1 00:00:09,008 --> 00:00:11,144 WELCOME TO THE CLINICAL CENTER GRAND ROUNDS, 2 00:00:11,211 --> 00:00:14,948 A WEEKLY SERIES OF EDUCATIONAL LECTURES FOR PHYSICIANS AND 3 00:00:15,014 --> 00:00:17,584 HEALTH CARE PROFESSIONALS BROADCAST FROM THE CLINICAL 4 00:00:17,650 --> 00:00:20,553 CENTER AT THE NATIONAL INSTITUTES OF HEALTH IN 5 00:00:20,620 --> 00:00:22,355 BETHESDA, MD. 6 00:00:22,422 --> 00:00:25,892 THE NIH CLINICAL CENTER IS THE WORLD'S LARGEST HOSPITAL TOTALLY 7 00:00:25,959 --> 00:00:29,596 DEDICATED TO INVESTIGATIONAL RESEARCH AND LEADS THE GLOBAL 8 00:00:29,662 --> 00:00:32,532 EFFORT IN TRAINING TODAY'S INVESTIGATORS AND DISCOVERING 9 00:00:32,599 --> 00:00:34,701 TOMORROW'S CURES. 10 00:00:34,768 --> 00:00:44,811 LEARN MORE BY VISITING US ONLINE AT HTTP://CLINICALCENTER.NIH.GOV 11 00:00:44,878 --> 00:00:47,580 >> SO IN THE TRADITION OF GRAND 12 00:00:47,647 --> 00:00:49,048 ROUNDS AS THE CLOCK STRIKES 13 00:00:49,115 --> 00:00:50,583 EXACTLY 12, WE WILL START. 14 00:00:50,650 --> 00:00:55,355 TODAY I AM PLEASED TO INTRODUCE 15 00:00:55,422 --> 00:00:56,289 ELANA ROSENTHALL, AS OUR 16 00:00:56,356 --> 00:00:56,523 SPEAKER. 17 00:00:56,589 --> 00:00:58,091 BEFORE I TELL YOU ABOUT HER, I 18 00:00:58,158 --> 00:00:59,793 THINK YOU KNOW FROM BEING HERE 19 00:00:59,859 --> 00:01:02,095 BEFORE HOW TO GET YOUR CMEs 20 00:01:02,162 --> 00:01:05,598 AND I THINK ALSO AWARE THAT 21 00:01:05,665 --> 00:01:07,434 THOSE OF YOU ONLINE CAN SUBMIT 22 00:01:07,500 --> 00:01:09,068 YOUR QUESTIONS AND TOM WILL READ 23 00:01:09,135 --> 00:01:10,904 THOSE AT THE END IF WE HAVE TIME 24 00:01:10,970 --> 00:01:13,173 AND OF COURSE, WE ENCOURAGE ALL 25 00:01:13,239 --> 00:01:17,710 OF YOU HERE TO ASK SPEAKERS AT 26 00:01:17,777 --> 00:01:18,077 THE MICROPHONE. 27 00:01:18,144 --> 00:01:20,914 FIFTEEN YEARS AGO BEING WE 28 00:01:20,980 --> 00:01:22,215 STARTED AS AN INTRAMURAL PROGRAM 29 00:01:22,282 --> 00:01:24,250 LOOKING AT HIV IN THE DISTRICT 30 00:01:24,317 --> 00:01:25,518 OF COLUMBIA TO SEA WHAT WE COULD 31 00:01:25,585 --> 00:01:28,755 DO TO TRY TO REDUCE THE IMPACT 32 00:01:28,822 --> 00:01:30,356 OF HIV IN THE CITY AND 1 OF THE 33 00:01:30,423 --> 00:01:32,692 THINGS THAT OUR STAFF HAVE 34 00:01:32,759 --> 00:01:36,429 RECOGNIZED OVER THE YEARS AND 35 00:01:36,496 --> 00:01:38,364 WHAT LARGE IMPACT SUBSTANCE USE 36 00:01:38,431 --> 00:01:40,433 AND OPIOID USE DISORDER HASOT 37 00:01:40,500 --> 00:01:41,968 ABILITY OF PATIENTS TO EITHER 38 00:01:42,035 --> 00:01:45,371 AVOID GETTING HIV OR TO TAKE 39 00:01:45,438 --> 00:01:47,340 THEIR MEDICATIONS. 40 00:01:47,407 --> 00:01:49,442 TODAY, ELANA, IS GOING TO SPEAK 41 00:01:49,509 --> 00:01:51,945 ABOUT THE INTERSECTION BETWEEN 42 00:01:52,011 --> 00:01:53,513 OPIOIDS AND INFECTIOUS DISEASE 43 00:01:53,580 --> 00:01:54,581 BOTH VIRAL AND BACTERIAL 44 00:01:54,647 --> 00:01:57,884 DISEASES AND I THINK THIS IS 1 45 00:01:57,951 --> 00:01:59,686 OF MANY INITIATIVES THAT NIH IS 46 00:01:59,752 --> 00:02:01,421 SPONSORING NOW TO TRY TO DEAL 47 00:02:01,488 --> 00:02:05,158 WITH THE OPIOID EPIDEMIC IN THE 48 00:02:05,225 --> 00:02:05,492 UNITED STATES. 49 00:02:05,558 --> 00:02:06,893 WE APPRECIATE THE FACT THAT 50 00:02:06,960 --> 00:02:11,131 THESE PROGRAMS ARE SUPPORTED BY 51 00:02:11,197 --> 00:02:14,133 NIAID, BY NIDA, BILET NATIONAL 52 00:02:14,200 --> 00:02:16,002 INSTITUTE OF MENTAL HEALTH, BY 53 00:02:16,069 --> 00:02:16,936 THE OFFICE OF AIDS RESEARCH AND 54 00:02:17,003 --> 00:02:19,038 BY A NUMBER OF YOU WHO ARE HERE 55 00:02:19,105 --> 00:02:20,406 SO THESE PROGRAMS COULD NOT 56 00:02:20,473 --> 00:02:23,576 EXIST WITHOUT THIS KIND OF 57 00:02:23,643 --> 00:02:24,043 SUPPORT. 58 00:02:24,110 --> 00:02:26,012 SO ELANA CAME TO OUR PROGRAM 59 00:02:26,079 --> 00:02:27,413 ALMOST 10 YEARS AGO FROM HER 60 00:02:27,480 --> 00:02:29,616 INTERNAL MEDICINE AND INFECTIOUS 61 00:02:29,682 --> 00:02:32,819 DISEASE TRAINING AT BETH ISRAEL 62 00:02:32,886 --> 00:02:33,820 DECONNIST, SHE CAME HERE BECAUSE 63 00:02:33,887 --> 00:02:36,789 SHE REALLY HAS A PASSION FOR 64 00:02:36,856 --> 00:02:38,591 DEALING WITH PATIENTS WITH 65 00:02:38,658 --> 00:02:40,393 INFECTIOUS DISEASE AND SUBSTANCE 66 00:02:40,460 --> 00:02:41,094 USE DISORDER. 67 00:02:41,160 --> 00:02:43,062 SHE HAS BEEN A MAJOR ARCHITECT 68 00:02:43,129 --> 00:02:44,697 IN THE DIRECTION OF OUR PROGRAM 69 00:02:44,764 --> 00:02:46,266 HAS TAKEN AND SHE'S GOING TO 70 00:02:46,332 --> 00:02:48,368 TELL YOU ABOUT WHERE OUR PROGRAM 71 00:02:48,434 --> 00:02:50,336 IS NOW, WHAT WE'RE DOING AND 72 00:02:50,403 --> 00:02:57,510 WHAT SHE SEES IS THE FUTURE. 73 00:02:57,577 --> 00:02:58,311 ELANA? 74 00:02:58,378 --> 00:02:59,045 >> THANK YOU, DOCTOR. 75 00:02:59,112 --> 00:03:00,813 HE DIDN'T MENTION MY HIGHEST 76 00:03:00,880 --> 00:03:02,415 ACCOLADE WHICH THAT I WAS A 77 00:03:02,482 --> 00:03:04,517 SUMMER INTERN HERE FOR 3 YEARS 78 00:03:04,584 --> 00:03:08,221 IN I THINK 2000, 2001, AND 2003, 79 00:03:08,288 --> 00:03:10,290 SO, IT FEELS VERY MUCH LIKE A 80 00:03:10,356 --> 00:03:11,891 HOME COMING TO ME, OVER HERE 81 00:03:11,958 --> 00:03:13,927 SITTING IN THE SEATS, LESS 82 00:03:13,993 --> 00:03:14,894 STRESSFUL BUT THANK YOU EVERYONE 83 00:03:14,961 --> 00:03:16,829 FOR COMING TO HEAR MY TALK TODAY 84 00:03:16,896 --> 00:03:19,732 ABOUT ACHIEVING SOURCE CONTROL, 85 00:03:19,799 --> 00:03:21,968 ADDRESSING ADDICTION IN PATIENTS 86 00:03:22,035 --> 00:03:25,104 WITH INFECTIOUS COMPLICATIONS OF 87 00:03:25,171 --> 00:03:25,838 SUBSTANCE USE. 88 00:03:25,905 --> 00:03:32,779 THESE ARE MY DISCLOSURES. 89 00:03:32,845 --> 00:03:33,813 AND THE LEARNING POINT. 90 00:03:33,880 --> 00:03:35,682 SO WHAT IS SOURCE CONTROL? 91 00:03:35,748 --> 00:03:39,452 I WANT TO TART OFF BY EXPLAINING 92 00:03:39,519 --> 00:03:41,988 THAT ID PHYSICIANS ARE OBSESSED 93 00:03:42,055 --> 00:03:43,656 WITH THE CONCEPT OF IDENTIFYING 94 00:03:43,723 --> 00:03:46,793 THE SOURCE OF INFECTION, CALL US 95 00:03:46,859 --> 00:03:48,361 PERSISTENT, PERHAPS CALL US NOSY 96 00:03:48,428 --> 00:03:52,699 BUT I. DOCTORS ARE NOTERIOUS FOR 97 00:03:52,765 --> 00:03:53,566 EXHAUSTING ASKING QUESTIONS 98 00:03:53,633 --> 00:03:56,736 ABOUT ALL ASPECTS OF THEIR 99 00:03:56,803 --> 00:03:59,405 LIECHS, PETS, HOBBIES, HABITS, 100 00:03:59,472 --> 00:04:00,340 TRAVEL, TRAVEL FROM 40 YEARS 101 00:04:00,406 --> 00:04:02,976 AGO, EVERYTHING IS RELEVANT TO 102 00:04:03,042 --> 00:04:05,078 OUR HISTORIES ON OUR CERTIFYING 103 00:04:05,144 --> 00:04:06,779 EXAMS AND FAIR WELL IN OUR 104 00:04:06,846 --> 00:04:08,615 CLINICS WE SEE ALL SORTS OF 105 00:04:08,681 --> 00:04:14,320 PATIENTS WHO HAVE FALLEN ILL WHO 106 00:04:14,387 --> 00:04:15,021 INADVERTENTLY BECOME ILWHETHER 107 00:04:15,088 --> 00:04:17,857 IT'S MOWING OVER A RABBIT, 108 00:04:17,924 --> 00:04:22,729 HIKING IN A CAVE WITH BATS OR 109 00:04:22,795 --> 00:04:25,365 ANYONE WHO HAS TAKEN THE 110 00:04:25,431 --> 00:04:26,099 DOCTOR'S INFECTIOUS DISEASE 111 00:04:26,165 --> 00:04:27,133 COURSE KNOWS WHAT I'M TALKING 112 00:04:27,200 --> 00:04:28,067 ABOUT. 113 00:04:28,134 --> 00:04:29,702 AND ONCE WE IDENTIFY A SOURCE, 114 00:04:29,769 --> 00:04:32,972 WE ARE DOGGED IN OUR PURSUIT TO 115 00:04:33,039 --> 00:04:33,940 ERADICATE IT. 116 00:04:34,007 --> 00:04:35,942 DOES THE PATIENT HAVE ROTTEN 117 00:04:36,009 --> 00:04:37,677 TEETH, TAKE THEM ALL OUT. 118 00:04:37,744 --> 00:04:40,880 DO THEY HAVE OLD HARDWARE 119 00:04:40,947 --> 00:04:42,849 EMBEDDED IN THE MYOCARDIUM THAT 120 00:04:42,915 --> 00:04:44,684 COULD BE INFECTED, GET RID OF 121 00:04:44,751 --> 00:04:44,951 IT. 122 00:04:45,018 --> 00:04:49,122 I ONCE WENT SO FAR TO PRESCRIBE 123 00:04:49,188 --> 00:04:54,527 A PROTOCOL FOR A DOG ONCE FOR A 124 00:04:54,594 --> 00:04:54,894 PATIENT. 125 00:04:54,961 --> 00:04:56,262 AUDACIOUS DEMANDS, WE KNOW 126 00:04:56,329 --> 00:04:59,699 TREEING THE INFECTION IS NOT 127 00:04:59,766 --> 00:05:00,833 ENOUGH, ACHIEVING SOURCE CONTROL 128 00:05:00,900 --> 00:05:02,969 IS CRITICAL TO LONG-TERM HEALTH 129 00:05:03,036 --> 00:05:03,903 OF THE PATIENT. 130 00:05:03,970 --> 00:05:05,938 AND YET, THIS SAME FOCUS IS NOT 131 00:05:06,005 --> 00:05:07,173 APPLIED TO PATIENTS WITH 132 00:05:07,240 --> 00:05:09,976 INFECTIONS DUE TO ADICK, 133 00:05:10,043 --> 00:05:11,210 SOMETHING WE ENCOUNTER FAR TOO 134 00:05:11,277 --> 00:05:11,411 OFTEN. 135 00:05:11,477 --> 00:05:13,513 SO I WILL TELL YOU A STORY, 136 00:05:13,579 --> 00:05:14,747 2ATORYS ABOUT PATIENTS OF MINE, 137 00:05:14,814 --> 00:05:17,216 AND I WILL TELL YOU IN ADVANCE, 138 00:05:17,283 --> 00:05:18,418 NEITHER HAVE HAPPY ENDINGS. 139 00:05:18,484 --> 00:05:20,687 THE FIRST WAS A 37 YEAR-OLD JAZZ 140 00:05:20,753 --> 00:05:22,855 MUSICIAN I MET AS A FELLOW IN 141 00:05:22,922 --> 00:05:23,923 BOSTON YEARS AGO. 142 00:05:23,990 --> 00:05:25,391 HE WAS HOSPITALIZED WITH OPIOID 143 00:05:25,458 --> 00:05:29,395 USE DISORDER THAT WAS 144 00:05:29,462 --> 00:05:30,530 COMPLICATED BY INFECTIVE 145 00:05:30,596 --> 00:05:30,863 ENDOCARTITEIS. 146 00:05:30,930 --> 00:05:33,633 HE GOT EXCEPTIONAL CARE FOR HIS 147 00:05:33,700 --> 00:05:34,267 INFECTION. 148 00:05:34,333 --> 00:05:36,402 CT SURGERY, EXCISED AND REPLACED 149 00:05:36,469 --> 00:05:38,938 HIS INFECTED VALVE, I.D. 150 00:05:39,005 --> 00:05:40,773 SELECTED THE PERFECT REGIMEN FOR 151 00:05:40,840 --> 00:05:42,875 HIS ANTIBIOTICS BUT NO 1 152 00:05:42,942 --> 00:05:43,943 ADDRESSED HIS ADDICTION. 153 00:05:44,010 --> 00:05:46,546 HE WAS DISCHARGED TO A MEDICAL 154 00:05:46,612 --> 00:05:48,648 REHAB, COMPLOATED HIS ANTIBIOTIC 155 00:05:48,715 --> 00:05:51,718 THERAPY, WENT HOME, CURED OF HIS 156 00:05:51,784 --> 00:05:52,285 ENDOCARTITEIS. 157 00:05:52,351 --> 00:05:53,619 BUT NOT SURPRISINGLY A FEW 158 00:05:53,686 --> 00:05:55,621 MONTHS HE RETURNED WITH AN 159 00:05:55,688 --> 00:05:56,789 INFECTION ON HIS PROSTHETIC 160 00:05:56,856 --> 00:06:00,093 VALVE, AND THIS TIME, CT SURGERY 161 00:06:00,159 --> 00:06:01,094 CAME, ACTUALLY DON'T THINK THEY 162 00:06:01,160 --> 00:06:02,628 EVEN SAW THE PATIENT AND THEY 163 00:06:02,695 --> 00:06:05,098 JUST WENT STRAIGHT TO HIS CHART, 164 00:06:05,164 --> 00:06:07,600 WROTE 6 WORDS. 165 00:06:07,667 --> 00:06:11,104 NO SURGERY, FETAL CARE, 166 00:06:11,170 --> 00:06:11,804 INTRACTABLE ADDICTION. 167 00:06:11,871 --> 00:06:15,208 I DON'T KNOW HOW THEY KNEW THAT 168 00:06:15,274 --> 00:06:16,576 BECAUSE NO 1 HAD ACTUALLY CARED 169 00:06:16,642 --> 00:06:18,444 ENOUGH TO TRY TO TREAT HIS 170 00:06:18,511 --> 00:06:19,946 ADDICTION BUT THAT WAS IT. 171 00:06:20,012 --> 00:06:21,447 A DEATH SENTENCE BECAUSE WE ALL 172 00:06:21,514 --> 00:06:22,915 KNEW THAT WITHOUT THE SURGERY HE 173 00:06:22,982 --> 00:06:25,752 WAS NOT GOING TO SURVIVE AND HE 174 00:06:25,818 --> 00:06:26,252 DIED. 175 00:06:26,319 --> 00:06:31,724 HE DIED A MISERABLE PAINFUL 176 00:06:31,791 --> 00:06:32,291 PREVENTIBLE DEATH. 177 00:06:32,358 --> 00:06:34,460 AFTER AN ADDICTION THAT WAS 178 00:06:34,527 --> 00:06:36,696 PERFECTLY TREATED BUT COMPLETELY 179 00:06:36,763 --> 00:06:39,432 DEVOID OF SOURCE CONTROL. 180 00:06:39,499 --> 00:06:41,601 WOULD HE BE ALIVE TODAY IF WE 181 00:06:41,667 --> 00:06:44,103 TREATED HIS ADDICTION, I 182 00:06:44,170 --> 00:06:45,605 HONESTLY DON'T KNOW, BUT I KNOW 183 00:06:45,671 --> 00:06:49,408 THAT WE DIDN'T EVEN TRY AND 184 00:06:49,475 --> 00:06:50,042 THAT'S A TRAGEDY. 185 00:06:50,109 --> 00:06:52,011 LATER IN MY CAREER, I 186 00:06:52,078 --> 00:06:53,813 ENCOUNTERED A LOVELY PATIENT WHO 187 00:06:53,880 --> 00:06:56,749 HAD HEPATITIS C THAT WAS A 188 00:06:56,816 --> 00:06:58,251 RESULT OF INJECTING OPIOIDS. 189 00:06:58,317 --> 00:07:04,857 HE WAS REALLY EXCITED TO GET HIS 190 00:07:04,924 --> 00:07:07,460 HEPC, FULLY ADHERED TO HIS 191 00:07:07,527 --> 00:07:09,862 REGIMEN, AND WAS CURED HE DID 192 00:07:09,929 --> 00:07:15,101 NOT DIE OF HEPATITIS E ATULAR 193 00:07:15,168 --> 00:07:17,303 CELLULAROSEIS, HE DID NOT 194 00:07:17,370 --> 00:07:18,437 CONTRACT LIVER DISEASE, BUT A 195 00:07:18,504 --> 00:07:20,807 YEAR AFTER I CURED HIS DISEASE, 196 00:07:20,873 --> 00:07:27,213 HE WAS FOUND IN HIS BATH TUB 197 00:07:27,280 --> 00:07:29,982 WITH RIGOR MORTIS WITH A NEEDLE 198 00:07:30,049 --> 00:07:30,550 IN HIS ARM. 199 00:07:30,616 --> 00:07:33,586 WHY AM I TELLING YOU THESE 200 00:07:33,653 --> 00:07:33,820 STORIES? 201 00:07:33,886 --> 00:07:34,854 BECAUSE INCREASINGLY WE'RE 202 00:07:34,921 --> 00:07:35,688 SEEING YOUNG PATIENTS THAT ARE 203 00:07:35,755 --> 00:07:36,989 DYING BECAUSE WE'RE TREATING 204 00:07:37,056 --> 00:07:38,090 THEIR INFECTIONS WITH LITTLE 205 00:07:38,157 --> 00:07:38,958 REGARD FOR THE ADDICTION THAT 206 00:07:39,025 --> 00:07:40,860 CAUSED THEM AND IF WE HOPE TO 207 00:07:40,927 --> 00:07:42,695 SAVE THEIR LIVES WE NEED TO 208 00:07:42,762 --> 00:07:44,564 COMMIT TO TRULY ACHIEVING SOURCE 209 00:07:44,630 --> 00:07:46,899 CONTROL FOR INFECTIONS DUE TO 210 00:07:46,966 --> 00:07:47,233 SUBSTANCE USE. 211 00:07:47,300 --> 00:07:51,270 HOW DO WE DO THAT? 212 00:07:51,337 --> 00:07:51,604 LET'S DISCUSS. 213 00:07:51,671 --> 00:07:53,239 SO THE FIRST STEP IN ACHIEVING 214 00:07:53,306 --> 00:07:54,674 SOURCE CONTROL FOR INFECTIONS 215 00:07:54,740 --> 00:07:56,142 DUE TO SUBSTANCE USE IS TO 216 00:07:56,209 --> 00:07:57,577 LOCALIZE WHERE THE INFECTIONS 217 00:07:57,643 --> 00:08:00,179 ARE HAPPENING AND GO THERE. 218 00:08:00,246 --> 00:08:02,782 TO EXPLAIN THIS, I WANT TO 219 00:08:02,849 --> 00:08:04,383 HIGHLIGHT THE ORIGINS OF OUR 220 00:08:04,450 --> 00:08:05,218 CLINICAL RESEARCH PROGRAM THAT 221 00:08:05,284 --> 00:08:07,954 THE DOCTOR WAS MENTIONING, THE 222 00:08:08,020 --> 00:08:09,455 D. C. PARTNERSHIP FOR HIV/AIDS 223 00:08:09,522 --> 00:08:09,922 PROGRESS. 224 00:08:09,989 --> 00:08:12,258 IT ALL BEGAN IN 2007 WHEN THE D. 225 00:08:12,325 --> 00:08:13,893 C. DEPARTMENT OF HEALTH 226 00:08:13,960 --> 00:08:15,428 CONDUCTED ITS FIRST ASSESSMENT 227 00:08:15,494 --> 00:08:16,929 OF HIV PREVALENCE, AND FOUND 228 00:08:16,996 --> 00:08:22,301 THAT D. C. HAD EPIDEMIC LEVELS 229 00:08:22,368 --> 00:08:25,137 OF HIV, 3% OF THE POPULATION HAD 230 00:08:25,204 --> 00:08:26,405 HIV, WITH NEW DIAGNOSIS EVERY 231 00:08:26,472 --> 00:08:30,643 YEAR IN A CITY WITH FEWER THAN 232 00:08:30,710 --> 00:08:31,344 600,000 RESIDENTS. 