fetal HIV transmission in collaboration between the SIU and high-risk obstetric physicians.
k. dental care is provided by the faculty of the CWRU School of Dentistry at a clinical site located across the street from the SIU facility and assures comprehensive oral care for SIU patients. We receive Title III funding to support dental care of SIU patients in the dental resident's clinic under the guidance of Dr. Fady Faddoul.
l. access to HIV treatment trials. The SIU is also the site of a highly respected NIH-funded AIDS Clinical Trials Unit. The ACTU provides access to state-of-the-art HIV treatment trials assuring that our patients have access to the newest and potentially most promising treatment regimens for HIV infection and its complications.
m. substance abuse counseling is available by referral to one of approximately thirty agencies in our community that provide these services. Patients are interviewed by the SIU social worker and a detailed information sheet, describing the facilities, their services and insurance requirements is provided and discussed with the patients to identify the most appropriate provider.
n. mental health services are presently provided through referral to several providers in the community, and Dr. Cindy Vrabel in the Psychiatry department at University Hospitals of Cleveland. We have some Title III funding to support psychiatric visits with Dr. Vrabel.
o. home health care is provided by collaboration with a number of service agencies including University Hospitals Home Health Care, Visiting Nurse Association, Cuyahoga County Department of Senior and Adult Services, and Hospice of the Western Reserve and is supervised and monitored by SIU physicians and staff.
p. hospice care is provided by Hospice of the Western Reserve (HWR) after referral of the appropriate patients.
3. Case management is provided to assure that patients have access to federal, state and local resources to support their medical, financial, housing, transportation and social needs. Appropriate referrals are made to the AIDS Taskforce for housing and substance abuse; support groups at AIDS Taskforce, The Open House and The Living Room; transportation and food from the AIDS Taskforce.
4. Dietary counseling is provided to assure optimal education regarding nutritional support, as well as diet modification for medical problems such as nausea, diarrhea or elevated triglycerides or blood sugar secondary to protease inhibitor therapy. A Ryan White Title I funded dietician is present in clinic to consult with the physician and patients.
5. Hospitalization is provided on the dedicated HIV service (the Carpenter service) located on Divisions 60/65 at University Hospitals of Cleveland. Patient care is supervised by SIU faculty on monthly rotation to assure continuity of care. The frequency of hospitalizations among our patients is low; currently the HIV census is usually 3 to 5 patients.
6. Nursing Home care is provided by referral to one of several local facilities including St. Augustine Manor, Rudwick Manor, Hospice of the Western Reserve and these services are supervised by SIU physicians and staff.
7. Emergency Medication Assistance is provided at the outpatient hospital pharmacy for patients who have no prescription coverage. This Ryan White Title I funded program is limited to short term medications such as antibiotics, and each patient has an $800 cap. In addition, we have a modest amount of Title III funds for medications.
8. Short term Medication Assistance enables patients on the state ADAP program to obtain a temporary
supply of medication from the hospital pharmacy to avoid interruption in their therapy. This program is
also funded by Ryan White Title I.
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act
The Ryan White CARE Act is the result of Congressional legislation passed originally in 1990 and most
recently reauthorized in 2000 for the next five years. This program is run under the federal Health
Resources and Services Administration's HIV/AIDS Bureau. The Ryan White CARE Act provides funding to
States and other public or private non-profit entities to develop, organize, coordinate and operate
more effective and cost efficient systems for the delivery of essential health care and support services
to medically underserved individuals affected by HIV. The SIU has funding under the Ryan White CARE Act
Titles I, II and III. By legislative mandate, no Ryan White dollars may be used for inpatient
hospitalizations or emergency room visits.
Ryan White Title I CARE Act funds are available to metropolitan areas with at least 2,000 cases of HIV
during the previous 5 years and have a population of at least 500,000 people. Cuyahoga County applies for
and in turn awards entities within the county Ryan White Title I dollars on an annual basis.
