It’s a Thursday afternoon at the David Powell Health Center. In one room, an attending physician and a Dell Medical School student are doing a routine, three-month check up with a patient who lives with HIV, ensuring their once-daily pill is still working well and analyzing bloodwork for any disease progression. In the next room, the team will meet with a patient who has just been referred to the clinic with a new HIV diagnosis; the air is heavy with emotion, as stigma surrounding the condition adds to the patient’s feelings of shame and fear.
In this learning environment, Dell Med residents and students have the opportunity to practice long-term primary care and gain specialized knowledge in HIV care. It’s the result of a partnership between Dell Med and the David Powell Health Center, a Central Health-affiliated CommUnityCare health center with a unique focus on HIV care.
Michael Stefanowicz, M.D., medical director of the David Powell Health Center and assistant professor in Dell Med’s Department of Population Health, notes HIV care has improved drastically in recent years — a diagnosis that was all but a death sentence decades ago now requires a simple once-a-day pill regimen to keep it under control. But broadly, HIV is not emphasized in medical school curricula.
“Many HIV primary care providers have been in this space since the epidemic in the ’80s and have robust institutional knowledge, but they stand to retire in the next decade,” Stefanowicz says. “There is an immense anticipated need for new practitioners, which is why our clinic is excited about partnering with Dell Med, building a sustainable pathway for new primary care providers to carry the torch.”
A ‘Game-Changing’ Elective
Brandon Herrera-Doerre, M.D., second-year internal medicine resident in the Primary Care Track, is interested in practicing in a rural setting like his childhood home in southwest Florida. He jumped at the chance to learn about HIV care, as 50% of new HIV cases occur in the southeastern U.S. — and in Travis County, people of color are disproportionately impacted.
Under the guidance of Robin Reister, M.D., assistant professor at Dell Med, Herrera-Doerre created a four-week elective that enables him to dive deep into the nuances of the HIV care space. The program is twofold: He takes a self-paced online module centered around the National HIV Curriculum, then works with five different Dell Med faculty, including Stefanowicz, to provide HIV care throughout the Austin area alongside community partners.
“In medical school, I was involved in an organization called Pride in Healthcare where I worked to bring awareness of LGBTQ+ issues to medical students,” Herrera-Doerre says. “This work solidified my desire to give back to LGBTQ+ communities. After this experience, I wanted to take time in residency to explore specializations within primary care, whether it’s women’s health or LGBTQ+ care.”
Herrera-Doerre was also able to facilitate patient connections during his clinic experience. One example: A patient needed a CT scan, but because English wasn’t their first language, Herrera-Doerre stepped in to help.
“On his way back to Dell Med after a shift, Brandon went above and beyond and stopped by the hospital to see if he could help schedule the scan,” Stefanowicz says. “Learners are able to take ownership of a patient’s situation just like an HIV specialist would.”
Herrera-Doerre, who calls the elective a “game-changer,” is interested in exploring HIV fellowships after residency. He hopes that with each clinical pearl he picks up during his elective, he can bring it to an underserved population as a future primary care physician.
“Infectious diseases disproportionately impact marginalized communities, and HIV is a great platform by which to render an equity-based framework in medical education,” Stefanowicz says. “HIV doesn’t exist in a vacuum. Every primary care resident will encounter HIV-positive patients.”
Seeing the Big Picture, Starting in Med School
Rabab Isa, a second-year Dell Med student, was in one of her summer rotations when she heard Parker Hudson, M.D., internal medicine residency program director and a primary care physician at the David Powell clinic, speak about infectious diseases. When it came time for Isa to select a longitudinal clerkship as part of Dell Med’s Leading EDGE curriculum, she decided to dive deep into primary care — specifically, HIV care under Hudson’s guidance.
“Instead of going to the David Powell clinic every day for about six weeks, which is standard for many medical school clerkships, I’ll be going to the same clinic once a week for two years,” Isa says. “This nontraditional structure will allow me to explore the field of primary care and allow me see the big picture of the work I’m doing.”
Isa’s longitudinal clerkship allows her to get a full student experience, following disease states closely over the course of months and building trust with patients, who face financial or psychosocial barriers to care, including widespread stigma about HIV. Often, the patients with the most advanced cases of HIV or AIDS are those who experience the most barriers to care.
“Medical education is heavily inpatient focused, which in the HIV care space means that you might only see patients with advanced disease. In the inpatient setting, this can create bias even among providers about what types of people are living with HIV in our country,” Hudson says. “In our clinic, we see patients of every socioeconomic background, of every career; the vast majority of them are taking their medicine every day and are able to live long, healthy lives.”
Over the next two years, Isa will function as a part of an integrated care team of nutritionists, behavioral specialists, pharmacists and more who are available in the clinic. Isa will conduct initial exams and screenings for patients, then propose a treatment plan to Hudson. All the while, she’ll be developing specialized knowledge of a care space that has undergone rapid changes in recent years.
“Although there’s no cure, we have come such a long way from the ’80s and ’90s. Of all the different hats I wear, working at the David Powell clinic is deeply satisfying,” Hudson says. “Caring for people with HIV and teaching people like Rabab bring me the most joy in medicine.”