233 00:08:31,410 --> 00:08:35,715 UPON THIS REALIZATION, A TEAM 234 00:08:35,781 --> 00:08:37,016 FROM NIH, INCLUDING 235 00:08:37,083 --> 00:08:37,850 [INDISCERNIBLE], [INDISCERNIBLE] 236 00:08:37,917 --> 00:08:40,586 AND DR. TONY FAUCI, RESOLVED TO 237 00:08:40,653 --> 00:08:42,421 BRING THE RESOURCES OF NIH TO 238 00:08:42,488 --> 00:08:44,690 THIS NEARBY EPIDEMIC WITH THE 239 00:08:44,757 --> 00:08:45,725 GOAL OF APPLYING STRATEGY IN HOW 240 00:08:45,791 --> 00:08:48,127 TO REDUCE THE BURDEN OF HIV IN 241 00:08:48,194 --> 00:08:51,364 URBAN AREAS WITH D. C. AS A 242 00:08:51,430 --> 00:08:51,731 NATIONAL MODEL. 243 00:08:51,797 --> 00:08:53,399 IN CONJUNCTION WITH D. C. 244 00:08:53,466 --> 00:08:55,067 [INDISCERNIBLE], THE OFFICE OF 245 00:08:55,134 --> 00:08:56,669 AIDS RESEARCH AND THE SCHOOL OF 246 00:08:56,736 --> 00:08:58,504 PUBLIC HEALTH, THE D. C. 247 00:08:58,571 --> 00:09:00,907 PARTNERSHIP FOR HIV/AIDS 248 00:09:00,973 --> 00:09:02,041 PROGRESS WAS BORN. 249 00:09:02,108 --> 00:09:03,876 AN INITIAL NEEDS ASSESSMENT 250 00:09:03,943 --> 00:09:05,511 INVOLVING COMMUNITY BASED 251 00:09:05,578 --> 00:09:08,381 ORGANIZATIONS, PROVIDERS AND 252 00:09:08,447 --> 00:09:09,482 PATIENTS WAS CONDUCTED. 253 00:09:09,548 --> 00:09:11,117 AND WITHIN NIH THOUGHT THE 254 00:09:11,183 --> 00:09:12,685 COMMUNITY WOULD IDENTIFY AS AN 255 00:09:12,752 --> 00:09:14,520 UNMET NEED WAS SUPPORT FOR 256 00:09:14,587 --> 00:09:15,087 TREATMENT OF HIV. 257 00:09:15,154 --> 00:09:16,355 THEY THOUGHT THEY WERE GOING TO 258 00:09:16,422 --> 00:09:19,125 GO IN AND DO A. R. T. BUT WHAT 259 00:09:19,191 --> 00:09:20,226 THEY ACTUALLY FOUND OUT WAS THAT 260 00:09:20,293 --> 00:09:22,261 THE COMMUNITY WAS MUCH MORE 261 00:09:22,328 --> 00:09:24,563 INTERESTED IN SUPPORT FOR 262 00:09:24,630 --> 00:09:27,500 SPECIALIST CARE FOR 263 00:09:27,566 --> 00:09:29,335 CO-MORBIDITIES INFECTION, 264 00:09:29,402 --> 00:09:29,969 SPECIFICALLY MENTAL HEALTH, 265 00:09:30,036 --> 00:09:33,005 HEPATITIS C AND SUBSTANCE USE 266 00:09:33,072 --> 00:09:34,340 DISORDER. 267 00:09:34,407 --> 00:09:35,908 DR. MARYLAND POWELL AND 268 00:09:35,975 --> 00:09:38,244 DR. [INDISCERNIBLE] AND THEIR 269 00:09:38,311 --> 00:09:40,012 TEAM AT NIMH SET OUT TO ADDRESS 270 00:09:40,079 --> 00:09:41,480 MENTAL HEALTH. 271 00:09:41,547 --> 00:09:45,351 WHILE UNDER THE SUPPORT OF 272 00:09:45,418 --> 00:09:46,686 DR. MIKE [INDISCERNIBLE], AND 273 00:09:46,752 --> 00:09:47,653 DR. [INDISCERNIBLE] THEY PUT 274 00:09:47,720 --> 00:09:49,055 THEIR FOCUS ON HEPATITIS C. 275 00:09:49,121 --> 00:09:50,623 THIS ALIGNED WITH THE TIMING OF 276 00:09:50,690 --> 00:09:52,358 THE REVOLUTION OF HEPATITIS C 277 00:09:52,425 --> 00:09:52,692 TREME. 278 00:09:52,758 --> 00:09:54,827 FOR THOSE WHO DON'T KNOW OR 279 00:09:54,894 --> 00:09:58,831 CHOOSE TO FORGET, THE MAIN STAY 280 00:09:58,898 --> 00:10:00,333 OF HEPC TREATMENT WAS INTERFERON 281 00:10:00,399 --> 00:10:00,967 BASE. 282 00:10:01,033 --> 00:10:04,804 IT WAS A TERRIBLE MEDICATION, IT 283 00:10:04,870 --> 00:10:06,839 MODULATED THE IMMUNE SYSTEM TO 284 00:10:06,906 --> 00:10:09,075 HELP GET RID OF HEPATITIS C, BUT 285 00:10:09,141 --> 00:10:11,344 IT HAD ENORM AUSSIDE EFFECTS, IT 286 00:10:11,410 --> 00:10:12,378 WAS TOLERATED THERE WERE 287 00:10:12,445 --> 00:10:13,746 COMPLICATIONS TO TREATMENT AND 288 00:10:13,813 --> 00:10:15,881 IF YOU DID SOMEHOW MAKE YOUR WAY 289 00:10:15,948 --> 00:10:17,917 THROUGH 12 MONTHS OF TREATMENT, 290 00:10:17,984 --> 00:10:22,888 THE CARE RATES WERE NOT VERY 291 00:10:22,955 --> 00:10:23,656 GOOD, AND HIV. 292 00:10:23,723 --> 00:10:25,091 SETHE FIRST STEP WAS TO BRING 293 00:10:25,157 --> 00:10:28,494 THE SPECIALIST CARE TO THE D. C. 294 00:10:28,561 --> 00:10:30,463 COMMUNITY TO PROVIDE THEM WITH 295 00:10:30,529 --> 00:10:31,897 HEP C TREATMENT BECAUSE AT THE 296 00:10:31,964 --> 00:10:33,899 TIME YOU COULD ONLY GET IT FROM 297 00:10:33,966 --> 00:10:34,467 A SPECIALIST. 298 00:10:34,533 --> 00:10:36,168 EARLY ON THE DOCTOR AND HIS TEAM 299 00:10:36,235 --> 00:10:37,403 RECOGNIZE THAD THOUGH THE 300 00:10:37,470 --> 00:10:39,138 DISTANCE BETWEEN D. C. AND 301 00:10:39,205 --> 00:10:40,473 BETHESDA IS FAIRLY SHORT, I MADE 302 00:10:40,539 --> 00:10:43,175 IT TODAY, IT WAS NONETHELESS 303 00:10:43,242 --> 00:10:44,477 INSURMOUNTABLE FOR MANY PATIENTS 304 00:10:44,543 --> 00:10:46,946 WITH THE GREATEST NEED, EVEN THE 305 00:10:47,013 --> 00:10:47,913 MAJOR ACADEMIC MEDICAL CENTERS 306 00:10:47,980 --> 00:10:49,115 IN D. C. WHICH ARE LOCATED IN 307 00:10:49,181 --> 00:10:51,384 THE NORTH AND WEST OF THE CITY, 308 00:10:51,450 --> 00:10:53,552 WERE LARGELY INACCESSIBLE TO THE 309 00:10:53,619 --> 00:10:55,287 PATIENT'S MOST IMPACTED BY HIV 310 00:10:55,354 --> 00:10:57,690 AND HEP C WHO WERE CLUSTERED IN 311 00:10:57,757 --> 00:10:58,024 THE SOUTHEAST. 312 00:10:58,090 --> 00:11:00,226 HE RECOGNIZED THAT IF WE WANTED 313 00:11:00,292 --> 00:11:01,427 TO ACCESS THE PATIENTS WE HAD TO 314 00:11:01,494 --> 00:11:02,828 BRING OURSELVES TO THEM. 315 00:11:02,895 --> 00:11:04,230 RATHER THAN ASKING THEM TO COME 316 00:11:04,296 --> 00:11:04,897 TO US. 317 00:11:04,964 --> 00:11:07,033 SO THE FIRST STEP TO ENGAGING 318 00:11:07,099 --> 00:11:10,102 THIS POPULATION WAS TO EMBED A 319 00:11:10,169 --> 00:11:11,470 TEAM AT UNITY HEALTH CENTER AND 320 00:11:11,537 --> 00:11:14,206 FAMILY MEDICAL AND COUNSELING 321 00:11:14,273 --> 00:11:15,775 SERVICES TO FEDERALLY QUALIFIED 322 00:11:15,841 --> 00:11:17,543 HEALTH CENTERS THAT WERE 323 00:11:17,610 --> 00:11:20,012 ACCESSING PATIENTS EMBEDDED IN 324 00:11:20,079 --> 00:11:23,916 WARDS 7 AND 8, REGIONS THAT ARE 325 00:11:23,983 --> 00:11:25,985 PREDOMINANTLY RACIAL MINORITY, 326 00:11:26,052 --> 00:11:26,652 DISPROPORTIONATELY SERVED AND 327 00:11:26,719 --> 00:11:29,422 LOW ACCESS TO CARE AND HIGH 328 00:11:29,488 --> 00:11:31,524 RATES OF HIV AND HEP C. 329 00:11:31,590 --> 00:11:33,859 SO IN THE STANDARD, THEY STARTED 330 00:11:33,926 --> 00:11:35,327 BUILDING TRUST AND ENGAGEMENT 331 00:11:35,394 --> 00:11:37,096 WITH PATIENTS AND PROVIDERS IN 332 00:11:37,163 --> 00:11:38,330 THE COMMUNITY. 333 00:11:38,397 --> 00:11:41,367 NOT LONG AFTER P-FAB WAS 334 00:11:41,434 --> 00:11:42,435 DEVELOPED, THE OPPORTUNITY AROSE 335 00:11:42,501 --> 00:11:43,602 TO BRING NOVEL THERAPEUTICS TO 336 00:11:43,669 --> 00:11:45,671 THE D. C. PATIENTS. 337 00:11:45,738 --> 00:11:46,972 DUE TO PREVIOUS COLLABORATIONS 338 00:11:47,039 --> 00:11:50,276 RELATED TO TREATMENTS FOR 339 00:11:50,342 --> 00:11:51,343 PNEUMOCYSTIS IN HIV, THE TEAM 340 00:11:51,410 --> 00:11:53,446 WAS APPROACHED BY A SMALL 341 00:11:53,512 --> 00:11:55,047 PHARMACEUTICAL COMPANY CALL TEST 342 00:11:55,114 --> 00:12:01,854 SET TO HELP TEST FOR HEPATITIS E 343 00:12:01,921 --> 00:12:02,121 C. 344 00:12:02,188 --> 00:12:03,889 THE NIH TEAM WAS ABLE TO ACCESS 345 00:12:03,956 --> 00:12:06,859 DONATED DRUG TO CONDUCT 346 00:12:06,926 --> 00:12:07,460 INVESTIGATOR INITIATED SICKLE 347 00:12:07,526 --> 00:12:08,494 SITE STUDIES AND WANTED TO 348 00:12:08,561 --> 00:12:09,862 PROVIDE THE D. C. COMMUNITY WITH 349 00:12:09,929 --> 00:12:12,231 ACCESS TO THIS PROMISE ARE 350 00:12:12,298 --> 00:12:12,531 THERAPEUTIC. 351 00:12:12,598 --> 00:12:14,100 INITIALLY, PATIENTS WERE 352 00:12:14,166 --> 00:12:16,168 RECRUITED BY THE NIH TEAM AT OUR 353 00:12:16,235 --> 00:12:17,703 COMMUNITY BASED SITES AND 354 00:12:17,770 --> 00:12:19,605 STUDIES WERE CONDUCTED ENTIRELY 355 00:12:19,672 --> 00:12:20,639 AT THE NIH. 356 00:12:20,706 --> 00:12:22,308 BUT THIS MODEL EVOLVED TO BRING 357 00:12:22,374 --> 00:12:24,577 PATIENTS TO THE NEYE H FOR THEIR 358 00:12:24,643 --> 00:12:25,811 FIRST ENROLLMENT VISIT BUTAR LOW 359 00:12:25,878 --> 00:12:28,514 THEM TO COMPLETE L FOLLOW UP 360 00:12:28,581 --> 00:12:30,082 VISITS IN THE COMMUNITY BASED 361 00:12:30,149 --> 00:12:30,382 SITES. 362 00:12:30,449 --> 00:12:31,584 AND THE FINAL ITERATION OF THIS 363 00:12:31,650 --> 00:12:33,252 MODEL WAS THAT THE NIH THROW A 364 00:12:33,319 --> 00:12:39,959 FOOTBALL WENT TO THE COMMUNITY 365 00:12:40,025 --> 00:12:41,560 BASED--STAFF WENT TO THE 366 00:12:41,627 --> 00:12:42,761 COMMUNITY BASED SITES FOR ACCESS 367 00:12:42,828 --> 00:12:43,562 OF COMMUNITY CARE. 368 00:12:43,629 --> 00:12:45,698 THIS MODEL WAS ABLE TO RESULT IN 369 00:12:45,764 --> 00:12:48,100 THE FIRST STUDY OF INTERFERON 370 00:12:48,167 --> 00:12:51,070 FREE HEPATITIS C TREATMENT IN 371 00:12:51,137 --> 00:12:52,905 THE UNITED STATES, FIRST STUDY 372 00:12:52,972 --> 00:12:55,307 OF INTERFERON IN RIBOFLAVORIN 373 00:12:55,374 --> 00:12:57,009 FOR HEPATITIS E C INFECTED 374 00:12:57,076 --> 00:12:58,911 PATIENTS AND SHORT DURATION OF 375 00:12:58,978 --> 00:13:00,279 HEPATITIS C TREATMENT, LARGEST 376 00:13:00,346 --> 00:13:01,413 STUDY OF DIRECT ANTIVIRALS IN 377 00:13:01,480 --> 00:13:03,549 BLACK PATIENT ANDS THE FIRST 378 00:13:03,616 --> 00:13:05,751 STUDY OF NONSPECIALIST LED 379 00:13:05,818 --> 00:13:09,622 HEPATITIS C TREATMENT IN HEP-C 380 00:13:09,688 --> 00:13:12,124 AND CO INFECTED PATIENTS. 381 00:13:12,191 --> 00:13:12,892 OVER 800 PREDOMINANTLY PLAQUE 382 00:13:12,958 --> 00:13:14,226 PATIENTS WERE TREATED FOR 383 00:13:14,293 --> 00:13:16,462 HEPATITIS C THROUGH THESE EARLY 384 00:13:16,529 --> 00:13:17,129 STUDIES INSURING REPRESENTATION 385 00:13:17,196 --> 00:13:19,064 IN THE RESEARCH BY PEOPLE CO 386 00:13:19,131 --> 00:13:20,900 INFECTED WITH HIV, AND RACIAL 387 00:13:20,966 --> 00:13:23,702 MINORITIES WHO ARE TRADITIONALLY 388 00:13:23,769 --> 00:13:24,503 UNDERREPRESENTED IN 389 00:13:24,570 --> 00:13:25,938 INVESTIGATIONAL DRUG STUDIES. 390 00:13:26,005 --> 00:13:27,106 THESE STUDIES HELPED CONTRIBUTE 391 00:13:27,173 --> 00:13:29,642 TO THE FDA APPROVAL AND 392 00:13:29,708 --> 00:13:30,809 GUIDELINES RECOMMENDATIONS FOR 393 00:13:30,876 --> 00:13:33,078 DIRECT AND ANTIVIRALS WHICH ARE 394 00:13:33,145 --> 00:13:34,880 INCREDIBLY SAFE, TOLERABLE AND 395 00:13:34,947 --> 00:13:37,216 OVER 90% EFFECTIVE AFTER 2-3 396 00:13:37,283 --> 00:13:37,917 MONTHS OF USE. 397 00:13:37,983 --> 00:13:39,685 NONE OF THIS WOULD HAVE BEEN 398 00:13:39,752 --> 00:13:41,587 POSSIBLE IF WE HADN'T LOCALIZED 399 00:13:41,654 --> 00:13:43,789 TD EPICENTER OF HEPATITIS C 400 00:13:43,856 --> 00:13:45,491 INFECTION IN DC AND GONE THERE. 401 00:13:45,558 --> 00:13:46,525 A SLIGHT INCONVENIENCE FOR THE 402 00:13:46,592 --> 00:13:48,127 TEAM, LED TO MASSIVE 403 00:13:48,194 --> 00:13:54,733 CONTRIBUTIONS TO SCIENCE, AND 404 00:13:54,800 --> 00:13:55,334 THE COMMUNITY. 405 00:13:55,401 --> 00:13:57,570 AS D. A.s WERE COMING DOWN THE 406 00:13:57,636 --> 00:13:59,572 PIPELINE, A NEW EPIDEMIC WAS 407 00:13:59,638 --> 00:14:01,240 GAINING TRACTION, THE MODERN 408 00:14:01,307 --> 00:14:02,074 OPIOID EPIDEMIC. 409 00:14:02,141 --> 00:14:04,677 WHILE OPIOIDS HAVE BEEN AROUND 410 00:14:04,743 --> 00:14:07,980 SINCE THE TIME OF HIPIECE OF 411 00:14:08,047 --> 00:14:10,082 CONTENT RATEASE, THE MODERN 412 00:14:10,149 --> 00:14:12,418 OPIDDOID ERA IS CATEGORIZED IN 3 413 00:14:12,484 --> 00:14:12,618 WAVES. 414 00:14:12,685 --> 00:14:15,487 FIRST WAVE TART NOTHING THE LATE 415 00:14:15,554 --> 00:14:17,523 1990S WAS RELATED TO OPIOID 416 00:14:17,590 --> 00:14:21,460 PILLS, THERE WAS A DRAMATIC RISE 417 00:14:21,527 --> 00:14:23,095 OF OPIOID PILLS FOLLOWED BY 418 00:14:23,162 --> 00:14:24,296 RECOMMENDATIONS BY MEDICAL 419 00:14:24,363 --> 00:14:28,000 SOCIETIES TO FOCUS ON PAIN 420 00:14:28,067 --> 00:14:29,835 CONTROL ACCOMPANIED BY MARKETING 421 00:14:29,902 --> 00:14:30,436 BY PHARMACEUTICAL COMPANIES 422 00:14:30,502 --> 00:14:32,438 EMPLOY AFTER THE OPIOID PILL 423 00:14:32,504 --> 00:14:34,607 PRESCRIBING SO SAW A WAVE OF 424 00:14:34,673 --> 00:14:36,308 OVERDOSE DEATH WITH A 425 00:14:36,375 --> 00:14:37,376 PARAILLUMINATE RISE IN 426 00:14:37,443 --> 00:14:38,711 INRECYCLINGING DRUG USE, THIS 427 00:14:38,777 --> 00:14:39,945 INCREASE IN HEROIN USE WAS IN 428 00:14:40,012 --> 00:14:41,513 PART DUE TO THE FACT THAT PEOPLE 429 00:14:41,580 --> 00:14:43,382 WHO HAD DEVELOPED OPIOID USE 430 00:14:43,449 --> 00:14:44,750 DISORDER THROUGH PILL USE, WERE 431 00:14:44,817 --> 00:14:46,418 FINDING IT DIFFICULT TO OBTAIN 432 00:14:46,485 --> 00:14:47,686 OR AFFORD SUFFICIENT QUANTITIES 433 00:14:47,753 --> 00:14:49,488 OF PILLS TO MEET THEIR NEEDS. 434 00:14:49,555 --> 00:14:51,590 SO THE NATURAL TRANSITION WAS TO 435 00:14:51,657 --> 00:14:53,926 HEROIN WHICH WAS CHEAPER AND 436 00:14:53,993 --> 00:14:55,027 MORE READILY AVAILABLE. 437 00:14:55,094 --> 00:14:57,596 THE THIRD WAVE, IS DUE TO 438 00:14:57,663 --> 00:15:00,065 SYNTHETIC OPIOIDS SUCH AS FENT 439 00:15:00,132 --> 00:15:02,935 NILE VIRUS AND FENTAFYL AN LOGS, 440 00:15:03,002 --> 00:15:05,704 AS YOU CAN SEE THE INTRODUCTION 441 00:15:05,771 --> 00:15:09,108 OF SYNTHETIC OPIOIDS WHICH ARE 442 00:15:09,174 --> 00:15:10,876 MUCH MORE POTENT THAN HEROIN 443 00:15:10,943 --> 00:15:13,746 WHICH HAS LED TO RISING 444 00:15:13,812 --> 00:15:15,247 OVERDOSES IN 2013. 445 00:15:15,314 --> 00:15:16,982 THE DRAMATIC REDUCTIONTIC SPREAD 446 00:15:17,049 --> 00:15:18,284 OF OPIOID USE ACROSSLET COUNTRY 447 00:15:18,350 --> 00:15:19,952 AND INTO THE DRUG SUPPLY AS 448 00:15:20,019 --> 00:15:22,488 RESULT INDEED A PRECIPITOUS RISE 449 00:15:22,554 --> 00:15:24,556 IN OVERDOSE RELATED DEATHS. 450 00:15:24,623 --> 00:15:25,924 CLIMAXING IN 2022, OUR MOST 451 00:15:25,991 --> 00:15:28,661 RECENT DATA WHEN OVER 109,000 452 00:15:28,727 --> 00:15:30,663 PEOPLE DIED OF OVERDOSE. 453 00:15:30,729 --> 00:15:32,831 TO PUT THIS IN PERSPECTIVE, THE 454 00:15:32,898 --> 00:15:34,433 CURRENT ANNUAL RATE OF OVERDOSE 455 00:15:34,500 --> 00:15:36,235 DEATH SYSTEM OVER DOUBLE THE 456 00:15:36,302 --> 00:15:38,070 NUMBER OF ANNUAL DEATHS AT THE 457 00:15:38,137 --> 00:15:39,672 PEAK OF THE HIV EPIDEMIC. 458 00:15:39,738 --> 00:15:45,811 CLEARLY THIS IS A BIG PROBLEM. 