Alta Bates Summit Medical Center

Can a Long-acting, Injectable Drug Prevent HIV Infections?

Posted on May 31, 2020 in Alta Bates Summit Medical Center, Community Benefit, Expanding Access, Innovation, People, Quality, Research, Scroll Images

Christopher Hall, M.D., knows well the uncertainty and fear sparked by an infectious disease outbreak, as well as the excitement spurred by new research to develop effective treatment and vaccines.

An infectious disease specialist and researcher at Sutter’s Alta Bates Summit Medical Center (ABSMC) in Oakland, Dr. Hall began working to combat the HIV virus in 1987 in Washington, DC. Subsequent clinical leadership work at prominent HIV/AIDS care centers earned him the “street cred” to be selected for consulting roles for sexually transmitted infection (STI) prevention training programs, and membership among a national coalition of STI experts.

While the world awaits effective, safe treatments and a potential vaccine for COVID-19, HIV research has dramatically flashed forward since the AIDS epidemic of the 1980s. Among the biggest achievements in HIV prevention came in 2012, when the U.S. Food and Drug Administration (FDA) approved a daily pill called Truvada® as a means to prevent HIV virus infection—a strategy known as HIV pre-exposure prophylaxis (PrEP) for people who are HIV-negative.

Dr. Hall hopes his latest research initiative will have a similar significant impact. He leads Sutter’s participation at ABSMC in a clinical trial testing a new long-acting, injectable drug for the prevention of HIV. Earlier this month, preliminary results of an international study of the antiviral cabotegravir as PrEP were released by the HIV Prevention Trials Network (HPTN).(1,2) The results haven’t yet been published in a peer-reviewed journal.

The international, Phase 3 study known as HPTN 083 compares the effectiveness of bimonthly cabotegravir injections with oral Truvada® as PrEP to prevent HIV infection in people aged 18 years and older.

Chris Hall, M.D. and research coordinator Trish Smallwood

“This large-scale study is the first of its kind to show a long-acting form of HIV prevention to be highly effective,” says Dr. Hall. “Without a vaccine, the more options for PrEP that we can prove are effective and safe, and make accessible to people who may benefit, the better. Different options are needed for different patients. Cabotegravir injection may be an excellent tool to include in the PrEP toolkit, especially for people who have difficulty taking a daily oral medication as PrEP.”

HPTN 083—a four-year trial that began in 2016—is led by the National Institute of Allergy and Infectious Diseases (NIAID). The study randomized approximately 4,600 men and transgender women who have sex with men and are at high risk of contracting HIV, to receive either intramuscular injections with cabotegravir every two months, daily Truvada®, or placebo.(3)

Among the 50 people who became infected with HIV during course of the study, 12 were randomized to receive cabotegravir and 38 received daily Truvada®. Results showed that one third as many people became infected on cabotegravir compared with the oral drugs.

Though the study was designed to demonstrate that cabotegravir was at least as effective as conventional Truvada®, early results suggested the superiority of the injectable medication. With the encouraging results, an independent safety committee recommended the study stop early.

Conducting the study through ABSMC’s East Bay Advanced Care (EBAC) presented a unique opportunity to enroll participants from diverse, underserved communities in San Francisco’s East Bay area.(4) A commonly reported criticism of past HIV prevention research has been that the populations studied did not reflect the populations most affected.(5,6)

“We enrolled participants from San Francisco’s East Bay with the goal to study a patient population that closely reflects people at highest risk of HIV infection,” says Dr. Hall. Two-thirds of the participants were younger than 30 years old, 12% were transgender women, and 50% were African American.

“All three demographics are among the most vulnerable and at highest risk for acquiring HIV. And although specific enrollment of Latinos/Hispanics was not originally part of the study design, people from Hispanic communities were actively recruited and enrolled, and the study is stronger with their participation.”

Though results of the HPTN 083 study may be a coup for the international HIV/AIDS community, its added value in Northern California may lie in providing a new asset for EBAC: knowledge from medical research that may benefit people seeking care at the Center.