University Hospitals has been a recipient of Title I dollars for the past 5 years. With the funding that
we receive the John T. Carey Special Immunology Unit (SIU) is able to provide primary care for over 900
HIV+ patients. Specifically the Title I dollars fund a portion of a SIU physician's salary, the salaries
of 1.6 full time equivalents (FTE) SIU acute care nurses, the salary of a SIU social worker and half of the
salary of the SIU's registered dietician. In addition, Title I CARE Act dollars are available to pay for
physician visits, laboratory and medication charges for patients that have no form of insurance and are
not on public assistance.
University Hospitals of Cleveland was awarded funding from the Ohio Department of Health from Ryan White
Title II dollars to hire 2 additional social workers bringing the total number of social workers to three.
The SIU was awarded Ryan White Title III CARE Act funding beginning in October 2000. Title III funds are
available to assist HIV+ persons that lack health insurance or are underinsured to pay for the cost of
their care. Title III funds are available for such services including, but not limited to Dentistry,
Psychiatry, Medicine specialty visits, Surgery, Ophthalmology, Obstetrics/Gynecology, and Radiology and
laboratory services. Patients meet with a Title III funded Financial Counselor who determines their
eligibility in this program based on the federal poverty guidelines. Depending on their income, patients
may be charged for their care based on a sliding fee scale. Grant dollars pay for the difference between
the charges and the patient's responsibility. In addition, the grant has allowed us to hire a full-time
pharmacist. The funds received from the Title III grant assist the SIU's over 900 HIV+ patients in being
able to afford their comprehensive health care.
Travelers' HealthCare Center
Medical Director: David Bobak, M.D.
The Travelers' Healthcare Center at University Hospitals of Cleveland provides
comprehensive pre- and post-travel consultation, immunizations and health advice
for groups and individuals traveling abroad for business or pleasure.
The Travelers' HealthCare Center offers a full range of services to safeguard
your health while traveling, with programs to meet individual needs. Itinerary-specific
medical consultation and immunizations, started 4 to 6 weeks before departure,
will significantly reduce the possibility of acquiring serious diseases while
traveling to developing and emerging countries.
The University Hospitals Travelers' HealthCare Center is part of the hospital's
Division of Infectious Diseases in the Department of Medicine, and was one of
the first centers in the country established exclusively for the study and treatment
of international health problems. Each of our travel physicians is a board-certified
specialist in Internal Medicine and Infectious Diseases and is experienced in
the prevention, identification and treatment of international health problems.
Our services include:
• Pre-travel and health care planning for individuals and groups with
special attention to the needs of the international business traveler.
•A complete vaccination program customized for your destination, accompanied
by an International Certificate of Vaccination.
• Advice and counseling on preventive measures that will best maintain
your personal health abroad, such as guidelines for food and water consumption.
• Complete and up-to-date information on health hazards and epidemics
relevant to your specific travel itinerary.
•Post-travel diagnosis and treatment of illnesses acquired while traveling
abroad.
•Travelers' HealthCare Center physicians are available to present on-site,
pre-travel seminars for groups of ten or more business or private travelers.
Infection Control
The Department of Infection Control and Prevention at University Hospitals
of Cleveland coordinates efforts to prevent and control nosocomial infection.
We perform surveillance and documentation of nosocomial infection, offer consultation
on infection control issues and oversee policy and procedure development. We
also provide educational programs to improve patient care and comply with regulatory
agencies. We have input in many areas of hospital functions through committee
membership.
STAFF MEMBERS
Hospital Epidemiologist
Robert A. Salata, M.D. (Medical Director), robert.salata@case.edu
Infection Control Practitioners
• Pamela R. Parker, RN, BSN, Med, CIC (Director), pamela.parker@uhhs.com
• Julia Wendt, RN, BSN, CIC, julia.wendt@uhhs.com
• Susan Conte, RN, BSN, CIC (Rainbow Babies and Childrens' Hospitals), susan.conte@uhhs.com
Infection Control Coordinator
Kathleen Baird, RN, AD
Pediatric Liaison
Philip Toltzis, M.D.
Pharmacy Liaison
Ronald Cowan, PharmD