459 00:15:45,878 --> 00:15:53,986 ALONG WITH THE RISKS OF OVERLOAD 460 00:15:54,053 --> 00:15:57,690 DEATH, THE MODES OF INJECTION 461 00:15:57,756 --> 00:16:05,631 CAN BE OFTEN FATAL, AND THE 462 00:16:05,698 --> 00:16:06,699 ACQUISITION OF BLOOD BORN 463 00:16:06,765 --> 00:16:08,467 TRANSITIONS DUE TO SHARING OR 464 00:16:08,534 --> 00:16:10,102 INJEKING EQUIM, OF NOTE, 465 00:16:10,169 --> 00:16:12,638 TRANSMISSION OF SOME INFECTIONS 466 00:16:12,705 --> 00:16:13,372 ESPECIALLY HEPATITIS C CAN OCCUR 467 00:16:13,439 --> 00:16:15,607 WITH THE SHARING OF EQUIPMENT 468 00:16:15,674 --> 00:16:18,310 USED FOR INTRA NAIS AT DRUG USE, 469 00:16:18,377 --> 00:16:20,446 INFECTIONS ACQUIRED VIA 470 00:16:20,512 --> 00:16:22,081 TRANSMISSION INCLUDE HIV, 471 00:16:22,147 --> 00:16:26,585 HEPATITIS B, C, AND D. 472 00:16:26,652 --> 00:16:27,753 THE SECOND CONTAMINATION IS 473 00:16:27,820 --> 00:16:31,390 DURING THE PROCESS WHICH RESULTS 474 00:16:31,457 --> 00:16:34,893 IN INOCULATION DUE TO NONSTERILE 475 00:16:34,960 --> 00:16:35,728 INJECTING PROCESSES, THIS 476 00:16:35,794 --> 00:16:43,702 RESULTS IN KIN AND SOFT TISSUE 477 00:16:43,769 --> 00:16:48,040 INFECTIONS, BACTERIAEMIA AND 478 00:16:48,107 --> 00:16:51,944 SEPSIS AND SUCH WITH THE RISE OF 479 00:16:52,010 --> 00:16:54,012 THE OPIOID EPIDIMMIC WE'VE SEEN 480 00:16:54,079 --> 00:16:57,883 A RISE IN CONTAMINATIONS. 481 00:16:57,950 --> 00:17:00,552 FROM 2004-2014 THERE WAS A 300% 482 00:17:00,619 --> 00:17:03,922 INCREASE IN HEPATITIS C INDENTS 483 00:17:03,989 --> 00:17:08,260 THAT PARALLELLED 134% INCREASE 484 00:17:08,327 --> 00:17:09,862 FOR OPIOID INJECTION. 485 00:17:09,928 --> 00:17:11,463 THESE REENFORCE THAT IN THE 486 00:17:11,530 --> 00:17:13,966 UNITED STATES HEPATITIS C AND 487 00:17:14,032 --> 00:17:16,034 OPIOID USE DISORDER ARE ENDEMIC. 488 00:17:16,101 --> 00:17:19,538 JUF AS WE'VE SEEN A RISE IN 489 00:17:19,605 --> 00:17:20,506 TRANSMISSION RELATED INFECS, 490 00:17:20,572 --> 00:17:24,009 BOTH HAVE WE SEEN A RISE OF 491 00:17:24,076 --> 00:17:24,676 INFECTIONS ASSOCIATE WIDE INYEKS 492 00:17:24,743 --> 00:17:25,844 USE OVER THE PAST DECADE EMPLOY 493 00:17:25,911 --> 00:17:29,214 AS WE CAN SEE FROM THIS FIGURE 494 00:17:29,281 --> 00:17:32,418 HOSPITAL DISCHARGE DATA IN OARG 495 00:17:32,484 --> 00:17:33,085 ORGFROM 2008-2018, THERE HAS 496 00:17:33,152 --> 00:17:36,488 BEEN A DRAMATIC REDUCTIONTIC 497 00:17:36,555 --> 00:17:39,191 INCREASE FOR HOSPITALIZATIONS 498 00:17:39,258 --> 00:17:40,793 FOR DRUG RELATED BACTERIAL 499 00:17:40,859 --> 00:17:41,093 INFECTIONS. 500 00:17:41,160 --> 00:17:43,228 SO WHAT CAN WE DO TO HELP PEOPLE 501 00:17:43,295 --> 00:17:45,631 WITH OPIOID USE DISORDER. 502 00:17:45,697 --> 00:17:47,566 1 THING IS WE CAN TREAT THEM. 503 00:17:47,633 --> 00:17:50,269 THE GOLD STANDARD USE FOR OPIOID 504 00:17:50,335 --> 00:17:51,236 DISORDER IS MEDICATION BASED 505 00:17:51,303 --> 00:17:53,939 THERAPY AND THERE ARE CURRENTLY 506 00:17:54,006 --> 00:17:55,507 3 FDA APPROVED THERAPIES TO 507 00:17:55,574 --> 00:17:59,878 TREAT DISORDER. 508 00:17:59,945 --> 00:18:01,814 METHADONE, BUPRENORPH AND 509 00:18:01,880 --> 00:18:03,982 THEY'RE BOTH AGONIST OF THE 510 00:18:04,049 --> 00:18:12,724 OPIOID RECEPTOR AND WHILE 511 00:18:12,791 --> 00:18:14,393 NALTREKS OWN IS THE ANTAGONIST. 512 00:18:14,460 --> 00:18:16,995 THE REASON WE USE HAD IS BECAUSE 513 00:18:17,062 --> 00:18:19,331 IT WORKS, IT REDUCES DRUG USE 514 00:18:19,398 --> 00:18:19,765 WHILE IN TREATMENT. 515 00:18:19,832 --> 00:18:21,800 HERE YOU CAN SEE PEOPLE WHO 516 00:18:21,867 --> 00:18:26,038 INJECT DRUGS USING METHADONE, 517 00:18:26,104 --> 00:18:26,939 THE PERCENT STEADILY DECREASED 518 00:18:27,005 --> 00:18:28,607 IN THE COURSE OF TREATMENT. 519 00:18:28,674 --> 00:18:30,075 HOWEVER IN THOSE THORS SET 520 00:18:30,142 --> 00:18:32,478 MAINTENANCE THERE WAS A STUDY 521 00:18:32,544 --> 00:18:35,147 INYECTING DRUG USE OVER TIME. 522 00:18:35,214 --> 00:18:37,249 FURTHER, OPIOID AGONIST THERAPY 523 00:18:37,316 --> 00:18:37,950 REDUCES MORTALITY. 524 00:18:38,016 --> 00:18:40,486 HERE DATA FROM A TODAY IN 525 00:18:40,552 --> 00:18:41,186 MASSACHUSETTS EVALUATED 526 00:18:41,253 --> 00:18:43,388 MORTALITY AS SEEN ON THE Y-AXIS 527 00:18:43,455 --> 00:18:45,557 IN PATIENTS WITH A RECENT 528 00:18:45,624 --> 00:18:45,958 NONFATAL OVERDOSE. 529 00:18:46,024 --> 00:18:47,693 WHAT THEY FOUND WAS THAT 530 00:18:47,759 --> 00:18:49,661 PATIENTS NOT ON MEDICATION FOR 531 00:18:49,728 --> 00:18:50,596 OPIOID USE DISORDER HAD THE 532 00:18:50,662 --> 00:18:52,731 HIGHEST RATES OF MORTALITY, 533 00:18:52,798 --> 00:18:54,500 WHILE ENGAGEMENT AND OPIOID 534 00:18:54,566 --> 00:18:55,901 AGONIST THERAPY WAS 535 00:18:55,968 --> 00:18:57,035 SIGNIFICANTLY ASSOCIATED WITH 536 00:18:57,102 --> 00:19:01,874 DECREASE MORTALITY FOR A YEAR 537 00:19:01,940 --> 00:19:03,308 AFTER OVERDOSE. 538 00:19:03,375 --> 00:19:05,744 ENIMAIJMENT IN M. O. D. REDUCES 539 00:19:05,811 --> 00:19:07,346 HEPATITIS C TRANSMISSION BY 540 00:19:07,412 --> 00:19:09,615 CREASING INYEKS, FREQUENCY AND 541 00:19:09,681 --> 00:19:10,883 REDUCING RISK TAKING BEHAVIORS. 542 00:19:10,949 --> 00:19:12,584 IN THIS STUDY OF PEOPLE WHO 543 00:19:12,651 --> 00:19:14,119 INJECT DRUGS UNDER THE AGE OF 544 00:19:14,186 --> 00:19:16,555 30, BEING ON MAINTENANCE OPIOID 545 00:19:16,622 --> 00:19:18,490 AGONIST THERAPY SEEN IN GREEN IS 546 00:19:18,557 --> 00:19:20,559 ASSOCIATED WITH SIGNIFICANTLY 547 00:19:20,626 --> 00:19:22,361 LOWER INCIDENCE OF HEPATITIS C 548 00:19:22,427 --> 00:19:24,596 COMPARED TO NO DRUG TREATMENT IN 549 00:19:24,663 --> 00:19:25,230 PURPLE, NONMEDICATION BASED 550 00:19:25,297 --> 00:19:28,767 TREATMENT IN BLUE AND DETOX 551 00:19:28,834 --> 00:19:30,302 ALONE IN YELLOW. 552 00:19:30,369 --> 00:19:32,971 FURTHER, M. O. U. D. IMPROVES 553 00:19:33,038 --> 00:19:34,473 HIV OUTCOMES BY INCREASING 554 00:19:34,540 --> 00:19:36,708 UPTAKE OF A. R. T. AND IMPROVING 555 00:19:36,775 --> 00:19:38,544 ADHERENCE AND RETEPGZ TO A. R. 556 00:19:38,610 --> 00:19:40,579 T. AND RESULT NOTHING A HIGHER 557 00:19:40,646 --> 00:19:44,783 LIKELIHOOD OF HIV VIRAL 558 00:19:44,850 --> 00:19:45,150 SUPPRESSION. 559 00:19:45,217 --> 00:19:46,785 THOUGH M. O. U. D. HAS BEEN 560 00:19:46,852 --> 00:19:49,488 PROVEN FOR DECADES TO IMPROVE 561 00:19:49,555 --> 00:19:54,927 OPIOID USE DISORDER OUTCOMES, 562 00:19:54,993 --> 00:19:55,494 ACCESSIBILITY REMAINS POOR. 563 00:19:55,561 --> 00:19:58,330 IN THE U.S. THERE WERE 564 00:19:58,397 --> 00:20:00,065 6.1 MILLION PEOPLE IN OPIOID USE 565 00:20:00,132 --> 00:20:01,767 DISORDER AND ONLY 1 IN 4 566 00:20:01,833 --> 00:20:04,002 RECEIVED MEDICATION EMPLOY AS 567 00:20:04,069 --> 00:20:05,737 THERE ARE ONLY 144 MEDICATION 568 00:20:05,804 --> 00:20:07,039 ADDICTION SPECIALISTS IN THE 569 00:20:07,105 --> 00:20:07,973 UNITED STATES, WHO CANNOT 570 00:20:08,040 --> 00:20:10,309 POSSIBLY MEET THE NEEDINGS OF 571 00:20:10,375 --> 00:20:12,611 THIS ENTIRE POPULATION, IT IS I 572 00:20:12,678 --> 00:20:14,813 PERRATIVE THAT THE NONADDICTION 573 00:20:14,880 --> 00:20:15,714 SPECIALISTS, AND PRIMARY CARE 574 00:20:15,781 --> 00:20:17,916 PROVIDERS TAKE ON THE CHALLENGE 575 00:20:17,983 --> 00:20:20,919 IN PROVIDING ACCESS TO M. O. U. 576 00:20:20,986 --> 00:20:23,055 D. FOR PATIENTS AND ESPECIALRY 577 00:20:23,121 --> 00:20:24,723 THOSE WITH COMORBID INFECTIONS. 578 00:20:24,790 --> 00:20:27,693 I ALSO WANT TO HIGHLIGHT A CORE 579 00:20:27,759 --> 00:20:29,728 PRESENCE PEL WITH THE MANAGEMENT 580 00:20:29,795 --> 00:20:30,896 AND SUBSTANCE USE DISORDERS, 581 00:20:30,963 --> 00:20:32,064 THAT PRINCIPLE IS HARM 582 00:20:32,130 --> 00:20:33,398 REDUCTION, THE PRACTICE OF 583 00:20:33,465 --> 00:20:34,733 RIDUCING THE NEGATIVE 584 00:20:34,800 --> 00:20:35,667 CONSEQUENCES OF DRUG USE 585 00:20:35,734 --> 00:20:36,868 INCLUDING IN PEOPLE WHO ARE NOT 586 00:20:36,935 --> 00:20:39,438 READY OR NOT ABLE TO ABSTAIN 587 00:20:39,504 --> 00:20:40,806 FROM KRUG USE COMPLETELY. 588 00:20:40,872 --> 00:20:42,874 THIS IS SAVING EVEN IF SOMEONE 589 00:20:42,941 --> 00:20:44,309 CONTINUES TO USE DRUGS THERE ARE 590 00:20:44,376 --> 00:20:46,645 THINGS WE CAN DO TO HELP THEM 591 00:20:46,712 --> 00:20:48,914 STAY SAFER TO HELP THEM STAY 592 00:20:48,981 --> 00:20:49,147 ALIVE. 593 00:20:49,214 --> 00:20:51,283 IN MEDICINE WE ARE CONSTABTLY 594 00:20:51,350 --> 00:20:52,651 EMPLOYING THE PRACTICE OF HARM 595 00:20:52,718 --> 00:20:54,486 REDUCTION, WHETHER IT'S 596 00:20:54,553 --> 00:20:56,888 CELEBRATING A PATIENT WITH 597 00:20:56,955 --> 00:20:59,491 DIABETES WHO A1C IS NOT AT GOAL 598 00:20:59,558 --> 00:21:01,760 DID YOU SIGNIFICANTLY IMPROVED 599 00:21:01,827 --> 00:21:04,229 OR USING A ANTIHYPER TENSIVE TO 600 00:21:04,296 --> 00:21:05,497 CONTROL BLOOD PRESSURE WHEN DIET 601 00:21:05,564 --> 00:21:06,999 AND EXERCISE ARE NOT SUFFICIENT 602 00:21:07,065 --> 00:21:08,900 AND DOING IT WITHOUT SHAME OR 603 00:21:08,967 --> 00:21:09,434 STIGMA. 604 00:21:09,501 --> 00:21:13,405 FOR A MULTITUDE OF REASONS 605 00:21:13,472 --> 00:21:16,174 INCLUDING STIGMA, AND STRUCTURAL 606 00:21:16,241 --> 00:21:18,276 INIQUITIES, THE TRIEWMENT OF 607 00:21:18,343 --> 00:21:19,711 SUBSTANCE USE DISORDERS HAS 608 00:21:19,778 --> 00:21:21,480 ALWAYS BEEN APPROACHED 609 00:21:21,546 --> 00:21:21,813 DIFFERENTLY. 610 00:21:21,880 --> 00:21:23,015 RATHER THAN FOCUSING ON 611 00:21:23,081 --> 00:21:24,416 PROGRESS, ABSENCE IS CONSIDERED 612 00:21:24,483 --> 00:21:26,018 THE ONLY SUCCESSFUL OUTCOME AND 613 00:21:26,084 --> 00:21:27,285 RATHER THAN OFFERING 614 00:21:27,352 --> 00:21:27,886 EVIDENCE-BASED MEDICATION FOR 615 00:21:27,953 --> 00:21:29,688 THE TREATMENT OF OPIOID USE 616 00:21:29,755 --> 00:21:30,922 DISORDER, PATIENTS ARE EXPECTED 617 00:21:30,989 --> 00:21:33,592 TO KICK THEIR ADDICTION WITH 618 00:21:33,659 --> 00:21:34,226 SHEER FORCE OF WILL. 619 00:21:34,292 --> 00:21:36,128 SOMETHING WE DON'T EXPECT FOR 620 00:21:36,194 --> 00:21:38,196 ANY OTHER CHRONIC DISEASE. 621 00:21:38,263 --> 00:21:40,666 INSTEAD WHEN WE THINK ABOUT 622 00:21:40,732 --> 00:21:41,667 GOALS FOR TREATING SUBSTANCE 623 00:21:41,733 --> 00:21:42,901 USE, WE NEED TO THINK ABOUT SOME 624 00:21:42,968 --> 00:21:44,136 OF THE HARMFUL CONSEQUENCES THAT 625 00:21:44,202 --> 00:21:47,839 WE WOULD LIKE TO ALLEVIATE, SUCH 626 00:21:47,906 --> 00:21:51,343 AS OVERDOSE DEATH AND 627 00:21:51,410 --> 00:21:52,277 ACQUISITION OF INFECTIOUS 628 00:21:52,344 --> 00:21:53,111 COMPLICATIONS. 629 00:21:53,178 --> 00:21:54,413 WOULD ABSTINENCE BE BE A GOOD 630 00:21:54,479 --> 00:21:56,548 WAY TO ACHIEVE THESE GOALS? 631 00:21:56,615 --> 00:21:56,848 ABSOLUTELY. 632 00:21:56,915 --> 00:21:58,283 BUT IT'S NOT THE ONLY WAY. 633 00:21:58,350 --> 00:22:01,053 AND THE REALITY IS FOR PATIENT 634 00:22:01,119 --> 00:22:03,689 WHO IS DESIRE ABSTINENCE, THE 635 00:22:03,755 --> 00:22:05,290 IDEA THAT PEOPLE GO FROM 636 00:22:05,357 --> 00:22:08,160 COMPLETE USE TO COMPLETE 637 00:22:08,226 --> 00:22:09,127 ABSTINENCE IS UNREALISTIC 638 00:22:09,194 --> 00:22:10,028 THEREFORE FOCUSING ON HARM 639 00:22:10,095 --> 00:22:12,831 REDUCTION IS A WAY TO REDUCE USE 640 00:22:12,898 --> 00:22:14,232 AND DEATH IN FOLKS USING THE 641 00:22:14,299 --> 00:22:16,168 DRUG AND IT'S ALSO A WAY TO 642 00:22:16,234 --> 00:22:18,637 HONOR THE DIGNITY AND AUTONOMY 643 00:22:18,704 --> 00:22:20,005 WITH THESE PATIENTS WHILE 644 00:22:20,072 --> 00:22:21,273 BUILDING RAPPORT WITH THIS 645 00:22:21,339 --> 00:22:22,107 POPULATION. 646 00:22:22,174 --> 00:22:23,241 SO USING MEDICATION FOR DISORDER 647 00:22:23,308 --> 00:22:27,145 IS 1 WAY TO REDUCE HARM, OTHER 648 00:22:27,212 --> 00:22:29,281 WAYS INCLUDE ENGAGING THEM TO 649 00:22:29,347 --> 00:22:31,483 NEEDLE AND SYRINGE PROGRAMS THAT 650 00:22:31,550 --> 00:22:32,684 IF THEY'RE INJECTING THEY'RE 651 00:22:32,751 --> 00:22:34,186 INYECTING WITH SAFE EQUIPMENT, 652 00:22:34,252 --> 00:22:36,655 TO PROVIDE SAFE INJECTION 653 00:22:36,722 --> 00:22:40,258 PRACTICE COUNSELING, OVERDOSE 654 00:22:40,325 --> 00:22:41,860 EDUCATION ANDINAL OX OWN USE AND 655 00:22:41,927 --> 00:22:44,329 MAKURE SURE THEY DON'T DIE FROM 656 00:22:44,396 --> 00:22:48,500 OVERDOSE AND ACCESS TO SAFE 657 00:22:48,567 --> 00:22:49,234 COMSUMPTION SITES. 658 00:22:49,301 --> 00:22:51,303 SO GETTING BACK TO OUR PROGRAM, 659 00:22:51,369 --> 00:22:59,578 AROUND 2015 I WAS FORTUNATE TO 660 00:22:59,644 --> 00:23:04,549 JOIN DCP, AND WE EXPANDED TO THE 661 00:23:04,616 --> 00:23:06,618 UNIVERSITY OF AND NOW UNDER THE 662 00:23:06,685 --> 00:23:08,220 DAY-TO-DAY LEADERSHIP OF MY CO 663 00:23:08,286 --> 00:23:09,354 DIRECTOR SARAH AND MYSELF AS 664 00:23:09,421 --> 00:23:11,690 WELL AS PROGRAM MANAGER RACHEL 665 00:23:11,757 --> 00:23:16,428 [INDISCERNIBLE], 1 OF THE 666 00:23:16,495 --> 00:23:18,263 ORIGINAL DCPFAPP PROGRAM, THIS 667 00:23:18,330 --> 00:23:18,830 ALLOWS US TO INTERNATIONAL 668 00:23:18,897 --> 00:23:21,800 CLASSIFICATION DPRAIT INTO THE 669 00:23:21,867 --> 00:23:27,639 BALTIMORE COMMUNITY AT THAT 670 00:23:27,706 --> 00:23:29,708 TIME, DA STUDIES AND SO WE'RE 671 00:23:29,775 --> 00:23:31,376 FOCUSED SHIFTED TO 672 00:23:31,443 --> 00:23:31,743 IMPLEMENTATION. 673 00:23:31,810 --> 00:23:33,945 MORE SPECIFICALLY HOW TO INSURE 674 00:23:34,012 --> 00:23:34,946 THAT MARGINALIZED POPULATIONS 675 00:23:35,013 --> 00:23:38,517 WERE ABLE TO ACCESS DAAs AND 676 00:23:38,583 --> 00:23:39,985 SUCCESSFULLY ACHIEVE HEPATITIS C 677 00:23:40,051 --> 00:23:40,352 CARE. 678 00:23:40,418 --> 00:23:41,987 WHAT OUR EXPERIENCES IN THE 679 00:23:42,053 --> 00:23:43,488 COMMUNITY LED US TO UNDERSTAND 680 00:23:43,555 --> 00:23:45,690 WAS THAT FINDING WAYS TO 681 00:23:45,757 --> 00:23:46,324 EFFECTIVELY IMPLEMENT HEPATITIS 682 00:23:46,391 --> 00:23:48,393 C TREATMENT IN PEOPLE WHO INYECT 683 00:23:48,460 --> 00:23:51,429 DRUGS WAS CRITICAL TO 684 00:23:51,496 --> 00:23:52,130 INTERRUPTING HEPC TRANSMISSION. 685 00:23:52,197 --> 00:23:56,034 HOE WE WERE EMBEDDED IN HQFCs, 686 00:23:56,101 --> 00:23:57,769 WE WERE TO INJECT PEOPLE WITH 687 00:23:57,836 --> 00:23:59,304 DRUGS WHO WERE NOT ENGAGE INDEED 688 00:23:59,371 --> 00:24:01,206 MEDICAL CARE SO WE HAD TO AGAIN 689 00:24:01,273 --> 00:24:02,741 EXPAND OUR CLINICAL OPERATIONS 690 00:24:02,808 --> 00:24:06,244 AND GO AND SEARCH FOR ADDITIONAL 691 00:24:06,311 --> 00:24:06,978 COMMUNITY PARTNERS. 