Of the more than 1.1 million people living with HIV in the U.S., about 500 are Vermonters. Due to the combined leadership of Christopher Grace, M.D., professor of medicine and director of infectious diseases at the University of Vermont/Fletcher Allen Health Care and Deborah Kutzko, A.P.R.N., nurse practitioner leader of the clinic program and a team of providers, nurses, social workers, dietician and psychiatrist, patients with HIV/AIDS in Vermont have been receiving state-of-the-art care through the Comprehensive Care Clinics for the past 25 years.
Established in 1987 at the former Medical Center Hospital of Vermont (now Fletcher Allen) in Burlington, the HIV/AIDS Comprehensive Care Clinics (CCC) program includes four clinics across the state. Begun in the Burlington clinic in 1987, the program added a Rutland clinic after receiving the first Ryan White CARE Act funding from the U.S. Health and Human Services Administration in 1994, then added a clinic in Brattleboro in 1995 and another in St. Johnsbury in 1996.
The creation of the state’s first long-term clinic for treatment of HIV – then an infection still widely misunderstood and stigmatized – was nothing short of heroic, according to Burlington, Vt.-based Vermont CARES Services Program Director Melissa Farr, M.S.W.
“This brave act, with broader public health goals and real human care in mind, gave rise to Vermont’s strong network of HIV care and treatment,” says Farr. “By forming what is now known as Vermont’s Comprehensive Care Clinic, Vermonters with HIV and AIDS are living longer, healthier lives.”
The Ryan White CARE Act funding – which totals about $800,000 annually – and other federal grants support the clinics’ space and personnel. Named after Ryan White, an Indiana teenager who became an active public educator on HIV/AIDS after he contracted the syndrome through a blood treatment for his hemophilia, the Ryan White CARE Act legislation passed in 1990. The funding goes to all 50 states and provides coverage for health care and support services for people living with HIV disease.
According to the Centers for Disease Control and Prevention, there are about 50,000 new HIV infections nationally each year. Grace says the number of active patients cared for in the clinics increases by about 35 to 50 patients each year. In fact, the program saw the highest numbers to date in fiscal year 2012.
During the 2011 year, the clinics cared for about 440 patients, operating as their Medical Home. Each clinic provides a physician, nurse, social worker, dietician, and psychiatric clinician. Grace has published data from this successful clinic model, which features an on-site nurse and on-site social worker, phone access to an infectious disease specialist, visits once per month to each site by dietician Shelly Gage, M.S., R.D., C.D., and psychiatric nurse practitioner Hella Douglas, A.P.R.N. Also once every month, W. Kemper Alston, M.D., M.P.H., professor of medicine, goes to Brattleboro, Mary Ramundo, M.D., associate professor of medicine, goes to St. Johnsbury, and Grace goes to Rutland. The group also has associates in northern counties of Vermont and upstate New York that assist with patient management.
The Burlington clinic, located at Fletcher Allen’s ambulatory care center, cares for about 300 patients and is staffed by Cindy Noyes, M.D.'06, Kristen Pierce, M.D.'03, Louis Polish, M.D.'81, and Sarah Mooney, M.D.'12, in addition to Grace, Alston and Ramundo. The Rutland clinic has about 50 patients, the Brattleboro clinic, about 60 to 70 patients, and up in the northeast corner of the state, in St. Johnsbury, there are roughly 20 patients receiving care.The collaborative relationship shared by Vermont CARES and the CCC has produced entry systems to medical case management and medical care.
“Consumers are able to begin working with a team that strives to support their overall well-being through stable housing, good nutrition, growing social networks, and mental health support,” Farr explains.