692 00:24:07,045 --> 00:24:09,147 SO WE ESTABLISHED SITES AND 693 00:24:09,214 --> 00:24:10,515 COMMUNITY BASED SETTINGS IN 694 00:24:10,582 --> 00:24:13,885 WASHINGTON D. C. AND BALTIMORE 695 00:24:13,952 --> 00:24:16,421 WHERE PEOPLE WERE INYECTING 696 00:24:16,488 --> 00:24:19,090 DRUGS WERE ALMOST COMFORTABLE, 697 00:24:19,157 --> 00:24:20,192 INCLUDING SYRINGE CENTERS, 698 00:24:20,258 --> 00:24:21,526 DROP-IN PROGRAMS, AND CLINICS 699 00:24:21,593 --> 00:24:23,295 AND HAVE WORKED THEIR WAY TO THE 700 00:24:23,361 --> 00:24:24,396 EASTERN SHORE AS WELL. 701 00:24:24,462 --> 00:24:26,765 TO HIGHLIGHT 1 OF OUR MAIN 702 00:24:26,832 --> 00:24:28,500 SITES, HIPS, THIS IS AN 703 00:24:28,567 --> 00:24:30,468 ORGANIZATION THAT HAS BEEN 704 00:24:30,535 --> 00:24:31,870 PROVIDING HARM REDUCTION 705 00:24:31,937 --> 00:24:33,805 SERVICES IN THE DISTRICT OF 706 00:24:33,872 --> 00:24:35,073 COLUMBIA SINCE 1993 WITH A 707 00:24:35,140 --> 00:24:37,242 SPECIAL EMPHASIS ON PEOPLE WHO 708 00:24:37,309 --> 00:24:41,046 INJECT DRUGS AND SEX WORKERS. 709 00:24:41,112 --> 00:24:44,216 WHILE HIPS OFFERED SAFE TESTING 710 00:24:44,282 --> 00:24:46,885 SUPPLIES, AND DROP HAD-IN 711 00:24:46,952 --> 00:24:48,053 CENTER, THE POPULATION THEY 712 00:24:48,119 --> 00:24:49,020 SERVED HAD DIFFICULTY 713 00:24:49,087 --> 00:24:50,589 ESTABLISHING AND REMAIN NOTHING 714 00:24:50,655 --> 00:24:52,457 HEALTHCARE AND SO 3 OUR 715 00:24:52,524 --> 00:24:53,491 COLLABORATION, ONSET CLAINICAL 716 00:24:53,558 --> 00:24:55,327 SERVICES WERE INTRODUCED IN 2016 717 00:24:55,393 --> 00:24:56,561 TO MEET THAT NEED. 718 00:24:56,628 --> 00:24:58,163 HERE YOU CAN SEE SOME OF THE 719 00:24:58,230 --> 00:25:01,466 SPACES THAT WE TURNED FROM 720 00:25:01,533 --> 00:25:03,068 LITERAL CLOSETS INTO A FLEBOT ME 721 00:25:03,134 --> 00:25:05,103 SUITE, DOWN IN THE MIDDLE YOU 722 00:25:05,170 --> 00:25:08,106 CAN SEE DANA 1 OF OUR COMMUNITY 723 00:25:08,173 --> 00:25:09,774 OUTREACH WORKERS DOING PARKS 724 00:25:09,841 --> 00:25:15,547 OUTREACH IN PLACES WHERE PEOPLE 725 00:25:15,614 --> 00:25:18,216 INYECT AND CONGREGATE, ALSO SOME 726 00:25:18,283 --> 00:25:19,451 PARKING SPOTS DURING THE HOT 727 00:25:19,517 --> 00:25:20,652 SUMMER AND COLD WINTER WE 728 00:25:20,719 --> 00:25:22,120 CONTINUE TO BE THERE PROVIDING 729 00:25:22,187 --> 00:25:22,854 CLINICAL SERVICES IN THE 730 00:25:22,921 --> 00:25:25,090 COMMUNITY TO OUR PATIENTS. 731 00:25:25,156 --> 00:25:28,727 SO I HOPE YOU TRUST ME FROM THE 732 00:25:28,793 --> 00:25:30,161 PICTURES WHEN I SAY WE BROUGHT 733 00:25:30,228 --> 00:25:31,129 OURSELVES TO THE COMMUNITY, AND 734 00:25:31,196 --> 00:25:33,899 WE SET UP IN TENTS, PARKING 735 00:25:33,965 --> 00:25:35,600 LOTS, PATIENT ACTIVE PORTA 736 00:25:35,667 --> 00:25:36,735 POTTYS BUT HOW DO WE GET THE 737 00:25:36,801 --> 00:25:38,904 PATIENTS TO MEET WITH US, 738 00:25:38,970 --> 00:25:39,938 BECAUSE MEETING WITH THEM IS 739 00:25:40,005 --> 00:25:41,873 JUST THE FIRST STEP. 740 00:25:41,940 --> 00:25:43,408 OUR MODELS OF ENDPAIJMENT IS NOT 741 00:25:43,475 --> 00:25:44,576 ONLY TO LEVERAGE THE TRUSTED 742 00:25:44,643 --> 00:25:45,610 RELATIONSHIPS OF THE COMMUNITY 743 00:25:45,677 --> 00:25:46,878 ORGANIZATIONS MAZATIONS WITH 744 00:25:46,945 --> 00:25:48,313 WHICH WE'RE PARTNERING, BUT ALSO 745 00:25:48,380 --> 00:25:50,649 TO PROVIDE A SPECTRUM OF CO 746 00:25:50,715 --> 00:25:52,484 LOCATED CLINICAL SERVICES 747 00:25:52,550 --> 00:25:54,119 INCLUDING INFECTIOUS DEC 748 00:25:54,185 --> 00:25:55,887 TREATMENT THAT INCOMPASSES HIV 749 00:25:55,954 --> 00:25:57,188 TREATMENT IS PREVENTION, 750 00:25:57,255 --> 00:25:59,190 HEPATITIS C, B, TEST XG 751 00:25:59,257 --> 00:26:00,158 TREATMENT, SUBITANCE USE 752 00:26:00,225 --> 00:26:01,226 DISORDER TREATMENT, MENTAL 753 00:26:01,293 --> 00:26:02,961 HEALTH AND GENDER AFFIRMING 754 00:26:03,028 --> 00:26:03,161 CARE. 755 00:26:03,228 --> 00:26:04,796 BECAUSE WHILE WE FOUND THAT MANY 756 00:26:04,863 --> 00:26:07,666 PATIENTS ARE INTERESTED IN 757 00:26:07,732 --> 00:26:09,734 TREATMENT OF HEP C AND HIV, SOME 758 00:26:09,801 --> 00:26:11,636 ARE INTERESTED THIS ENGAGE 759 00:26:11,703 --> 00:26:12,837 NOTHING OTHER MEDICAL PRIORITIES 760 00:26:12,904 --> 00:26:15,540 OR M. O. U. D. OR GENDER 761 00:26:15,607 --> 00:26:15,907 AFFIRMING CARE. 762 00:26:15,974 --> 00:26:17,342 THEREFORE CO LOCATION OF THESE 763 00:26:17,409 --> 00:26:19,344 SERVES ALLOWS US TO PRIORITIZE 764 00:26:19,411 --> 00:26:21,479 THE PATIENT'S INTEREST AND LAY 765 00:26:21,546 --> 00:26:22,113 ON OTHER PRIORITIES LIKE 766 00:26:22,180 --> 00:26:23,615 TREATMENT AND CARE OF HEPATITIS 767 00:26:23,682 --> 00:26:24,049 C. 768 00:26:24,115 --> 00:26:25,350 ONCE WE ESTABLISHED CLINICAL 769 00:26:25,417 --> 00:26:26,985 SERVICES THAT ARE ACCEPTABLE AND 770 00:26:27,052 --> 00:26:29,054 SUSTAINABLE, WE THEN LAYER ON 771 00:26:29,120 --> 00:26:30,956 RESEARCH ALONGSIDE CLINICAL 772 00:26:31,022 --> 00:26:31,222 CARE. 773 00:26:31,289 --> 00:26:32,324 IN THIS WAY, RESEARCH IS BEING 774 00:26:32,390 --> 00:26:34,292 OFFERED BY A TRUSTED TEAM WITHIN 775 00:26:34,359 --> 00:26:35,226 THE COMMUNITY SITE, AND THE 776 00:26:35,293 --> 00:26:37,228 PATIENTS ARE ABLE TO RECEIVE 777 00:26:37,295 --> 00:26:39,798 CLINICAL CARE WITHOUT RESEARCH, 778 00:26:39,864 --> 00:26:41,466 CLINICAL WITH RESEARCH OR 779 00:26:41,533 --> 00:26:43,535 RESEARCH ALONE. 780 00:26:43,601 --> 00:26:47,472 INSURING THAT THE INVOLVEMENT IN 781 00:26:47,539 --> 00:26:48,907 STUDIES IS COMPLETELY 782 00:26:48,974 --> 00:26:49,207 NONCOERCIVE. 783 00:26:49,274 --> 00:26:50,775 THAT BRINGS US TO THE NEXT 784 00:26:50,842 --> 00:26:51,109 POINT. 785 00:26:51,176 --> 00:26:52,477 DON'T JUST TREAT THE INFECTION, 786 00:26:52,544 --> 00:26:55,747 TREAT THE SOURCE OF THE 787 00:26:55,814 --> 00:26:56,247 INFECTION. 788 00:26:56,314 --> 00:26:57,415 TO HIGHLIGHT THIS PRINCIPLE, I 789 00:26:57,482 --> 00:26:58,516 WANT TO DISCUSS THE ANCHOR 790 00:26:58,583 --> 00:27:00,218 STUDY, THIS WAS A TODAY TO TREAT 791 00:27:00,285 --> 00:27:02,954 EPITITIS C IN PEOPLE WITH OPIOID 792 00:27:03,021 --> 00:27:04,556 USE DISORDER ACTIVELY INJEKING 793 00:27:04,622 --> 00:27:04,789 OPIOIDS. 794 00:27:04,856 --> 00:27:06,958 AT THE TIME THE STUDY WAS 795 00:27:07,025 --> 00:27:10,628 INITIATED IN 2017, PEOPLE WHO US 796 00:27:10,695 --> 00:27:12,831 DRUGS WERE DENIED HEPC TREATMENT 797 00:27:12,897 --> 00:27:13,832 UNLESS THEY WERE ABNORMALITIES 798 00:27:13,898 --> 00:27:14,566 STINNENT, SOMETIMES FOR A YEAR 799 00:27:14,632 --> 00:27:17,969 AND BEING TOLD THEY BEING NOT 800 00:27:18,036 --> 00:27:19,971 GET HEP C TREATMENT UNTIL THEY 801 00:27:20,038 --> 00:27:21,673 OBTAINED TREATMENT FOR THEIR 802 00:27:21,740 --> 00:27:22,707 OPIOID USE DISORDER. 803 00:27:22,774 --> 00:27:24,809 THIS WAS NOT EFS BASED BUT THERE 804 00:27:24,876 --> 00:27:26,978 WAS VERY LITTLE EVIDENCE FOR THE 805 00:27:27,045 --> 00:27:28,480 TIME AND VERY LITTLE ACCESS TO 806 00:27:28,546 --> 00:27:30,415 M. O. U. D. 807 00:27:30,482 --> 00:27:32,350 SO WE DECIDE THE STUDY TO OFFER 808 00:27:32,417 --> 00:27:35,086 TREATMENT TO PEOPLE WHO INJECT 809 00:27:35,153 --> 00:27:37,022 OPIOID USE DISORDER WITH ACTIVE 810 00:27:37,088 --> 00:27:38,890 ONGOING DRUG INYEKS USE 811 00:27:38,957 --> 00:27:39,858 REGARDLESS OF WHETHER OR NOT 812 00:27:39,924 --> 00:27:42,060 THEY WERE ON M. O. U. D. WE 813 00:27:42,127 --> 00:27:43,695 WANTED TO ACCESS PATIENTS WITH 814 00:27:43,762 --> 00:27:45,663 CHAOTIC LIFE FACTORS WHO ARE 815 00:27:45,730 --> 00:27:47,332 UNIVERSALLY BEING EXCLUDED FOR 816 00:27:47,399 --> 00:27:48,633 TREATMENT BUT INVOFFED IN 817 00:27:48,700 --> 00:27:49,667 ONGOING TRANSMISSION. 818 00:27:49,734 --> 00:27:52,404 IN THE FIRST PART OF THE STUDY, 819 00:27:52,470 --> 00:27:54,039 PATIENTS WERE INITIATED ON 12 820 00:27:54,105 --> 00:27:55,240 WEEKS OF HEPATITIS C TREATMENT 821 00:27:55,306 --> 00:27:57,475 THAT WAS DONATED BY GILLIAD 822 00:27:57,542 --> 00:27:59,711 SCIENCES AND MONITORED FOR CARE 823 00:27:59,778 --> 00:28:00,445 AND REINFECTION. 824 00:28:00,512 --> 00:28:02,580 IN ADDITION WE OFFERED OPTIONAL 825 00:28:02,647 --> 00:28:05,750 UPTAKE OF CO LOCATED OPIOID 826 00:28:05,817 --> 00:28:08,153 AGONIST WITH BUPRENORPH TO ALL 827 00:28:08,219 --> 00:28:09,587 ENROLLED PATIENTSA WELL AS 828 00:28:09,654 --> 00:28:11,156 OPTIONAL PREP FOR HIV 829 00:28:11,222 --> 00:28:11,556 PREVENTION. 830 00:28:11,623 --> 00:28:13,324 WE MONITOR PATIENTS OVER THE 831 00:28:13,391 --> 00:28:15,193 COURSE OF A 2 YEAR PERIOD FOR 832 00:28:15,260 --> 00:28:16,694 CHANGE IN DRUG USE FACTORS AND 833 00:28:16,761 --> 00:28:18,763 OTHER OUTCOMES WITH THE ULTIMATE 834 00:28:18,830 --> 00:28:21,599 GOAL BEING TO NOT ONLY CURE HEP 835 00:28:21,666 --> 00:28:23,902 CONSIDER BUT TO USE IT AS AN 836 00:28:23,968 --> 00:28:25,804 OPPORTUNITY TO REDUCE OVERALL 837 00:28:25,870 --> 00:28:31,042 HARM ASSOCIATE WIDE OPIOID USE. 838 00:28:31,109 --> 00:28:32,243 PARTICIPANTS WERE DEDOMINANTLY 839 00:28:32,310 --> 00:28:35,680 BLACK MEN, THIRD ON CIRRHOSIS, 840 00:28:35,747 --> 00:28:37,615 OVER HALF UNSTABLY HOUSED AND 841 00:28:37,682 --> 00:28:39,217 ALMOST ALL WITH PREVIOUS 842 00:28:39,284 --> 00:28:40,685 INCARCERATE AND ALMOST ALL WITH 843 00:28:40,752 --> 00:28:42,320 NO OR GOVERNMENT BENEFITS ONLY. 844 00:28:42,387 --> 00:28:44,022 OUR PATIENTS HAD LIMITED ACCESS 845 00:28:44,089 --> 00:28:46,891 TO M. O. U. D., AND COCO 8ED, 846 00:28:46,958 --> 00:28:48,793 AND OF A HUNDRED PEOPLE WHO 847 00:28:48,860 --> 00:28:49,527 INJECT DRUGS WITH STARTED ON 848 00:28:49,594 --> 00:28:51,930 HEPATITIS E C TREATMENT, 2/3RDS 849 00:28:51,996 --> 00:28:54,132 WERE NOT ON BASE LINE, OF THOSE 850 00:28:54,199 --> 00:28:57,135 4 OUT OF 5, TARTED M. O. U. D. 851 00:28:57,202 --> 00:29:00,038 DURING TREATMENT AND 70% WERE 852 00:29:00,105 --> 00:29:01,072 RETAINED AT WEEK 24. 853 00:29:01,139 --> 00:29:02,874 THE RESULT IS THAT THE LARGE 854 00:29:02,941 --> 00:29:07,278 MAJORITY OF PATIENTS WERE CURED, 855 00:29:07,345 --> 00:29:09,747 82%, WITH 88% CURE RATE WHEN 856 00:29:09,814 --> 00:29:11,082 EXCLUDING THE FOLLOW UP OR DEAD 857 00:29:11,149 --> 00:29:12,984 PATIENTS, THIS WAS THE SUCCESS 858 00:29:13,051 --> 00:29:15,520 THROUGH THE LENS OF HEP C 859 00:29:15,587 --> 00:29:15,887 TREATMENT. 860 00:29:15,954 --> 00:29:18,456 WE ALSO FOUND THAT M. O. U. D. 861 00:29:18,523 --> 00:29:19,491 IMPACTED THAT CURE, IT WAS 862 00:29:19,557 --> 00:29:20,592 ASSOCIATE WIDE HIGHER RATES OF 863 00:29:20,658 --> 00:29:21,926 HEPATITIS E C CARE. 864 00:29:21,993 --> 00:29:23,895 WHILE BEING ON M. O. U. D. AT 865 00:29:23,962 --> 00:29:25,196 BASE LINE WAS NOT RELEVANT TO 866 00:29:25,263 --> 00:29:26,731 THE HEPATITIS E C OUTCOMES, 867 00:29:26,798 --> 00:29:29,634 PATIENTS ON M. O. U. D. BY THE 868 00:29:29,701 --> 00:29:31,336 EPPED OF TREATMENT WERE MORE 869 00:29:31,402 --> 00:29:32,704 SIGNIFICANTLY LIKELY TO ACHIEVE 870 00:29:32,770 --> 00:29:34,105 CARE, REINFORCING THAT PATIENTS 871 00:29:34,172 --> 00:29:36,040 DIDN'T NEED TO BE ON M. O. U. D. 872 00:29:36,107 --> 00:29:37,242 FOR HEPATITIS E C TREATMENT BUT 873 00:29:37,308 --> 00:29:39,010 CAN USE IT AS AN OPPORTUNITY TO 874 00:29:39,077 --> 00:29:41,813 ENGAGE THEM IN M. O. U. D. AND 875 00:29:41,880 --> 00:29:43,882 IMPROVE, THEREBY IMPROVE THE HEP 876 00:29:43,948 --> 00:29:45,116 C OUTCOMES. 877 00:29:45,183 --> 00:29:47,652 WE ALSO LOOKED AT NONHEP C 878 00:29:47,719 --> 00:29:49,420 OUTCOMES SO USING THE DARK RISK 879 00:29:49,487 --> 00:29:51,256 TAKING BEHAVIOR KALE TO,A 880 00:29:51,322 --> 00:29:52,357 ASSESSES PREVIOUS MONTH RISK 881 00:29:52,423 --> 00:29:53,791 BEHAVIORS AND WE FOUND A 882 00:29:53,858 --> 00:29:54,959 SIGNIFICANT DECLINE IN RISK 883 00:29:55,026 --> 00:29:57,562 BEHAVIOR FROM DAY 0 TO WEEK 24 884 00:29:57,629 --> 00:29:59,464 SEEN IN PATIENTS STARTED AND 885 00:29:59,531 --> 00:30:03,101 RETAIN ON O. A. T. BUT NO 886 00:30:03,168 --> 00:30:03,902 SIGNIFICANT EXCHANGES OF 887 00:30:03,968 --> 00:30:07,038 PATIENTS ON BASE LINE OR NOT ON 888 00:30:07,105 --> 00:30:07,338 OAT. 889 00:30:07,405 --> 00:30:09,607 FURTHER WE FOUND THAT M. O. U. 890 00:30:09,674 --> 00:30:11,176 D. AND SBR WERE ASSOCIATE WIDE 891 00:30:11,242 --> 00:30:14,913 QUALITY OF LIFE. 892 00:30:14,979 --> 00:30:17,015 USING THE HCBC QUALITY OF LIFE, 893 00:30:17,081 --> 00:30:22,587 ASSESSED AT DAY 0 AND 24, WE SAW 894 00:30:22,654 --> 00:30:23,688 THAT ACHIEVING SVR, IN BLUE AT 895 00:30:23,755 --> 00:30:26,257 THE TOP AND BEING AT THE BOTTOM 896 00:30:26,324 --> 00:30:27,325 LINE, WERE BOTH ASSOCIATE WIDE 897 00:30:27,392 --> 00:30:29,127 IMPROVED QUALITY OF LCH. 898 00:30:29,194 --> 00:30:30,595 HOWEVER PEOPLE NOT ON M. O. U. 899 00:30:30,662 --> 00:30:37,168 D. OR DID NOT KARKS CHIEF SCVR 900 00:30:37,235 --> 00:30:40,071 DID NOT ACHIEVE THESE 901 00:30:40,138 --> 00:30:40,405 IMPROVEMENTS. 902 00:30:40,471 --> 00:30:43,141 SO THIS IS AN OPPORTUNITY TO NOT 903 00:30:43,208 --> 00:30:45,910 ONLY IMPROVE HEP C CURE RATES IN 904 00:30:45,977 --> 00:30:48,079 THOSE WHO INJECT DRUGS BUT TO 905 00:30:48,146 --> 00:30:49,647 REDUCE HARM DURING THE COURSE OF 906 00:30:49,714 --> 00:30:50,949 THE HEP C TREATMENT. 907 00:30:51,015 --> 00:30:54,352 BUT WHAT ABOUT LONG-TERM? 908 00:30:54,419 --> 00:30:57,121 I WANT TO HIGHLIGHT 2-POINTS. 909 00:30:57,188 --> 00:30:59,958 THE FIRST IS THAT 82% OF OUR 910 00:31:00,024 --> 00:31:01,693 PARTICIPANTS COMPLETED THE FINAL 911 00:31:01,759 --> 00:31:01,993 STUDY VISIT. 912 00:31:02,060 --> 00:31:04,929 OF OUR OVERALL STUDY OF 198 913 00:31:04,996 --> 00:31:06,231 PATIENTS, THAT'S 82% OF PEOPLE 914 00:31:06,297 --> 00:31:07,799 WHO WERE ACTIVELY USING DRUGS AT 915 00:31:07,865 --> 00:31:10,935 THE TIME OF ENROLL AM, 916 00:31:11,002 --> 00:31:11,869 MAINTAINED ENGAGEMENT FOR 2 917 00:31:11,936 --> 00:31:12,170 YEARS. 918 00:31:12,237 --> 00:31:13,705 WHEN LOOKING AT ONLY THE SUBSET 919 00:31:13,771 --> 00:31:15,373 WHO ARE ALIVE AT THE END OF THE 920 00:31:15,440 --> 00:31:16,975 STUDY OR HAD NOT REALLY 921 00:31:17,041 --> 00:31:19,277 TERMINATED AT THAT TIME POINT, 922 00:31:19,344 --> 00:31:21,312 IT WAS 94%. 923 00:31:21,379 --> 00:31:23,448 AND OF THOSE, OVER HALF ENROLLED 924 00:31:23,514 --> 00:31:25,950 IN A 2 YEAR EXTENSION STUDY. 925 00:31:26,017 --> 00:31:29,254 THERE IS NO QUESTION IN MY MIND 926 00:31:29,320 --> 00:31:31,289 THAT THIS LONGITUDIAL ENGAGEMENT 927 00:31:31,356 --> 00:31:33,391 AND M. O. U. D. CARE IS ONLY 928 00:31:33,458 --> 00:31:34,525 POSSIBLE BECAUSE OF OUR 929 00:31:34,592 --> 00:31:35,293 COMMUNITY BASED RESEARCH MODEL 930 00:31:35,360 --> 00:31:36,561 EMPLOY WE COULD NOT HAVE GOTTEN 931 00:31:36,628 --> 00:31:37,762 MOST OF THESE PATIENTS THROUGH 932 00:31:37,829 --> 00:31:40,498 THE GATES AT NIH EVEN IF THEY 933 00:31:40,565 --> 00:31:41,599 SHOWED UP. 934 00:31:41,666 --> 00:31:43,067 THEY DON'T HAVE IDs, THEY 935 00:31:43,134 --> 00:31:44,802 COULDN'T HAVE COME IN BUT THEY 936 00:31:44,869 --> 00:31:46,838 WERE HAPPY AND EAGER TO SEE US 937 00:31:46,904 --> 00:31:49,140 AT SITES THAT FELT CULTURAL AND 938 00:31:49,207 --> 00:31:49,407 CONFIDENT. 939 00:31:49,474 --> 00:31:51,542 I ALSO WANT TO HIGHLIGHT THAT 940 00:31:51,609 --> 00:31:53,478 OVER THE COURSE OF THE ANCHOR 941 00:31:53,544 --> 00:31:54,912 STUDY, 3-QUARTERS OF THE 942 00:31:54,979 --> 00:31:56,447 PARTICIPANTS WERE EVER ON M. O. 943 00:31:56,514 --> 00:31:58,583 U. D. THROUGH 1 OF OUR SITES. 944 00:31:58,650 --> 00:32:03,855 AND HERE'S WHY IT MATTERS? 945 00:32:03,921 --> 00:32:05,923 WE HAD A STAGGERING AMOUNT OF 946 00:32:05,990 --> 00:32:08,426 DEATH AMONG OUR PATIENTS. 947 00:32:08,493 --> 00:32:10,828 TWENTY-SIX PARTICIPANTS DIED OF 948 00:32:10,895 --> 00:32:13,131 WHOM 77% DIED OF OVERDOSE. 949 00:32:13,197 --> 00:32:14,999 I KNEW THEM ALL. 950 00:32:15,066 --> 00:32:16,434 I WONDER WHAT WE COULD HAVE DONE 951 00:32:16,501 --> 00:32:19,170 FOR THEM TO KEEP THEM ALIVE. 952 00:32:19,237 --> 00:32:21,406 BUT I AM LIGHTLY COMFORTED BY 953 00:32:21,472 --> 00:32:22,774 THE UNDERSTANDING THAT M. O. U. 954 00:32:22,840 --> 00:32:26,878 D. WAS ASSOCIATED WITH A 62% 955 00:32:26,944 --> 00:32:28,546 REDUCTION IN MORTALITY. 956 00:32:28,613 --> 00:32:29,814 WE SAVED SOME LIVES, NOT ALL, 957 00:32:29,881 --> 00:32:32,317 BUT WE SAVED SOME, BECAUSE WE 958 00:32:32,383 --> 00:32:33,918 ENGAGE THEM IN HEPC CARE BUT 959 00:32:33,985 --> 00:32:35,586 IT'S NOT ACTUALLY BECAUSE WE 960 00:32:35,653 --> 00:32:37,555 CURED THEIR HEP C THAT THEIR 961 00:32:37,622 --> 00:32:38,122 LIVES WERE SAVED. 962 00:32:38,189 --> 00:32:40,158 IT'S BECAUSE IN THE PROCESS OF 963 00:32:40,224 --> 00:32:43,094 TREATING THEIR HEP C, WE ALSO 964 00:32:43,161 --> 00:32:44,996 CHOSE TO ADDRESS THE SOURCE OF 965 00:32:45,063 --> 00:32:46,898 THEIR INFECTION AND THEIR OPILOT 966 00:32:46,964 --> 00:32:48,266 PROJECT IDENTITY USE DID ORDER, 967 00:32:48,333 --> 00:32:50,468 IN RESEARCH WE SPENT A LOT OF 968 00:32:50,535 --> 00:32:52,003 TIME THINKING ABOUTEN POINTS AND 969 00:32:52,070 --> 00:32:53,738 I CAN SAY WITH CONFIDENCE IF 970 00:32:53,805 --> 00:32:56,541 YOUR GELLERT IS TO REDUCE 971 00:32:56,607 --> 00:33:01,579 MORTAILITY OF PEOPLE WHO USE 972 00:33:01,646 --> 00:33:03,014 DRUGS AND HAVE HEP C, BUT YOU 973 00:33:03,081 --> 00:33:06,184 HAVE TO TREAT THEIR OPIOID USE 974 00:33:06,250 --> 00:33:06,451 DISORDER. 975 00:33:06,517 --> 00:33:08,052 SO WE FOCUSED ON INFECTIONS 976 00:33:08,119 --> 00:33:09,287 RELATED TO OPIOID USE DISORDER 977 00:33:09,354 --> 00:33:11,422 THAT ARE SEEN IN THE OUTPATIENT 978 00:33:11,489 --> 00:33:11,656 SETTING. 979 00:33:11,723 --> 00:33:12,690 BUT IT'S ALSO CRITICAL THAT 980 00:33:12,757 --> 00:33:14,025 EVERY TOUCH POINT WITH THE 981 00:33:14,092 --> 00:33:14,959 HEALTHCARE SYSTEM BE AN 982 00:33:15,026 --> 00:33:16,527 OPPORTUNITY TO ENGAGE PEEMENT 983 00:33:16,594 --> 00:33:17,695 WITH OPIOID USE DISORDER AND 984 00:33:17,762 --> 00:33:17,962 TREATMENT. 985 00:33:18,029 --> 00:33:19,630 SO WE ALSO WANT TO FOCUS FOR A 986 00:33:19,697 --> 00:33:20,765 FEW MINUTES ON INFECTIONS THAT 987 00:33:20,832 --> 00:33:23,634 BRING PEOPLE TO THE HOSPITAL. 988 00:33:23,701 --> 00:33:25,937 AS I MENTIONED BEFORE, THERE'S 989 00:33:26,003 --> 00:33:28,639 BEEN A PRECIPITOUS RISE IN 990 00:33:28,706 --> 00:33:29,807 BACTERIAL FUNGAL INFECS 991 00:33:29,874 --> 00:33:32,443 ASSOCIATED WITH CONTAMINATION 992 00:33:32,510 --> 00:33:35,913 DURING INJECTION, LEAVING SOFT 993 00:33:35,980 --> 00:33:36,447 TISSUE INRECYCLINGS, 994 00:33:36,514 --> 00:33:38,049 ENDOCARTITIS, YOU NAME IT. 995 00:33:38,116 --> 00:33:40,218 UNLIKE CHRONIC VIRAL INFECTIONS 996 00:33:40,284 --> 00:33:41,919 LIKE HIV AND HEPATITIS C WHICH 997 00:33:41,986 --> 00:33:43,888 WILL KILL PEOPLE OVER YEARS TO 998 00:33:43,955 --> 00:33:45,556 DECK'SS THESE INFECS CAN MAKE 999 00:33:45,623 --> 00:33:47,458 YOUNG PEOPLE ACUTELY ILL ASK 1000 00:33:47,525 --> 00:33:48,860 RESULT IN SIGNIFICANT MORBIDITY 1001 00:33:48,926 --> 00:33:50,294 OR EVEN MORTALITY IN A VERY 1002 00:33:50,361 --> 00:33:53,498 SHORT PERIOD OF TIME. 1003 00:33:53,564 --> 00:33:55,199 IN ORDER TO BETTER UNDERSTAND 1004 00:33:55,266 --> 00:33:56,467 HOW TO IMPACT CHANGE IN THESE 1005 00:33:56,534 --> 00:33:58,369 PATIENTS WE HAD TO FIRST 1006 00:33:58,436 --> 00:34:00,638 UNDERSTAND THE STATUS QUO AND WE 1007 00:34:00,705 --> 00:34:03,074 WERE VERY FORTUNATE AS ALWAYS TO 1008 00:34:03,141 --> 00:34:04,909 RECEIVE SUPPORT FROM DR. BOB 1009 00:34:04,976 --> 00:34:06,411 [INDISCERNIBLE] TO CREATE A 1010 00:34:06,477 --> 00:34:09,213 CONSORTIUM BETWEEN THE 1011 00:34:09,280 --> 00:34:11,048 UNIVERSITY OF MARYLAND, GW, 1012 00:34:11,115 --> 00:34:12,650 UNIVERSITY OF ALABAMA BIRMINGHAM 1013 00:34:12,717 --> 00:34:15,453 AND EMORY UNIVERSITY TO CONDUCT 1014 00:34:15,520 --> 00:34:17,555 A RETROSPECTIVE REVIEW OF 1015 00:34:17,622 --> 00:34:18,489 PATIENTS HOSPITALIZED IN 2018 1016 00:34:18,556 --> 00:34:21,559 WITH INFECTIONS DUE TO INYECTING 1017 00:34:21,626 --> 00:34:21,793 OPIOIDS. 1018 00:34:21,859 --> 00:34:24,262 WE SAW 322 PATIENTS WHO MET THE 1019 00:34:24,328 --> 00:34:26,798 CRITERIA AND THERE WAS ACROSS 1020 00:34:26,864 --> 00:34:29,767 THE BOARD SUBOPTIMAL M. O. U. D. 1021 00:34:29,834 --> 00:34:31,369 ENGAGEMENT DURING THE 1022 00:34:31,436 --> 00:34:31,736 HOSPITALIZATION. 1023 00:34:31,803 --> 00:34:35,706 HERE WE SEE THAT 29 RS --29% OF 1024 00:34:35,773 --> 00:34:36,974 THE PATIENTS WERE ON BASE LINE 1025 00:34:37,041 --> 00:34:39,477 M. O. U. D. 1026 00:34:39,544 --> 00:34:40,378 SO THE MINORITY. 1027 00:34:40,445 --> 00:34:42,513 THE REST WERE CONTINUED ON M. O. 1028 00:34:42,580 --> 00:34:44,849 U. D. DURING HOSPITALIZATION. 1029 00:34:44,916 --> 00:34:51,022 WHEREAS THE 71%, NOT AT BASE 1030 00:34:51,088 --> 00:34:55,126 LINE, ONLY 29% WERE PUT ON M. O. 1031 00:34:55,193 --> 00:34:57,562 U. D., AND IF WE LOOK AT THE 1032 00:34:57,628 --> 00:34:59,430 OVERALL CONTINUUM OF M. O. U. D. 1033 00:34:59,497 --> 00:35:01,833 CARE, WE CAN ALSO SEE THAT ONLY 1034 00:35:01,899 --> 00:35:05,603 41% HAVE M. O. U. D. ON THEIR 1035 00:35:05,670 --> 00:35:06,704 DISCHARGE PRESCRIPTION, 40% HAD 1036 00:35:06,771 --> 00:35:09,407 AN M. O. U. D. REFERRAL AND ONLY 1037 00:35:09,474 --> 00:35:11,542 8 AND HALF% WERE LINKED TO M. O. 1038 00:35:11,609 --> 00:35:13,077 U. D. IN THE YEAR FOLLOWING 1039 00:35:13,144 --> 00:35:14,679 DISCHARGE AND REMEMBER, THESE 1040 00:35:14,745 --> 00:35:17,348 ARE ALL PATIENTS WHO HAVE OPIOID 1041 00:35:17,415 --> 00:35:18,483 USE DISORDER AND WERE 1042 00:35:18,549 --> 00:35:19,917 HOSPITALIZED FOR A COMPLICATION 1043 00:35:19,984 --> 00:35:22,720 OF THEIR OPIOID USE DISORDER. 1044 00:35:22,787 --> 00:35:25,356 WE ALSO FOUND DRAMATICALLY HIGH 1045 00:35:25,423 --> 00:35:27,191 RATES OF PREMATURE DISCHARGE, 1 1046 00:35:27,258 --> 00:35:30,728 IN MY PATIENTS LEFT PREMATURELY, 1047 00:35:30,795 --> 00:35:31,696 PREMATURE DISCHARGE WAS 1048 00:35:31,762 --> 00:35:32,597 ASSOCIATE WIDE NOT TREATING 1049 00:35:32,663 --> 00:35:33,998 THEIR ARK DICTION, NOT BEING ON 1050 00:35:34,065 --> 00:35:35,700 PATIENT M. O. U. D., NOT BEING 1051 00:35:35,766 --> 00:35:36,534 INITIATE OFFICE OF DIVERSITY M. 1052 00:35:36,601 --> 00:35:39,337 O. U. D. AND NOT HAVING AN 1053 00:35:39,403 --> 00:35:41,472 ADDICTION CONSOLE. 1054 00:35:41,539 --> 00:35:42,874 THAL IS PARTICULARLY CONCERNING 1055 00:35:42,940 --> 00:35:44,375 BECAUSE OF THE 1 IN 5 PATIENT 1056 00:35:44,442 --> 00:35:46,444 WHO IS LEFT PREMATURELY, 80% OF 1057 00:35:46,511 --> 00:35:49,447 THEM HAD NO PLAN FOR ANTIBIOTIC 1058 00:35:49,514 --> 00:35:51,182 TREATMENT COMPLETION, OKAY, 1059 00:35:51,249 --> 00:35:52,350 THEY'RE HOSPITALIZED FOR AN 1060 00:35:52,416 --> 00:35:54,585 INFECTION, THEY LEFT WITH AN 1061 00:35:54,652 --> 00:35:55,553 ANTIBIOTIC PLAN. 1062 00:35:55,620 --> 00:35:56,687 WE'RE NOT TREATING THEIR 1063 00:35:56,754 --> 00:35:59,624 INFECTION OR ADICK AT THAT 1064 00:35:59,690 --> 00:35:59,824 POINT. 1065 00:35:59,891 --> 00:36:05,196 OF THE 316 PATIENTS DISCHARGED 1066 00:36:05,263 --> 00:36:06,631 ALIVE, HALF WERE READMITTED IN 1067 00:36:06,697 --> 00:36:08,900 THE FOLLOWING YEAR FOLLOWING 1068 00:36:08,966 --> 00:36:09,700 SENTINAL ADMISSION. 1069 00:36:09,767 --> 00:36:11,068 READMISSION WAS NOT ASSOCIATED 1070 00:36:11,135 --> 00:36:13,137 WITH M. O. U. D. RECEIVED OR 1071 00:36:13,204 --> 00:36:14,572 CONSULTATION WHICH WAS A 1072 00:36:14,639 --> 00:36:16,874 DISAPPOINTING FINDING FOR US BUT 1073 00:36:16,941 --> 00:36:18,109 I THINK REFLECTIVE OF THE FACT 1074 00:36:18,175 --> 00:36:21,279 THAT WE HAD VERY POOR RATES OF 1075 00:36:21,345 --> 00:36:22,480 LINKAGE AND RETENTION IN THE 1076 00:36:22,547 --> 00:36:22,813 COMMUNITY. 1077 00:36:22,880 --> 00:36:23,881 BUT WE WANTED TO BETTER 1078 00:36:23,948 --> 00:36:24,782 UNDERSTAND WHAT WAS HAPPENING, 1079 00:36:24,849 --> 00:36:26,784 WHY PEOPLE WERE GETTING 1080 00:36:26,851 --> 00:36:29,220 READMITTED SO OFTEN, WHAT WAS 1081 00:36:29,287 --> 00:36:29,954 HAPPENING DURING THE 1082 00:36:30,021 --> 00:36:31,355 READMISSIONS AND WHAT WERE THEY 1083 00:36:31,422 --> 00:36:31,522 FOR. 1084 00:36:31,589 --> 00:36:34,825 SO WE'RE IN THE PROCESS OF 1085 00:36:34,892 --> 00:36:36,360 EXPANDING A RETROSPECTIVE 1086 00:36:36,427 --> 00:36:38,362 ANALYSIS, WE'RE NOT DONE YET, 1087 00:36:38,429 --> 00:36:40,097 WE'RE LOOKING AT PATIENTS 1088 00:36:40,164 --> 00:36:41,365 HOSPITALIZED OVER A 4 YEAR 1089 00:36:41,432 --> 00:36:46,370 PERIOD AND SO FAR WE HAVE 1090 00:36:46,437 --> 00:36:50,875 IDENTIFIED 964 PATIENTS ALIVE. 1091 00:36:50,942 --> 00:36:52,443 MEDIAN TIME OF READMISSION WAS A 1092 00:36:52,510 --> 00:36:53,411 MONTH AND A HALF. 1093 00:36:53,477 --> 00:36:55,580 WHEN LOOKING AT THE CAUSE OF THE 1094 00:36:55,646 --> 00:36:56,948 FIRST READMISSION, 2/3RDS CAME 1095 00:36:57,014 --> 00:36:59,850 BACK FOR AN INFECTION, MORE 1096 00:36:59,917 --> 00:37:01,485 SPECIFICALLY, A THIRD WERE 1097 00:37:01,552 --> 00:37:04,522 RELATED TO PERSISTENT SENTINAL 1098 00:37:04,589 --> 00:37:06,290 INFECTION, AND A QUAURTER HAD 1099 00:37:06,357 --> 00:37:08,159 ACTUALLY RESOLVED THEIR INITIAL 1100 00:37:08,225 --> 00:37:10,928 INFECTION AND WERE BACK FOR A 1101 00:37:10,995 --> 00:37:14,732 NEW INFECTION RELATED TO 1102 00:37:14,799 --> 00:37:15,099 INYECTING DRUGS. 1103 00:37:15,166 --> 00:37:17,435 WHICH RAISES THE QUESTION, WHAT 1104 00:37:17,501 --> 00:37:18,803 ISHT VENTIONS CAN WE IMPLEMENT 1105 00:37:18,869 --> 00:37:20,438 FOR PEOPLE HOSPITALIZED WITH 1106 00:37:20,504 --> 00:37:24,275 INYEKS RELATED INFECTION TO 1107 00:37:24,342 --> 00:37:25,743 REDUCE REHOSPITALIZATION DUE TO 1108 00:37:25,810 --> 00:37:27,778 REDUCING INFECTION AND PREVENT 1109 00:37:27,845 --> 00:37:29,046 NEW INJECTION DRUG USE 1110 00:37:29,113 --> 00:37:29,347 INFECTIONS. 1111 00:37:29,413 --> 00:37:31,749 WE ARE VERY FORTUNATE THAT THE 1112 00:37:31,816 --> 00:37:32,683 HEAL INITIATIVE RECOGNIZED 1113 00:37:32,750 --> 00:37:34,051 IMPORTANCE OF THIS QUESTION AND 1114 00:37:34,118 --> 00:37:35,486 IS FUNDING A STUDY WHICH WILL BE 1115 00:37:35,553 --> 00:37:38,055 CONDUCTED OVER THE NEXT 4 YEARS 1116 00:37:38,122 --> 00:37:39,924 WHICH BRINGS US TO OUR NEXT 1117 00:37:39,991 --> 00:37:40,524 POINT. 1118 00:37:40,591 --> 00:37:41,926 IN ORDER TO ACHIEVE SOURCE 1119 00:37:41,993 --> 00:37:43,094 CONTROL FOR INFECTIONS DUE TO 1120 00:37:43,160 --> 00:37:44,695 SUBSTANCE USE, WE HAVE TO 1121 00:37:44,762 --> 00:37:45,396 CONDUCT PATIENT CENTERED 1122 00:37:45,463 --> 00:37:46,964 RESEARCH TO BETTER UNDERSTAND 1123 00:37:47,031 --> 00:37:48,899 HOW TO ACHIEVE SOURCE CONTROL. 1124 00:37:48,966 --> 00:37:50,034 THIS IS CRITICAL. 1125 00:37:50,101 --> 00:37:52,036 WE KNOW VERY LITTLE ABOUT 1126 00:37:52,103 --> 00:37:54,005 SPECIFIC ISHT VENTIONS TO REDUCE 1127 00:37:54,071 --> 00:37:56,474 RISKS OF INFECTION AMONG PEOPLE 1128 00:37:56,540 --> 00:37:57,808 WITH OPIOID USE DISORDER. 1129 00:37:57,875 --> 00:38:01,345 WE HAVE VERY LITTLE EVIDENT TO 1130 00:38:01,412 --> 00:38:02,913 INFORM CLINICIANS, GUIDELINES OR 1131 00:38:02,980 --> 00:38:03,180 PAYERS. 1132 00:38:03,247 --> 00:38:04,882 PRETTY MUCH WHAT WE DO KNOW IS 1133 00:38:04,949 --> 00:38:06,851 THAT M. O. U. D. IS IMPORTANT, 1134 00:38:06,917 --> 00:38:08,853 WE KNOW M. O. U. D. IS UPDATER 1135 00:38:08,919 --> 00:38:09,720 UTILIZE EXCLUDE WE THEED TO KNOW 1136 00:38:09,787 --> 00:38:11,522 HOW TO GET BETTER ACCESS TO M. 1137 00:38:11,589 --> 00:38:13,224 O. U. D. BUT WE ALSO KNOW 1138 00:38:13,290 --> 00:38:15,693 MEDICATION IS OFTEN NOT A 1139 00:38:15,760 --> 00:38:15,926 PANACEA. 1140 00:38:15,993 --> 00:38:18,696 WE NEED MORE WAYS TO HELP OUR 1141 00:38:18,763 --> 00:38:19,897 PATIENTS THEREFORE WE NEED 1142 00:38:19,964 --> 00:38:21,332 RESEARCH, ESPECIALLY WITH THE 1143 00:38:21,399 --> 00:38:22,400 FOCUS ON IMPLEMENTATION, TO 1144 00:38:22,466 --> 00:38:24,835 BETTER UNDERSTAND HOW TO 1145 00:38:24,902 --> 00:38:25,403 EFFECTIVELY AND SUSTAINABLY 1146 00:38:25,469 --> 00:38:29,573 TREAT THE SOURCE OF THESE 1147 00:38:29,640 --> 00:38:29,974 INFECTIONS. 1148 00:38:30,041 --> 00:38:32,043 TO TRY TO ENDEAVOR TO ANSWER 1149 00:38:32,109 --> 00:38:33,511 THESE QUESTIONS, WE'VE AGAIN 1150 00:38:33,577 --> 00:38:36,881 CREATED THE CONSORTIUM LED BY 1151 00:38:36,947 --> 00:38:37,381 DR. [INDISCERNIBLE] AT 1152 00:38:37,448 --> 00:38:38,482 INTRAMURAL WITH OUR TEAM AT 1153 00:38:38,549 --> 00:38:40,418 UNIVERSITY OF MARYLAND LED BY 1154 00:38:40,484 --> 00:38:45,623 SARAH, MYSELF AND ED 1155 00:38:45,690 --> 00:38:48,125 [INDISCERNIBLE], AND GW AND WEST 1156 00:38:48,192 --> 00:38:50,327 EMORY, AND THESE REPRESENT THE 1157 00:38:50,394 --> 00:38:52,396 SPECTRUM FOR ARK DICTION, 1158 00:38:52,463 --> 00:38:53,831 PRIMARY CARE, GENERAL MEDICINE, 1159 00:38:53,898 --> 00:38:54,932 EMERGENCY MEDICINE, ALL THE 1160 00:38:54,999 --> 00:38:57,268 PEOPLE WHO INTERFACE WITH THIS 1161 00:38:57,334 --> 00:38:58,002 PATIENT POPULATION. 1162 00:38:58,069 --> 00:39:01,272 AND THE FIRST THING WE DID, 1163 00:39:01,338 --> 00:39:02,106 WELL, PROBABLY THE SECOND THING 1164 00:39:02,173 --> 00:39:04,875 WE DID WAS TAKE THE DATA THAT WE 1165 00:39:04,942 --> 00:39:05,876 HAD ALREADY ACCUMULATED AND WE 1166 00:39:05,943 --> 00:39:08,345 WANTED TO MEET WITH OUR KEY 1167 00:39:08,412 --> 00:39:11,348 STAKEHOLDERS AT OUR INSTITUTIONS 1168 00:39:11,415 --> 00:39:12,917 TO REALLY SEE WHAT THEY THOUGHT 1169 00:39:12,983 --> 00:39:14,452 WERE THE REASONS THAT THESE 1170 00:39:14,518 --> 00:39:15,419 PATIENTS WERE GETTING 1171 00:39:15,486 --> 00:39:16,053 REHOSPITALIZED. 1172 00:39:16,120 --> 00:39:17,822 AND THE ANSWERS REALLY FELL INTO 1173 00:39:17,888 --> 00:39:18,255 2 BUCKETS. 1174 00:39:18,322 --> 00:39:21,592 THE FIRST WAS THAT THERE'S 1175 00:39:21,659 --> 00:39:24,295 LIMITATIONS OF I.D. AND M. O. U. 1176 00:39:24,361 --> 00:39:25,730 D. MEDICAL CARE DURING 1177 00:39:25,796 --> 00:39:26,097 HOSPITALIZATION. 1178 00:39:26,163 --> 00:39:27,264 THIS IDEA THAT THEY'RE NOT 1179 00:39:27,331 --> 00:39:29,133 GETTING ACCESS TO THE MEDICATION 1180 00:39:29,200 --> 00:39:31,736 THEY NEED, THEY'RE NOT GETTING 1181 00:39:31,802 --> 00:39:34,438 THE MEDICATION FOR OPIOID USE 1182 00:39:34,505 --> 00:39:36,173 DISORDER, THEY'RE NOT GETTING 1183 00:39:36,240 --> 00:39:37,875 ANTIBIOTICS WE NEED A BETTER WAY 1184 00:39:37,942 --> 00:39:38,776 TO INSURE THEY'RE GETTING THE 1185 00:39:38,843 --> 00:39:39,477 RIGHT MEDICAL CARE. 1186 00:39:39,543 --> 00:39:41,212 THE OTHER BUCKET WAS CHALLENGING 1187 00:39:41,278 --> 00:39:43,914 SOCIAL DETERMINE NABTS OF HEALTH 1188 00:39:43,981 --> 00:39:45,416 AND PSYCHOSOCIAL CIRCUMSTANCES. 1189 00:39:45,483 --> 00:39:47,451 HOW CAN WE EXPECT PEOPLE TO 1190 00:39:47,518 --> 00:39:48,219 PRIORITIZE ADDICTION AND 1191 00:39:48,285 --> 00:39:49,386 TREATMENT OF INFECTION WHEN 1192 00:39:49,453 --> 00:39:51,288 THEY'RE HOMELESS, WHEN THEY'RE 1193 00:39:51,355 --> 00:39:52,323 BEING TRAUMATIZED, WHEN THEY 1194 00:39:52,389 --> 00:39:53,858 DON'T HAVE ANY MONEY, RIGHT IN 1195 00:39:53,924 --> 00:39:57,194 SO THESE WERE REALLY THE MAIN 1196 00:39:57,261 --> 00:39:58,729 CHALLENGES AND AMONGST OUR GROUP 1197 00:39:58,796 --> 00:40:01,365 WE REALLY DEBATED WHICH OF THESE 1198 00:40:01,432 --> 00:40:02,900 CHALLENGES WERE MORE SALIENT AND 1199 00:40:02,967 --> 00:40:07,338 WE COULDN'T AGREEN CELLS OR 1200 00:40:07,404 --> 00:40:08,405 DECIDE SO WE THOUGHT THEY WERE 1201 00:40:08,472 --> 00:40:11,408 BOTH SO WE CAME UP WITH 2 TO 1202 00:40:11,475 --> 00:40:12,176 ADDRESS THESE ISSUES. 1203 00:40:12,243 --> 00:40:17,081 THE FIRST IS AN M. O. U. DAND ID 1204 00:40:17,148 --> 00:40:19,116 MEDICAL CLINIC WITH CARE AND 1205 00:40:19,183 --> 00:40:20,417 CARE COORDINATION BETWEEN THE 1206 00:40:20,484 --> 00:40:23,821 OUTPATIENT AND M. O. U. D. AND 1207 00:40:23,888 --> 00:40:24,455 D. D. PROVIDERS. 1208 00:40:24,522 --> 00:40:25,656 SO THE WHYED THAT THIS 1209 00:40:25,723 --> 00:40:26,624 INFORMATION WILL BE LINK FRIDAY 1210 00:40:26,690 --> 00:40:28,459 THE HOSPITAL INTO THE INTEGRATED 1211 00:40:28,526 --> 00:40:29,527 CLINIC WILL IMMEDIATELY HAVE 1212 00:40:29,593 --> 00:40:31,529 ACCESS TO A PROVIDER WHO CAN 1213 00:40:31,595 --> 00:40:33,330 PRESCRIBE MEDICATION FOR THE 1214 00:40:33,397 --> 00:40:34,999 OPIOID USE DID ORDER AND TREAT 1215 00:40:35,065 --> 00:40:37,735 THEIR ARK DICTION AS WELL AS 1216 00:40:37,802 --> 00:40:39,036 DOCTORS WHO WERE TREAT THEIR 1217 00:40:39,103 --> 00:40:41,272 DISEASES WHETHER IT'S SENTINAL 1218 00:40:41,338 --> 00:40:43,107 INFECTIONS, NEW INFECTIONS, 1219 00:40:43,174 --> 00:40:44,742 PREP, HIV TREME, HEAP TITIS C 1220 00:40:44,809 --> 00:40:45,810 TREME, WHATEVER THE NEEDS ARE, 1221 00:40:45,876 --> 00:40:47,845 THEY WILL BE SEEN BY THIS 1222 00:40:47,912 --> 00:40:49,013 COORDINATED CARE TEAM WITHIN THE 1223 00:40:49,079 --> 00:40:51,115 FIRST 14 DAYS AFTER DISCHARGE 1224 00:40:51,182 --> 00:40:52,216 AND MONTHLY THEREAFTER IF NOT 1225 00:40:52,283 --> 00:40:52,483 MORE. 1226 00:40:52,550 --> 00:40:54,251 AND THE MOPE IS THAT THIS 1227 00:40:54,318 --> 00:40:55,719 WILL--HOPE IS THAT THIS WILL 1228 00:40:55,786 --> 00:40:57,555 HELP TO ADDRESS THEIR ADICK, 1229 00:40:57,621 --> 00:40:59,056 RESOLVE INFECTION AND EITHER 1230 00:40:59,123 --> 00:41:00,457 PREVEBT OR RAPIDLY ADDRESS ANY 1231 00:41:00,524 --> 00:41:01,058 NEW INFECTIONS SOPHISTICATEDY 1232 00:41:01,125 --> 00:41:04,562 THAT THEY DON'T HAVE TO BE 1233 00:41:04,628 --> 00:41:04,895 HOSPITALIZED. 1234 00:41:04,962 --> 00:41:06,697 THE OTHER ARM, THE OTHER BUCKET 1235 00:41:06,764 --> 00:41:08,866 IS A SOCIAL SUPPORT ARM, AIMED 1236 00:41:08,933 --> 00:41:10,034 AT ADDRESSING SOCIAL 1237 00:41:10,100 --> 00:41:11,068 DETERMINANTS OF HEALTH AND 1238 00:41:11,135 --> 00:41:13,370 BARRIERS TO CARE THROUGH CASE 1239 00:41:13,437 --> 00:41:15,372 MANAGE AM, ADVOCACY, SERVICE 1240 00:41:15,439 --> 00:41:16,073 LINKAGE AND MOTIVATIONAL 1241 00:41:16,140 --> 00:41:18,042 INTERVIEWING AND THIS IS DONE IN 1242 00:41:18,108 --> 00:41:19,376 COLLABORATION WITH THE FRIENDS 1243 00:41:19,443 --> 00:41:21,145 RESEARCH AND HEAVILY DEVELOPED 1244 00:41:21,212 --> 00:41:24,515 BASED ON THEIR NAV-STAR MODEL, 1245 00:41:24,582 --> 00:41:28,385 IN 2021, WHICH SHOWED THAT AN 1246 00:41:28,452 --> 00:41:29,720 AGGRESSIVE CASE MANAGEMENT 1247 00:41:29,787 --> 00:41:30,354 NAVIGATION INTERVENTION CAN 1248 00:41:30,421 --> 00:41:31,655 REDUCE THE NUMBER OF ADMISSIONS 1249 00:41:31,722 --> 00:41:33,457 OVER 1 YEAR AND INCREASE ENTRY 1250 00:41:33,524 --> 00:41:35,593 INTO SUBSTANCE USE TREATMENT, SO 1251 00:41:35,659 --> 00:41:37,127 WE'RE WORKING VERY CLOSELY WITH 1252 00:41:37,194 --> 00:41:38,796 THEM TO,A DATA PROTECTION THIS 1253 00:41:38,863 --> 00:41:42,533 MODEL FOR OW SPECIFIC PATIENT 1254 00:41:42,600 --> 00:41:45,669 POPULATION 1255 00:41:45,736 --> 00:41:46,003 POPULATION. 1256 00:41:46,070 --> 00:41:48,005 SO WHAT THIS WILL LOOK LIKE 1257 00:41:48,072 --> 00:41:51,075 START NOTHINGAUK, WE ARE GOING 1258 00:41:51,141 --> 00:41:52,643 TO HOUSE PATIENTS AND WE'RE 1259 00:41:52,710 --> 00:41:53,811 GOING TO ENROLL 600 AND THEY 1260 00:41:53,878 --> 00:41:56,013 WILL BE RANDOMIZED TO RECEIVE 1261 00:41:56,080 --> 00:42:00,451 THIS INTEGRATED I.D. M. O. U. D. 1262 00:42:00,517 --> 00:42:02,086 OR THE TROAMENT OR OR TREATMENT 1263 00:42:02,152 --> 00:42:02,920 AS USUAL. 1264 00:42:02,987 --> 00:42:04,588 THE TREATMENT WILL LAST FOR 6 1265 00:42:04,655 --> 00:42:06,857 MONTHS, AT THE END WE WILL REARK 1266 00:42:06,924 --> 00:42:08,292 ASSESSES FOR THE PRIMARY 1267 00:42:08,359 --> 00:42:08,726 OUTCOME. 1268 00:42:08,792 --> 00:42:09,693 BUT WE WILL THEM OVER THE COURSE 1269 00:42:09,760 --> 00:42:12,029 OF A YEAR AND LOOK AT A NUMBER 1270 00:42:12,096 --> 00:42:13,230 OF SECONDARY OUTCOMES INCLUDING 1271 00:42:13,297 --> 00:42:15,099 IMPACT ON DRUG USE, SOCIAL 1272 00:42:15,165 --> 00:42:16,033 DETERMINANTS OF HEALTH BUT I 1273 00:42:16,100 --> 00:42:17,635 WANT TO DRAW SPECIFIC FOCUS TO 1274 00:42:17,701 --> 00:42:19,036 THE BOTTOM, TOO WHICH IS 1275 00:42:19,103 --> 00:42:20,537 IMPLEMENTATION IS COST 1276 00:42:20,604 --> 00:42:21,205 EFFECTIVENESS. 1277 00:42:21,272 --> 00:42:23,173 BECAUSE IT'S BECOME REALLY CLEAR 1278 00:42:23,240 --> 00:42:25,376 THAT IF WE CREATE AN 1279 00:42:25,442 --> 00:42:26,243 INTERVENTION THAT'S EFFECTIVE, 1280 00:42:26,310 --> 00:42:28,579 BUT THAT WE CAN'T--IS NOT 1281 00:42:28,646 --> 00:42:29,947 FEASIBLE OR ACCEPTABLE, IT 1282 00:42:30,014 --> 00:42:30,714 DOESN'T MATTER. 1283 00:42:30,781 --> 00:42:32,783 IF WE CREATE AN INTERVENTION 1284 00:42:32,850 --> 00:42:33,918 THAT'S ACCEPTABLE, BUT NOT COST 1285 00:42:33,984 --> 00:42:36,353 EFFECTIVE FOR THE HEALTH SYSTEM, 1286 00:42:36,420 --> 00:42:36,820 IT DOESN'T MATTER. 1287 00:42:36,887 --> 00:42:38,155 WE NEED TO BOTH CREATE 1288 00:42:38,222 --> 00:42:39,290 INTERVENTIONS THAT WORK AS WELL 1289 00:42:39,356 --> 00:42:43,594 AS THAT ARE FEASIBLE AND 1290 00:42:43,661 --> 00:42:43,894 SUSTAINABLE. 1291 00:42:43,961 --> 00:42:45,663 OKAY AND IN THE LAST FEW MINUTES 1292 00:42:45,729 --> 00:42:47,197 I WANT TO LIGHT 1 LAST POINT 1293 00:42:47,264 --> 00:42:48,766 WHICH IS THAT IT WE'RE TRYING TO 1294 00:42:48,832 --> 00:42:50,067 ACHIEVE SOURCE CONTROL FOR 1295 00:42:50,134 --> 00:42:52,303 INFECTIONS DUE TO SUBSTANCE USE, 1296 00:42:52,369 --> 00:42:53,637 WE CAN'T ANCHOR ON A SINGLE 1297 00:42:53,704 --> 00:42:59,109 SOURCE WOORKS HAVE TO EXPAND OUR 1298 00:42:59,176 --> 00:43:00,110 FOCUS. 1299 00:43:00,177 --> 00:43:01,745 AND THIS IS A LITTLE BIT OF A 1300 00:43:01,812 --> 00:43:03,047 BITTER PILL TO SWALLOW BECAUSE 1301 00:43:03,113 --> 00:43:05,115 OVER THE LAST DECADE WE'VE 1302 00:43:05,182 --> 00:43:06,250 REALLY BEEN LASER FOCUSED ON 1303 00:43:06,317 --> 00:43:08,285 OPIOIDS BUT THE REALITY IS, THAT 1304 00:43:08,352 --> 00:43:10,020 THE MAJORITY OF OUR PATIENTS ARE 1305 00:43:10,087 --> 00:43:11,889 USING MULTIPLE TYPES OF 1306 00:43:11,956 --> 00:43:13,590 SUBSTANCES, THEY HAVE 1307 00:43:13,657 --> 00:43:13,991 POLYSUBSTANCE USE. 1308 00:43:14,058 --> 00:43:15,993 AND IF YOU LOOK AT THIS OVERDOSE 1309 00:43:16,060 --> 00:43:18,228 GRAPHIC, YOU CAN SEE YES, THE 1310 00:43:18,295 --> 00:43:19,496 MAJORITY OF OVERDOSES ARE 1311 00:43:19,563 --> 00:43:21,332 RELATED TO OPIOIDS BUT THERE'S A 1312 00:43:21,398 --> 00:43:23,801 SIGNIFICANT PORTION OF PATIENTS 1313 00:43:23,867 --> 00:43:25,369 FROM DRUGS OTHER THAN OPIOIDS. 1314 00:43:25,436 --> 00:43:28,205 I WANT TO BRING YOUR ATTENTION 1315 00:43:28,272 --> 00:43:29,840 PARTICULARLY TO STIMULANT WHICH 1316 00:43:29,907 --> 00:43:32,009 IS ARE ARE PREVALENT AND 1317 00:43:32,076 --> 00:43:35,512 PROBLEMATIC FOR AT RISK HIV USE. 1318 00:43:35,579 --> 00:43:36,213 METHAMILLIO FET MINE IS 1319 00:43:36,280 --> 00:43:41,585 ASSOCIATE WIDE HIGH RATE OF 1320 00:43:41,652 --> 00:43:43,253 SEXUAL ACQUISITION, FOR MSM, FOR 1321 00:43:43,320 --> 00:43:44,788 USE WITH CHEM SEX AND COCAINE 1322 00:43:44,855 --> 00:43:48,192 USE IS ASSOCIATED WITH INCREASED 1323 00:43:48,258 --> 00:43:49,293 CARDIOVASCULAR RISK, 1324 00:43:49,360 --> 00:43:50,127 INFLAMMATION, MORTALITY AND 1325 00:43:50,194 --> 00:43:52,029 PEOPLE WITH HIV WHO ARE 1326 00:43:52,096 --> 00:43:53,230 DISPROPORTIONATELY LIKELY TO BE 1327 00:43:53,297 --> 00:43:54,531 USING COCAINE. 1328 00:43:54,598 --> 00:43:56,700 UNFORTUNATELY, THERE ARE NOT FDA 1329 00:43:56,767 --> 00:43:58,635 APPROVED MEDICATIONS FOR THE 1330 00:43:58,702 --> 00:44:00,037 TREATMENT OF METHAMPHETAMINE USE 1331 00:44:00,104 --> 00:44:02,439 DISORDER OR COCAINE USE 1332 00:44:02,506 --> 00:44:02,873 DISORDER. 1333 00:44:02,940 --> 00:44:04,174 BUT WE HAVE BEEN FORTUNATE TO 1334 00:44:04,241 --> 00:44:06,410 FIND OUT JUST LAST WEEK THAT WE 1335 00:44:06,477 --> 00:44:08,779 GOT SOME FUNDING PRACTICES O. A. 1336 00:44:08,846 --> 00:44:10,381 R. TO 1 DUCT 2 PILOT STUDIES. 1337 00:44:10,447 --> 00:44:12,616 THE FIRST IS TO LOOK AT THE USE 1338 00:44:12,683 --> 00:44:15,586 OF LONG ACTING STIMULANTS FOR 1339 00:44:15,652 --> 00:44:16,954 METHAMILLIO FET MINE USE 1340 00:44:17,021 --> 00:44:19,823 DISORDER WITH THE IDEA OF 1341 00:44:19,890 --> 00:44:22,292 REDUCING HARM TO HIV RISK 1342 00:44:22,359 --> 00:44:24,428 BEHAVIOR, PREP ENGAGEMENT, ART 1343 00:44:24,495 --> 00:44:25,162 ENGAGEMENT, VIRAL SUPPRESSION. 1344 00:44:25,229 --> 00:44:28,766 SO WE'RE SEEING IF WE CAN USE 1345 00:44:28,832 --> 00:44:30,267 LONG ACTING STIMULANTS TO REDUCE 1346 00:44:30,334 --> 00:44:31,802 HARM IN THE HIV POPULATION. 1347 00:44:31,869 --> 00:44:35,172 AND THE OTHER IS TO LOOK AT 1348 00:44:35,239 --> 00:44:37,474 COCAINE USE DISORDER IN 1349 00:44:37,541 --> 00:44:38,442 COLLABORATION WITH 1350 00:44:38,509 --> 00:44:39,777 [INDISCERNIBLE] AT NIDA, AND SEE 1351 00:44:39,843 --> 00:44:42,446 IF WE CAN USE SEMIGLUE TIDE FOR 1352 00:44:42,513 --> 00:44:44,515 PEOPLE WITH COAIN USE TO SAFELY 1353 00:44:44,581 --> 00:44:45,449 AND EFFECTIVELY BOTH REDUCE 1354 00:44:45,516 --> 00:44:47,985 COCAINE USE AS WELL AS IMPROVE 1355 00:44:48,052 --> 00:44:49,153 CARDIOVASCULAR HEALTH IN PEOPLE 1356 00:44:49,219 --> 00:44:50,287 WITH AND WITHOUT HIV. 1357 00:44:50,354 --> 00:44:51,355 SO WE'RE REALLY EXCITED FOR THE 1358 00:44:51,422 --> 00:44:53,690 OPPORTUNITY TO BE ABLE TO EXPAND 1359 00:44:53,757 --> 00:44:55,526 OUR FOCUS A BIT BEYOND OPIOID 1360 00:44:55,592 --> 00:44:57,027 USE DISORDER AND SEE IF WE CAN 1361 00:44:57,094 --> 00:45:00,297 CONTINUE TO BENEFIT THIS PATIENT 1362 00:45:00,364 --> 00:45:02,566 POPULATION. 1363 00:45:02,633 --> 00:45:04,768 SO IN CONCLUSION, JUST TO REMIND 1364 00:45:04,835 --> 00:45:06,136 YOU, HOPEFULLY I HAVE CONVINCED 1365 00:45:06,203 --> 00:45:07,671 YOU THAT IT IS CRITICAL IN 1366 00:45:07,738 --> 00:45:10,074 PEOPLE WHO USE DRUGS TO NOT ONLY 1367 00:45:10,140 --> 00:45:11,141 TREAT THEIR INFECTIONS ABOUT YOU 1368 00:45:11,208 --> 00:45:12,543 REALLY TO ADDRESS THEIR 1369 00:45:12,609 --> 00:45:13,410 ADDICTION IN ORDER TO ACHIEVE 1370 00:45:13,477 --> 00:45:13,777 SOURCE CONTROL. 1371 00:45:13,844 --> 00:45:15,779 AND THE WAY TO DO THIS IS TO 1372 00:45:15,846 --> 00:45:16,880 LOCALIZE WHERE THEIR INFECTIONS 1373 00:45:16,947 --> 00:45:19,349 ARE HAPPENING AND GO THERE, TO 1374 00:45:19,416 --> 00:45:20,451 TREAT THE SOURCE OF THE 1375 00:45:20,517 --> 00:45:22,152 INFECTION, NOT JUST THE 1376 00:45:22,219 --> 00:45:23,220 INFECTION ITSELF. 1377 00:45:23,287 --> 00:45:25,022 TO CONDUCT PATIENT CENTERED 1378 00:45:25,089 --> 00:45:26,557 RESEARCH TO BETTER UNDERSTAND 1379 00:45:26,623 --> 00:45:28,158 HOW TO ACHIEVE SOURCE CONTROL, 1380 00:45:28,225 --> 00:45:31,495 AND TO EXPAND OUR FOCUS AND NOT 1381 00:45:31,562 --> 00:45:33,197 ANCHOR ON A SINGLE SOURCE, I 1382 00:45:33,263 --> 00:45:34,531 ALSO WANT TO SAY THANK YOU TO 1383 00:45:34,598 --> 00:45:39,203 ALL THE MANY, MANY PEOPLE WHO 1384 00:45:39,269 --> 00:45:40,270 HAVE CHAMPIONED THIS PROGRAM 1385 00:45:40,337 --> 00:45:43,607 OVER THE LAST SEVERAL YEARS, 1386 00:45:43,674 --> 00:45:44,741 FACILITATED ALL THE ASPECTS OF 1387 00:45:44,808 --> 00:45:47,644 THIS PROGRAM TO MAKE IT WORK AND 1388 00:45:47,711 --> 00:45:49,079 COLLABORATED WITH US WHO HAVE 1389 00:45:49,146 --> 00:45:50,114 HELPED IN CLINICS AND THE 1390 00:45:50,180 --> 00:45:51,215 COMMUNITY AND OUR AMAZING TEAM 1391 00:45:51,281 --> 00:45:52,850 ON THE RIGHT THAT MAKES THIS ALL 1392 00:45:52,916 --> 00:45:53,750 HAPPEN. 1393 00:45:53,817 --> 00:45:54,618 SO THANK YOU. 1394 00:45:54,685 --> 00:46:01,258 [ APPLAUSE ] 1395 00:46:01,325 --> 00:46:02,693 >> AGAIN, WE'RE HAPPY TO ANSWER 1396 00:46:02,759 --> 00:46:04,495 QUESTIONS BUT LOOKING AROUND THE 1397 00:46:04,561 --> 00:46:05,462 AUDIENCE, IT'S WORTH POINTING 1398 00:46:05,529 --> 00:46:07,431 OUT A FEW PEOPLE HERE THAT MAKE 1399 00:46:07,498 --> 00:46:10,167 THIS POSSIBLE, I MEAN MARY 1400 00:46:10,234 --> 00:46:11,235 Mc LAUGH LYNN PROBABLY SAW ALL 1401 00:46:11,301 --> 00:46:12,703 THE PATIENTS WE SAW UP IN THE 1402 00:46:12,769 --> 00:46:15,539 CLINIC OR PROBABLY MOST OF THEM. 1403 00:46:15,606 --> 00:46:16,740 JIM WE APPRECIATE THE FACT THIS 1404 00:46:16,807 --> 00:46:17,941 IT GIVES US THE FLEXIBILITY TO 1405 00:46:18,008 --> 00:46:20,944 HAVE THIS KIND OF PROGRAM AND 1406 00:46:21,011 --> 00:46:23,013 THERE ARE PROBABLY OTHER PEOPLE 1407 00:46:23,080 --> 00:46:24,348 I'M MISSING BUT THE PERSON WHO 1408 00:46:24,414 --> 00:46:27,718 IS REALLY KEY IS ROB PALMER IS 1409 00:46:27,784 --> 00:46:30,621 THE 1 WHO IS NOT THE SCIENTIST, 1410 00:46:30,687 --> 00:46:33,690 BUT MAKES ALL THE MONEY FLOW SO 1411 00:46:33,757 --> 00:46:34,525 THESE THINGS CAN HAPPEN. 1412 00:46:34,591 --> 00:46:36,727 THIS CERTAIN LE WOULDN'T HAPPEN 1413 00:46:36,793 --> 00:46:37,828 WITHOUT ROB PALMER AND SEAN 1414 00:46:37,895 --> 00:46:39,796 [INDISCERNIBLE] IS THE CHIEF OF 1415 00:46:39,863 --> 00:46:40,964 INFECTIOUS DISEASE AT MARYLAND 1416 00:46:41,031 --> 00:46:43,100 WHO STARTED OUT IN THE FAUCI LAB 1417 00:46:43,167 --> 00:46:44,401 AND ALSO THE SCIENTIFIC AND 1418 00:46:44,468 --> 00:46:45,669 CLINICAL BRAINS BEHIND THAT. 1419 00:46:45,736 --> 00:46:47,905 SO THERE ARE A LOT PEOPLE HERE 1420 00:46:47,971 --> 00:46:48,939 WHO MADE THIS POSSIBLE. 1421 00:46:49,006 --> 00:46:51,842 BUT ARE THERE ANY QUESTIONS OR 1422 00:46:51,909 --> 00:46:52,509 COMMENTS OR TOM? 1423 00:46:52,576 --> 00:47:01,318 I DON'T KNOW IF YOU HAVE NONE 1424 00:47:01,385 --> 00:47:02,085 THERE? 1425 00:47:02,152 --> 00:47:04,054 ONE OF THE ISSUES ELANA, BEING 1426 00:47:04,121 --> 00:47:05,122 IN THE COMMUNITY, SOME OF THE 1427 00:47:05,189 --> 00:47:07,624 IDEAS ABOUT WHAT I THOUGHT WERE 1428 00:47:07,691 --> 00:47:08,492 IMPORTANT HERE WERE NOT THE 1429 00:47:08,559 --> 00:47:10,460 WHYEDS THAT YOU AND SARAH AND 1430 00:47:10,527 --> 00:47:12,963 SEAN THOUGHT WERE IMPORTANT FROM 1431 00:47:13,030 --> 00:47:15,132 BEING IN THE COMMUNITY TALKING 1432 00:47:15,199 --> 00:47:16,533 TO STAKEHOLDERS AND TALKS TO 1433 00:47:16,600 --> 00:47:18,535 PATIENTS BUT YOU WANT TO SAY HOW 1434 00:47:18,602 --> 00:47:20,804 THAT CHANGES YOUR PERSPECTIVE ON 1435 00:47:20,871 --> 00:47:22,739 WHAT RESEARCH QUESTIONS ARE 1436 00:47:22,806 --> 00:47:23,006 IMPORTANT? 1437 00:47:23,073 --> 00:47:24,575 NYEAH, I THINK IT'S CRITICAL, 1438 00:47:24,641 --> 00:47:25,542 WE'RE INCREDIBLE LOAMACYY 1439 00:47:25,609 --> 00:47:28,045 FORTUNATE TO GET THE INSIGHT OF 1440 00:47:28,111 --> 00:47:29,446 OUR PATIENTS AND COMMUNITY 1441 00:47:29,513 --> 00:47:31,114 STAKEHOLDERS WHEN WE WERE 1442 00:47:31,181 --> 00:47:31,815 DESEENING RESEARCH, 1 OF THE 1443 00:47:31,882 --> 00:47:34,117 LAST STUDIES I MENTION, THE 1444 00:47:34,184 --> 00:47:37,788 METHAMPHETAMINE STUDY WAS NOT 1445 00:47:37,854 --> 00:47:38,422 OUR IDEA. 1446 00:47:38,488 --> 00:47:39,957 IT WAS BROUGHT TO US BY THE 1447 00:47:40,023 --> 00:47:41,191 PATIENTS BECAUSE THEY IMU WE 1448 00:47:41,258 --> 00:47:45,329 WERE PROVIDING LOW BARRIER HARM 1449 00:47:45,395 --> 00:47:45,996 REDUCTION OPIOID USE DISORDER 1450 00:47:46,063 --> 00:47:46,730 TREATMENT AND THEY WANTED TO 1451 00:47:46,797 --> 00:47:50,400 KNOW IF WE COULD DO THE SAME 1452 00:47:50,467 --> 00:47:51,001 WITH METHAMPHETAMINE DISORDER 1453 00:47:51,068 --> 00:47:52,436 AND IF YOU DID THROUGH REDIT AND 1454 00:47:52,502 --> 00:47:53,537 TALK TO PATIENTS, THIS IS 1455 00:47:53,604 --> 00:47:55,405 SOMETHING THEY'RE DOING IN THE 1456 00:47:55,472 --> 00:47:57,007 COMMUNITY, THEY'RE ACCESSING 1457 00:47:57,074 --> 00:47:57,741 LONGAC BEING STIMULANTS AND 1458 00:47:57,808 --> 00:48:00,010 THEY'RE USING IT TO REDUCE HARM 1459 00:48:00,077 --> 00:48:01,044 THEMSELVES BUT THEY CAN'T FIND 1460 00:48:01,111 --> 00:48:02,746 PROVIDER WHO IS WILL DO IT ARE 1461 00:48:02,813 --> 00:48:04,848 FOR THEM BECAUSE THERE'S NOT AN 1462 00:48:04,915 --> 00:48:06,783 EVIDENT BASE FOR IT SO WE REALLY 1463 00:48:06,850 --> 00:48:09,319 DESIGNED AND TRIED TO GET THE 1464 00:48:09,386 --> 00:48:10,621 STUDY FUNDED FOR 5 YEARS NOW 1465 00:48:10,687 --> 00:48:11,922 BECAUSE THE PATIENTS WERE ASKING 1466 00:48:11,989 --> 00:48:13,790 FOR IT, AND EVERY TIME WE SEE 1467 00:48:13,857 --> 00:48:16,426 THEM, WE HAVE NOTHING TO DO FOR 1468 00:48:16,493 --> 00:48:16,727 THEM. 1469 00:48:16,793 --> 00:48:18,061 AND WE'RE JUST SCARED AND I 1470 00:48:18,128 --> 00:48:20,964 THINK THE OTHER HING IS THAT, 1471 00:48:21,031 --> 00:48:21,999 YOU KNOW UNFORTUNATELY I DIDN'T 1472 00:48:22,065 --> 00:48:23,667 HAVE TIME TO MENTION BUT WE'VE 1473 00:48:23,734 --> 00:48:26,603 BEEN ABLE TO REEL KEEPSAKESLY 1474 00:48:26,670 --> 00:48:28,905 EXPAND INTO THE GENDER AND 1475 00:48:28,972 --> 00:48:29,473 SEXUAL MINORITY POPULATION. 1476 00:48:29,539 --> 00:48:32,376 WE HAVE A COHORT OF TRANSGENDER 1477 00:48:32,442 --> 00:48:34,811 PATIENTS WHO WE STARTED DOING 1478 00:48:34,878 --> 00:48:36,013 CLINICAL CARE WITH OVER COVID 1479 00:48:36,079 --> 00:48:37,848 BECAUSE HIPS THE HARM REDUCTION 1480 00:48:37,914 --> 00:48:39,316 ORGANIZATION WHERE WE'RE 1481 00:48:39,383 --> 00:48:39,850 OPERATING BASICALLY KACCT 1482 00:48:39,916 --> 00:48:40,917 IMPEDIMENTS TO US AND SAID WE 1483 00:48:40,984 --> 00:48:42,419 HAVE ALL THESE PATIENT WHO IS 1484 00:48:42,486 --> 00:48:43,420 ARE LOSING ACCESS TO CARE 1485 00:48:43,487 --> 00:48:45,555 BECAUSE OF COVID, WHAT CAN WE 1486 00:48:45,622 --> 00:48:45,922 DO? 1487 00:48:45,989 --> 00:48:48,025 WE'RE LIKE WE WILL LEARN HOW TO 1488 00:48:48,091 --> 00:48:49,293 DO GEBDER AFFIRMING CARE, WHY 1489 00:48:49,359 --> 00:48:50,694 NOT AND THROUGH THAT 1490 00:48:50,761 --> 00:48:52,596 COLLABORATION, WE HAVE DEVELOPED 1491 00:48:52,663 --> 00:48:56,033 AN HPV PROGRAM AND WE'VE REALLY 1492 00:48:56,099 --> 00:49:00,871 BEEN ABLE TO DO ANNAL APPLIEDS 1493 00:49:00,937 --> 00:49:03,073 ON ALL OF OUR PATIENTS AND WE 1494 00:49:03,140 --> 00:49:06,176 HAVE HRA CLINIC IN CONJUNCTION 1495 00:49:06,243 --> 00:49:07,210 WITH ANDREA HERE AND THAT WAS 1496 00:49:07,277 --> 00:49:08,679 BORN OUT OF A NEED THAT WAS 1497 00:49:08,745 --> 00:49:09,780 IDENTIFIED TO US IN THE 1498 00:49:09,846 --> 00:49:11,882 COMMUNITY, 1 OF OUR COMMUNITY 1499 00:49:11,948 --> 00:49:12,849 HEALTH WORKERRED HAD ANALL 1500 00:49:12,916 --> 00:49:15,118 CANCER AND THIS IS A HUGE KIND 1501 00:49:15,185 --> 00:49:17,587 OF UNMET NEED THAT HE'S 1502 00:49:17,654 --> 00:49:19,089 IDENTIFIED TO US AS WELL AND I 1503 00:49:19,156 --> 00:49:20,057 THINK WITHOUT THE PERSPECTIVE OF 1504 00:49:20,123 --> 00:49:21,892 MY PATIENTS I WOULD BE VERY OUT 1505 00:49:21,958 --> 00:49:23,293 MUCH TOUCH AND SO THE WAY THAT 1506 00:49:23,360 --> 00:49:25,996 WE'RE ABLE TO ENGAGE THEM IS 1507 00:49:26,063 --> 00:49:27,431 BECAUSE THEY WANT TO DO THIS 1508 00:49:27,497 --> 00:49:29,766 WERE WITH US, THEY'RE EXCITED, 1509 00:49:29,833 --> 00:49:31,401 AI LOT OF THESE THINGS ARE THEIR 1510 00:49:31,468 --> 00:49:32,969 IDEAS SO IT'S WHAT MAKES IT 1511 00:49:33,036 --> 00:49:35,972 MEANINGFUL TO US TO DO WHEN 1512 00:49:36,039 --> 00:49:37,207 WE'RE DEALING WITH IRB 1513 00:49:37,274 --> 00:49:38,942 CHALLENGES AND YOU KNOW THE 1514 00:49:39,009 --> 00:49:39,676 CONCERN ABOUT RETENTION IN 1515 00:49:39,743 --> 00:49:41,078 PATIENTS WHO ARE ACTIVELY USING 1516 00:49:41,144 --> 00:49:48,685 AND THINGS LIKE THAT. 1517 00:49:48,752 --> 00:49:50,053 BUT IT'S ALSO HOW WE DO THE WORK 1518 00:49:50,120 --> 00:49:52,589 THAT WE DO THAT'S IMPACTFUL 1519 00:49:52,656 --> 00:49:54,691 NBEFORE WE GET TO YOUR QUESTION, 1520 00:49:54,758 --> 00:49:55,959 BUT THE FIRST MONEY WE GOT FROM 1521 00:49:56,026 --> 00:49:58,295 THE PROGRAM WAS FROM NIMH WHICH 1522 00:49:58,362 --> 00:50:00,697 REALLY GOT US STARTED AND THE 1523 00:50:00,764 --> 00:50:02,899 PSYCHIATRIC SUPPORT THAT WE GOT 1524 00:50:02,966 --> 00:50:04,468 AND THE COLLABORATION WITH 1525 00:50:04,534 --> 00:50:06,403 MARILYN, DIANE AND OTHER PEOPLE 1526 00:50:06,470 --> 00:50:07,371 HAS BEEN ESSENTIAL BECAUSE IT'S 1527 00:50:07,437 --> 00:50:10,006 HARD TO DO THIS KIND OF PROGRAM 1528 00:50:10,073 --> 00:50:11,408 OR IMPOSSIBLE SOILY AS 1529 00:50:11,475 --> 00:50:12,209 INFECTIOUS DEC PEOPLE IF YOU 1530 00:50:12,275 --> 00:50:16,646 TONIGHT HAVE MORE OF A SENSE OF 1531 00:50:16,713 --> 00:50:18,648 ADDICTION IN MEDICINE AND 1532 00:50:18,715 --> 00:50:19,850 PSYCHIATRIST, BUT I DON'T KNOW 1533 00:50:19,916 --> 00:50:21,385 IF MARYLAND WANTS TO SAY 1534 00:50:21,451 --> 00:50:22,552 ANYTHING, BUT AGAIN, WE WILL GET 1535 00:50:22,619 --> 00:50:24,221 TO YOUR QUESTION IN 30-SECONDS 1536 00:50:24,287 --> 00:50:25,489 BUT NIH IS THE LAND OF 1537 00:50:25,555 --> 00:50:26,823 OPPORTUNITY IN THAT IF YOU CAN'T 1538 00:50:26,890 --> 00:50:29,025 GET WHAT YOU WANT OUT OF YOUR 1539 00:50:29,092 --> 00:50:29,826 INSTITUTE OR ANOTHER INSTITUTE, 1540 00:50:29,893 --> 00:50:31,461 YOU CAN ALWAYS GO TO OTHER 1541 00:50:31,528 --> 00:50:34,765 PEOPLE IN THE OFFICE OF AIDS 1542 00:50:34,831 --> 00:50:36,166 RESEARCH, THE HEAL INITIATIVE, 1543 00:50:36,233 --> 00:50:37,701 LOTS OF PLACES WE GO AND LOOK 1544 00:50:37,768 --> 00:50:38,402 FOR MONEY. 1545 00:50:38,468 --> 00:50:39,836 YOU'RE NOT ALWAYS SUCCESSFUL BUT 1546 00:50:39,903 --> 00:50:41,605 IF YOU LOOK OFTEN ENOUGH, CAN 1547 00:50:41,671 --> 00:50:42,939 YOU BE SUCCESSFUL AND THERE ARE 1548 00:50:43,006 --> 00:50:45,275 LOTS OF PEOPLE WHO LIKE ANDREA 1549 00:50:45,342 --> 00:50:46,943 WHO WILL EXPAND THE KIND OF 1550 00:50:47,010 --> 00:50:48,378 PROGRAMS YOU DO, I DON'T THINK 1551 00:50:48,445 --> 00:50:51,481 WE THOUGHT ABOUT DOING HPV 1552 00:50:51,548 --> 00:50:52,883 INITIALLY BUT CERTAINLY AN 1553 00:50:52,949 --> 00:50:54,885 INIMPORTANT INITTIAIVE IT NOW, 1554 00:50:54,951 --> 00:50:58,121 BUT OKAY, YOU HAVE A QUESTION 1555 00:50:58,188 --> 00:51:00,724 NSORRY, I'M DEANNA CANNED WHAT, 1556 00:51:00,791 --> 00:51:01,858 I AM AT-- 1557 00:51:01,925 --> 00:51:03,260 >> HI. 1558 00:51:03,326 --> 00:51:04,461 >> AND I'M ALSO THE ACTING 1559 00:51:04,528 --> 00:51:07,497 DIRECTOR OF THE OFFICE OF AIDS 1560 00:51:07,564 --> 00:51:08,432 RESEARCH WHICH YOU JUST 1561 00:51:08,498 --> 00:51:10,033 MENTIONED AND SPEAKING OF MONEY, 1562 00:51:10,100 --> 00:51:12,936 MY QUESTION IS ABOUT THE COSTS 1563 00:51:13,003 --> 00:51:14,104 ASSOCIATED WITH THIS KIND OF 1564 00:51:14,171 --> 00:51:14,671 CARE. 1565 00:51:14,738 --> 00:51:19,142 SO I LOVE THIS STUFF, YOU 1566 00:51:19,209 --> 00:51:21,378 TOUCHED ON IT AND ACTUALLY EARLY 1567 00:51:21,445 --> 00:51:24,381 ON I WAS VERY INTERESTED IN THE 1568 00:51:24,448 --> 00:51:26,349 ECONOMICS, I STUDIED THE 1569 00:51:26,416 --> 00:51:27,717 ECONOMICS OF HEALTHCARE AND THEN 1570 00:51:27,784 --> 00:51:30,854 RAN INTO THE STRUGGLE OF THE 1571 00:51:30,921 --> 00:51:32,255 POLITICAL PROBLEM OF WHO PAYS 1572 00:51:32,322 --> 00:51:33,790 FOR THESE SORTS OF, THIS SORT OF 1573 00:51:33,857 --> 00:51:44,334 CARE AND HOW CAN YOU MAKE IT 1574 00:51:44,868 --> 00:51:46,470 REALLY SHOW THAT IT IS COST 1575 00:51:46,536 --> 00:51:47,838 EECTIVE BOTH ECONOMICALLY AND 1576 00:51:47,904 --> 00:51:48,238 POLITICALLY. 1577 00:51:48,305 --> 00:51:50,740 SO HOW CAN WE TURN IT INTO 1578 00:51:50,807 --> 00:51:54,377 SOMETHING THAT IS REALLY 1579 00:51:54,444 --> 00:51:56,146 APPEALING ECONOMICALLY WHEN THE 1580 00:51:56,213 --> 00:52:00,050 COSTS ARE USUALLY BORN BY THAT 1581 00:52:00,116 --> 00:52:02,285 HOMELESS PERSON OR EEIVET 1582 00:52:02,352 --> 00:52:04,554 CRULLLY IT'S BORNE BY SOCIETY. 1583 00:52:04,621 --> 00:52:09,059 BUT HOW DO WE DO THAT BETTER? 1584 00:52:09,125 --> 00:52:09,726 >> YEAH THAT'S A GREAT QUESTION 1585 00:52:09,793 --> 00:52:11,294 AND I THINK AT THE CRUX OF HOW 1586 00:52:11,361 --> 00:52:15,465 WE CAN GET ANYTHING DONE. 1587 00:52:15,532 --> 00:52:18,535 FOR THE CHOICE STUDY WE ARE 1588 00:52:18,602 --> 00:52:20,504 COLLABORATING WITH PEOPLE AT 1589 00:52:20,570 --> 00:52:23,106 CORNELL WHO THAT'S THEIR WHOLE 1590 00:52:23,173 --> 00:52:25,675 FOCUS IS ECONOMIC FEASIBILITY 1591 00:52:25,742 --> 00:52:26,710 AND COST EFFECTIVENESS SO THEY 1592 00:52:26,776 --> 00:52:30,113 LOOK AT THINGS NOT JUST IN 1593 00:52:30,180 --> 00:52:31,414 [INDISCERNIBLE] BUT WHAT IS THE 1594 00:52:31,481 --> 00:52:33,617 COST TO THE SYSTEM AND THEY ALSO 1595 00:52:33,683 --> 00:52:37,354 ELECTRIC AT OUTCOMES BEYOND JUST 1596 00:52:37,420 --> 00:52:38,955 YOU KNOW LIVES SAVED BUT ALSO 1597 00:52:39,022 --> 00:52:43,093 ARE THEY GOING TO BE 1598 00:52:43,159 --> 00:52:43,927 INCARCERATED? 1599 00:52:43,994 --> 00:52:44,861 WHAT'S THEIR UTILIZATION? 1600 00:52:44,928 --> 00:52:46,396 HOW OFTEN ARE THEY GOING TO THE 1601 00:52:46,463 --> 00:52:47,063 EMERGENCY DEPARTMENT? 1602 00:52:47,130 --> 00:52:48,665 HOW OFTEN ARE THEY GOING TO 1603 00:52:48,732 --> 00:52:50,567 PRIMARY CARE AND THINGS LIKE 1604 00:52:50,634 --> 00:52:52,235 THAT SO WE CAN TAKE THIS TO THE 1605 00:52:52,302 --> 00:52:54,137 HELT SYSTEM AND SAY LOOK AT ALL 1606 00:52:54,204 --> 00:52:56,139 THE WAYS WE'VE SAVED YOU MONEY 1607 00:52:56,206 --> 00:52:57,274 EVEN THOUGH YOU HAVE TO PAY FOR 1608 00:52:57,340 --> 00:52:59,843 THIS PEER TO HELP WITH THIS 1609 00:52:59,910 --> 00:53:00,143 NAVIGATION. 1610 00:53:00,210 --> 00:53:01,011 IT WAS--I DIDN'T MENTION IT BUT 1611 00:53:01,077 --> 00:53:03,713 1 OF THE BIG PARTS OF OUR DEBATE 1612 00:53:03,780 --> 00:53:05,549 ABOUT WHAT INTERVENTION TO DO 1613 00:53:05,615 --> 00:53:07,684 WAS THAT TECHNICALLY, YOU KNOW 1614 00:53:07,751 --> 00:53:08,418 HAVING NAVIGATORS HELP SUPPORT 1615 00:53:08,485 --> 00:53:10,253 PATIENTS IS A LOW COST 1616 00:53:10,320 --> 00:53:13,290 INTERVENTION BUT IT'S NOT A 1617 00:53:13,356 --> 00:53:14,791 REIMBURSABLE INTERVENTION. 1618 00:53:14,858 --> 00:53:16,092 WHEREAS TAKING TOO DOCTORS AND 1619 00:53:16,159 --> 00:53:18,662 INTEGRATING THEM IN THE CLINIC, 1620 00:53:18,728 --> 00:53:20,263 IS WE CAN DO THAT, THAT'S 1621 00:53:20,330 --> 00:53:21,131 SOMETHING WE CAN BILL FOR. 1622 00:53:21,197 --> 00:53:24,134 SO I THINK THE OTHER CHALLENGE 1623 00:53:24,200 --> 00:53:25,902 WE'VE RUN INTO BECAUSE WE'RE 1624 00:53:25,969 --> 00:53:27,871 DOING THESE INTERVENTIONS IN 4 1625 00:53:27,938 --> 00:53:29,239 DIFFERENT ESTATE STATES, D. C. 1626 00:53:29,306 --> 00:53:30,941 IS NOT EXACTLY A STATE BUT 1627 00:53:31,007 --> 00:53:31,641 ENCOUNTERING DIFFERENT UPON 1628 00:53:31,708 --> 00:53:33,543 ISSUES IN TERMS OF MEDICAID 1629 00:53:33,610 --> 00:53:36,112 EXPANSION AND SOME PLACES 1630 00:53:36,179 --> 00:53:37,113 PEERINGS ARE REIMBURSABLE AND 1631 00:53:37,180 --> 00:53:38,381 SOME PLACES THEY'RE NOT SO I 1632 00:53:38,448 --> 00:53:39,015 DEFINITELY DEMONSTRATION HAVE 1633 00:53:39,082 --> 00:53:41,685 THE ANSWERS BUT I THINK 1634 00:53:41,751 --> 00:53:42,485 INCREASINGLY WE'RE UNDERSTANDING 1635 00:53:42,552 --> 00:53:44,087 THAT IT'S CRITICAL TO 1636 00:53:44,154 --> 00:53:45,455 INCORPORATE INTO OUR ALL OF OUR 1637 00:53:45,522 --> 00:53:46,890 STUDIES THIS ABILITY TO ASSESS 1638 00:53:46,957 --> 00:53:48,425 THE COST EFFECTIVENESS AND 1639 00:53:48,491 --> 00:53:49,292 ECONOMIC FEASIBILITY SO THAT AT 1640 00:53:49,359 --> 00:53:51,561 THE END AND IMPLEMENTATION 1641 00:53:51,628 --> 00:53:54,831 ASSPEBTS RIGHT IS IT FEASIBLE, 1642 00:53:54,898 --> 00:53:55,498 ACCEPTABLE? 1643 00:53:55,565 --> 00:53:55,799 SUSTAINABLE? 1644 00:53:55,865 --> 00:53:57,300 BECAUSE WE'VE SEEN TIME AND TIME 1645 00:53:57,367 --> 00:53:58,468 AGAIN THAT WE DO THESE GREAT 1646 00:53:58,535 --> 00:53:59,869 STUDY ANDS THEN NOTHING HAPPENS 1647 00:53:59,936 --> 00:54:01,571 FOR 10 YEARS, RIGHT IN AND SO, 1648 00:54:01,638 --> 00:54:05,609 WE ACTUALLY WANT TO BE ABLE TO 1649 00:54:05,675 --> 00:54:06,610 NOT ONLY PUSH FORWARD THE 1650 00:54:06,676 --> 00:54:08,578 SCIENCE BUT TAKE SCIENCE AND 1651 00:54:08,645 --> 00:54:09,579 CHANGE CLINICAL PRACTICE VERY 1652 00:54:09,646 --> 00:54:11,047 RAPIDLY IF WE HOPE TO IMPACT 1653 00:54:11,114 --> 00:54:12,382 CHANGE IN THESE PATIENTS. 1654 00:54:12,449 --> 00:54:14,017 SO, I'M NOT AN EXPERT IN HOW TO 1655 00:54:14,084 --> 00:54:16,252 DO IT BUT WE'RE FORTUNATE TO BE 1656 00:54:16,319 --> 00:54:17,554 ABLE TO COLLABORATE WITH EX 1657 00:54:17,621 --> 00:54:18,888 PERS AT THIS POINT WHO I AM 1658 00:54:18,955 --> 00:54:19,889 CONTIARAS DEPT CAN FIGURE IT 1659 00:54:19,956 --> 00:54:20,256 OUT. 1660 00:54:20,323 --> 00:54:23,560 >> AND AS I LOOK AT THE BRIGHT 1661 00:54:23,627 --> 00:54:25,161 LIGHT, RECOGNIZE DEANNA BEFORE 1662 00:54:25,228 --> 00:54:27,464 BECAUSE WE'VE GONE NOW 15 1663 00:54:27,530 --> 00:54:28,732 CONSECUTIVE YEARS OF FUNDING FOR 1664 00:54:28,798 --> 00:54:31,134 THE OFFICE OF AIDS RESEARCH AND 1665 00:54:31,201 --> 00:54:33,536 THEY'VE BEEN VERY FLEXIBLE ABOUT 1666 00:54:33,603 --> 00:54:35,005 ALLOWING US TO GET INTO AREAS 1667 00:54:35,071 --> 00:54:37,374 THAT WE DIDN'T KNOW THAT MUCH 1668 00:54:37,440 --> 00:54:38,041 ABOUT LIKE IMPLEMENTATION 1669 00:54:38,108 --> 00:54:39,309 RESEARCH WHICH I DIDN'T KNOW 1670 00:54:39,376 --> 00:54:41,311 ANYTHING ABOUT 6 OR 7 YEARS AGO, 1671 00:54:41,378 --> 00:54:45,482 AND THEN AGAIN TO OPIOID AND 1672 00:54:45,548 --> 00:54:47,584 ADDICTION MEDICINE WHICH ELANA 1673 00:54:47,651 --> 00:54:49,285 WILL TELL YOU I DIDN'T KNOW 1674 00:54:49,352 --> 00:54:50,053 ANYTHING ABOUT 6 OR 7 YEARS AGO 1675 00:54:50,120 --> 00:54:51,755 BUT WE GOT INTO THAT AND AGAIN, 1676 00:54:51,821 --> 00:54:53,289 THE KIND OF FUNDING YOU CAN GET 1677 00:54:53,356 --> 00:54:55,692 IF SOMEBODY LIKE THE OFFICE OF 1678 00:54:55,759 --> 00:54:57,427 AIDS RESEARCH, NIMH HAS 1679 00:54:57,494 --> 00:54:59,696 CONFIDENCE THAT YOU CAN 1680 00:54:59,763 --> 00:55:00,563 SUCCESSFULLY OPERATIONALIZE YOUR 1681 00:55:00,630 --> 00:55:01,831 PROGRAM HAS BEEN REALLY 1682 00:55:01,898 --> 00:55:02,999 ESSENTIAL FOR THIS PROGRAM. 1683 00:55:03,066 --> 00:55:05,035 SO WE APPRECIATE THAT AND WE'RE 1684 00:55:05,101 --> 00:55:07,437 ALSO VERY EXCITED ABOUT THESE 2 1685 00:55:07,504 --> 00:55:08,738 INMODEL CITIZENIVATION GRANTS 1686 00:55:08,805 --> 00:55:16,146 FOR AMPHETAMINE ANDS COCAINE. 1687 00:55:16,212 --> 00:55:19,816 WE ACTUALLY HAVE 1 QUESTION 1688 00:55:19,883 --> 00:55:20,383 ABOUT HPV. 1689 00:55:20,450 --> 00:55:22,385 >> NO, I'M NOT GOING TO ASK YOU 1690 00:55:22,452 --> 00:55:22,852 ABOUT HPV. 1691 00:55:22,919 --> 00:55:24,754 >> YOU WOULD HAVE TO ANSWER IT. 1692 00:55:24,821 --> 00:55:25,255 [LAUGHTER] 1693 00:55:25,321 --> 00:55:27,757 >> WELL IS AN INTERNAL DEBATE IN 1694 00:55:27,824 --> 00:55:29,125 OUR DIVISION ABOUT HOW OUT OF 1695 00:55:29,192 --> 00:55:31,561 TOUCH WE ARE WITH THE COMMUNITY 1696 00:55:31,628 --> 00:55:35,231 AND THIS IS A GREAT TALK IN THAT 1697 00:55:35,298 --> 00:55:35,632 SENSE. 1698 00:55:35,699 --> 00:55:37,167 THE CURRENT DEBATE IS WHETHER TO 1699 00:55:37,233 --> 00:55:38,034 INCORPORATE IN OUR SCIENTIFIC 1700 00:55:38,101 --> 00:55:39,869 REVIEW AND WHEN WE DESIGN 1701 00:55:39,936 --> 00:55:45,075 STUDIES INSIDE THE NIH, 1702 00:55:45,141 --> 00:55:45,909 COMMUNITY ADVISORS AND OTHER 1703 00:55:45,975 --> 00:55:50,280 WAYS IN WHICH WE CAN UNDERSTAND 1704 00:55:50,346 --> 00:55:51,815 BETTER THE NEEDS IN THE 1705 00:55:51,881 --> 00:55:54,284 COMMUNITY, DO YOU HAVE ANY 1706 00:55:54,350 --> 00:55:56,286 EXPERIENCE IN THAT FIELD IN 1707 00:55:56,352 --> 00:55:57,153 OTHER ACADEMIC INSTITUTIONS. 1708 00:55:57,220 --> 00:55:58,021 I FEEL LIKE WE'RE LATE TO THIS 1709 00:55:58,088 --> 00:55:59,622 AND DO HAVE YOU ANY SUGGESTION 1710 00:55:59,689 --> 00:56:03,126 HOW TO IMPLEMENT THAT? 1711 00:56:03,193 --> 00:56:04,527 >> YEAH, I THINK WE USED TO HAVE 1712 00:56:04,594 --> 00:56:05,829 A COMMUNITY ADVISORY BOARD AND 1713 00:56:05,895 --> 00:56:08,698 THEN IT LAPSED FOR A TIME AND 1714 00:56:08,765 --> 00:56:10,133 NOW WE'RE GOING BACK TO 1715 00:56:10,200 --> 00:56:12,335 IMPLEMENTING THAT AGAIN AND I 1716 00:56:12,402 --> 00:56:14,003 THINK THAT CABS ARE SOMETHING 1717 00:56:14,070 --> 00:56:15,605 THAT HAVE BECOME INCREASINGLY 1718 00:56:15,672 --> 00:56:16,773 UNDERSTOOD TO BE VERY IMPORTANT 1719 00:56:16,840 --> 00:56:19,509 IN THE CONDUCT OF RESEARCH, BOTH 1720 00:56:19,576 --> 00:56:22,045 FOR IDENTIFYING THE NEEDS OF THE 1721 00:56:22,112 --> 00:56:23,646 COMMUNITY AND ALSO FOR REVIEWING 1722 00:56:23,713 --> 00:56:25,515 THE RESEARCH THAT IS PLANNED AND 1723 00:56:25,582 --> 00:56:26,916 MAKING SURE THAT IT'S BEING DONE 1724 00:56:26,983 --> 00:56:29,018 IN A WAY THAT IS MEANINGFUL AND 1725 00:56:29,085 --> 00:56:30,420 RESPECTFUL OF THE POPULATIONS 1726 00:56:30,487 --> 00:56:31,654 AND TAKES INTO ACCOUNT THE NEEDS 1727 00:56:31,721 --> 00:56:34,791 OF THE PATIENTS AS WELL. 1728 00:56:34,858 --> 00:56:35,458 IT'S OBVIOUSLY EVERYTHING'S 1729 00:56:35,525 --> 00:56:37,193 EASIER SAID THAN DONE. 1730 00:56:37,260 --> 00:56:38,995 YOU KNOW, FINDING THE RIGHT 1731 00:56:39,062 --> 00:56:39,863 PEOPLE, ENGAGING THEM, FINDING A 1732 00:56:39,929 --> 00:56:41,331 WAI TO HAVE A MEANINGFUL 1733 00:56:41,397 --> 00:56:43,099 CONVERSATION WHERE YOU WILL GET 1734 00:56:43,166 --> 00:56:44,801 APPROPRIATE FEEDBACK AND WORK, 1735 00:56:44,868 --> 00:56:49,439 BUT IT'S WORK WORTH DOING AND I 1736 00:56:49,506 --> 00:56:50,907 THINK 1 OF THE KEY THING SYSTEM 1737 00:56:50,974 --> 00:56:51,741 VALUING THE TIME OF THE PEOPLE 1738 00:56:51,808 --> 00:56:54,611 THAT ARE DOING IT, THEY HAVE TO 1739 00:56:54,677 --> 00:56:55,712 BE COMPENSATED, YOU HAVE TO 1740 00:56:55,779 --> 00:56:56,646 SUPPORT THE TIME AND EFFORT OF 1741 00:56:56,713 --> 00:56:58,982 WHAT THEY'RE DOING BUT WE FOWBD 1742 00:56:59,048 --> 00:57:01,351 IN RECRUITING PEOPLE FOR THIS, 1743 00:57:01,417 --> 00:57:02,519 IS PEOPLE ARE REALLY EAGER TO 1744 00:57:02,585 --> 00:57:03,787 CONTRIBUTE AND SO I THINK IT 1745 00:57:03,853 --> 00:57:05,755 WOULD BE AMAZING TO HAVE THAT BE 1746 00:57:05,822 --> 00:57:09,225 SOMETHING THAT NIH TAKES ON 1747 00:57:09,292 --> 00:57:10,426 BECAUSE IT IS--IT IS REALLY A 1748 00:57:10,493 --> 00:57:12,228 WAY FOR US TO GET INSIGHT FROM 1749 00:57:12,295 --> 00:57:13,496 THE COMMUNITY AND ALSO FOR THEM 1750 00:57:13,563 --> 00:57:14,998 TO UNDERSTAND THAT OUR AIMS CAN 1751 00:57:15,064 --> 00:57:16,399 CONDUCTING RESEARCH ARE TO HELP 1752 00:57:16,466 --> 00:57:17,967 THE PASHT POPULATION AND 1753 00:57:18,034 --> 00:57:18,768 SOMETIMES IT'S HARD TO BELIEVE 1754 00:57:18,835 --> 00:57:20,570 THAT IF WE DON'T TAKE THEIR 1755 00:57:20,637 --> 00:57:22,238 PERSPECTIVE INTO,A COUNT AT ALL. 1756 00:57:22,305 --> 00:57:25,775 I THINK YOU KNOW, WE'RE VERY 1757 00:57:25,842 --> 00:57:26,576 FORTUNATE IN THE COMMUNITY DAY 1758 00:57:26,643 --> 00:57:28,812 IN AND DAY OUT, AND SO THEY JUST 1759 00:57:28,878 --> 00:57:30,880 COME UP AND TELL US, BUT EVEN 1760 00:57:30,947 --> 00:57:32,315 THEN WHEN WE DEVELOP NEW 1761 00:57:32,382 --> 00:57:35,018 PROTOCOLS, WE MAKE SURE THAT YOU 1762 00:57:35,084 --> 00:57:38,221 KNOW OUR COMMUNITY PARTNERS IN 1763 00:57:38,288 --> 00:57:40,657 OUR STUDIES OF TRANSGENDER 1764 00:57:40,723 --> 00:57:42,091 PEOPLE, OUR TRANSIMENDER 1765 00:57:42,158 --> 00:57:43,026 COMMUNITY HEALTH WORKERS ARE 1766 00:57:43,092 --> 00:57:44,093 VIEWING BOTH WHEN WE'RE DON 1767 00:57:44,160 --> 00:57:45,228 DUCTING AND THE LANGUAGE OF THE 1768 00:57:45,295 --> 00:57:46,529 SURVEYS AND THINGS LIKE THAT TO 1769 00:57:46,596 --> 00:57:48,431 MAKE SURE THAT IT ALIGNS WITH 1770 00:57:48,498 --> 00:57:49,999 THE INTEREST OF THE COMMUNITY. 1771 00:57:50,066 --> 00:57:51,701 >> LET ME JUST EXPAND ON THAT 1772 00:57:51,768 --> 00:57:52,035 FOR A MOMENT. 1773 00:57:52,101 --> 00:57:53,970 I THINK THAT MOST OF THE PEOPLE 1774 00:57:54,037 --> 00:57:55,104 IN THIS ROOM ARE HEALTHCARE 1775 00:57:55,171 --> 00:57:56,539 PROFESSIONAL ANDS I THINK THAT 1776 00:57:56,606 --> 00:57:58,508 WE ALL REMEMBER PATIENTS WHO 1777 00:57:58,575 --> 00:58:00,710 REALLY CHANGED OUR LIFE, SO 1778 00:58:00,777 --> 00:58:01,945 HEARING SOMETHING FROM THE 1779 00:58:02,011 --> 00:58:03,179 COMMUNITY ADVISORY BOARD ASK 1780 00:58:03,246 --> 00:58:05,081 HELPFUL BUT ACTUALLY SEEING A 1781 00:58:05,148 --> 00:58:05,882 PATIENT WITH A PROBLEM AND 1782 00:58:05,949 --> 00:58:07,750 DEALING WITH THEM, I THINK GIVES 1783 00:58:07,817 --> 00:58:08,885 YOU A MUCH DIFFERENT PERSPECTIVE 1784 00:58:08,952 --> 00:58:10,820 AND I THINK SOME OF THE ISSUES 1785 00:58:10,887 --> 00:58:12,155 WITH THE INTRAMURAL RESEARCH 1786 00:58:12,222 --> 00:58:13,423 PROGRAM, I THINK WE ARE ALL 1787 00:58:13,489 --> 00:58:15,291 GUILTY OF THAT, IS THAT THE MORE 1788 00:58:15,358 --> 00:58:16,926 WE'RE UPHERE IN BETHESDA IN THE 1789 00:58:16,993 --> 00:58:19,596 FENCE, THE MORE WE DON'T SEE 1790 00:58:19,662 --> 00:58:20,196 EXACTLY WHAT'S HAPPENING. 1791 00:58:20,263 --> 00:58:21,598 THE LONGER WE'RE HERE, THE THING 1792 00:58:21,664 --> 00:58:22,999 I WORRY ABOUT IS THAT WE'RE 1793 00:58:23,066 --> 00:58:24,167 GETTING OUT OF TOUCH WITH WHAT 1794 00:58:24,234 --> 00:58:26,369 SOME OF THE REAL PROGRAMS ARE, 1795 00:58:26,436 --> 00:58:27,871 SO COMMUNITY ADVOICERY BOARDS 1796 00:58:27,937 --> 00:58:29,205 ARE GREAT, BUT BEING OUT IN THE 1797 00:58:29,272 --> 00:58:29,973 COMMUNITY AND SEEING PEASHT 1798 00:58:30,039 --> 00:58:31,541 SYSTEM ALSO IMPORTANT AND I 1799 00:58:31,608 --> 00:58:33,776 THINK THAT YOU KNOW SEAN AND 1800 00:58:33,843 --> 00:58:35,011 ELANA, AND SARAH, DESERVE A LOT 1801 00:58:35,078 --> 00:58:36,579 OF CREDIT FOR SPENDING A LOT OF 1802 00:58:36,646 --> 00:58:37,647 TIME MANAGING THE PATIENTS AND 1803 00:58:37,714 --> 00:58:39,415 BEFORE WE CAME HERE ELANA WAS 1804 00:58:39,482 --> 00:58:41,050 TAKING A CALL FROM A PATIENT WHO 1805 00:58:41,117 --> 00:58:45,154 JUST GOTTEN OUT OF PRISON AND 1806 00:58:45,221 --> 00:58:50,126 HAD TO GET HIS--BUT THIS GIVES 1807 00:58:50,193 --> 00:58:52,028 YOUA SENSE OF WHAT THE REAL 1808 00:58:52,095 --> 00:58:53,229 PROBLEMS ARE. 1809 00:58:53,296 --> 00:58:54,130 NOT JUST IMPLEMENTATION, 1810 00:58:54,197 --> 00:58:56,032 SOMETIMES IT LEADS TO SPECIFIC 1811 00:58:56,099 --> 00:58:59,035 ISSUES ALSO, SO, AGAIN, IT'S 1812 00:58:59,102 --> 00:59:01,304 12:58 AND A HALF UNLESS TOM HAS 1813 00:59:01,371 --> 00:59:03,606 A FINAL QUESTION, AGAIN, WE 1814 00:59:03,673 --> 00:59:06,142 ALWAYS APPRECIATE THE FEW HARDY 1815 00:59:06,209 --> 00:59:07,744 PEOPLE WHO ACTUALLY COME IN 1816 00:59:07,810 --> 00:59:09,412 PERSON AND WE HOPE THAT MORE 1817 00:59:09,479 --> 00:59:11,080 PEOPLE IN GRAND ROUNDS IN THE 1818 00:59:11,147 --> 00:59:12,315 FUTURE WILL COME IN PERSON SO 1819 00:59:12,382 --> 00:59:13,449 THEY CAN ASK QUESTIONS SO THANK 1820 00:59:13,516 --> 00:59:16,486 YOU TO ALL OF YOU FOR ATTENDING. 1821 00:59:16,552 [ APPLAUSE ]