“At East Bay Advanced Care, we’re proud to offer hands-on support, medical treatments, complementary therapies and educational services for people living with HIV/AIDS,” says Jeff Burack, M.D., an internal medicine physician at Sutter and medical director of EBAC. “Insights from studying this promising new strategy for HIV prevention may greatly expand our ability to deliver care informed by science and guided by an ethos to support health equity.”

It is not yet known when single-agent cabotegravir will be reviewed for approval by the FDA for the prevention of HIV. A Viiv Healthcare press release stated that detailed results from HPTN 083 will be presented at an upcoming scientific meeting and used for regulatory submission to the FDA.

East Bay Advanced Care (EBAC): The largest HIV primary care clinic in the East Bay, EBAC delivers care and provides resources to approximately 1,400 people from diverse communities in the surrounding area.

The Center provides a comprehensive continuum of high-quality, professional treatment and support services to all clients regardless of their socioeconomic status. “Our mission is to provide essential, confidential medical and support services to all people living with HIV. The hope is to maximize quality and length of life, and to enhance personal dignity and self-empowerment in the face of HIV,” says Dr. Burack. Each year, an estimated 1.7 million people are newly diagnosed with HIV.(7) Interested in supporting research at EBAC? Donate to Alta Bates Summit Medical Center.

Targeting the HIV/AIDS virus—decades of research give new hope for “cure”: What does it take to halt a virus that has claimed the lives of approximately 32 million people?(7) HIV drugs cannot cure the disease, but they can help people with the virus stay healthy by preventing the virus from reproducing. The HIV virus completes several different steps to make copies of itself as part of the HIV lifecycle. If unimpeded, HIV integrates its viral DNA with the body’s healthy CD4 cells, essentially turning the CD4 cell into a factory that makes more HIV cells, resulting in an HIV infection. All HIV drugs work by interrupting a step in HIV’s lifecycle; this helps halt HIV replication.

Currently, six classes of HIV drugs target four steps of HIV’s lifecycle. Cabotegravir stops the HIV viral replication process at the crucial point of the virus attempting to integrate its DNA with the DNA of a healthy CD4 cell. “The approval of new classes of HIV drugs — and new drugs in the classes already available — will help provide more treatment options for people living with HIV,” says Dr. Hall.

References:

  1. Cabotegravir is manufactured by ViiV Healthcare.
  2. The HPTN 083 study that is part of the NIH-DAIDS-funded HIV Prevention Trials Network (HPTN). HTPN 083 was jointly funded by the U.S. NIAID, part of the NIH, and ViiV Healthcare, and was conducted by the HPTN. Study product was provided by ViiV Healthcare and Gilead Sciences.
  3. This particular group of study participants was selected because, in trials such as HPTN 083, demonstrating efficacy requires the population studied is at risk of acquiring HIV – otherwise, study endpoints cannot be reached in a reasonable amount of time.
  4. HPTN 083 was also offered to partners of existing patients as well as the clinic’s prevention program clients.
  5. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Jennifer A. Pellowski, Seth C. Kalichman, Karen A. Matthews, and Nancy Adler. Am Psychol. 2013 May-Jun; 68(4): 197–209. doi: 10.1037/a0032694.
  6. HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities of Color. Why We Need A Holistic Approach to Eliminate Racial Disparities in HIV/AIDS. Russell Robinson and Aisha C. Moodie-Mills. July 27, 2012.
  7. World Health Organization data. https://www.who.int/gho/hiv/en/

Sutter’s Alta Bates Summit Medical Center Welcomes New CEO

Posted on May 18, 2020 in Affiliates, Alta Bates Summit Medical Center, Uncategorized

OAKLAND, Calif. – David D. Clark, FACHE, begins a new role as chief executive officer of Alta Bates Summit Medical Center, part of the Sutter Health not-for-profit integrated network of care, on May 18. Clark served as interim CEO at Alta Bates Summit for the past year.

David D. Clark

“David Clark is an engaged and tireless leader who quickly immersed himself into all levels of the medical center’s operations when he assumed the interim CEO role at Alta Bates Summit a year ago. Since joining Sutter, David has built a diverse, cohesive, and values-driven team focused on strategy development and deployment, community relations, and operations improvement with a focus on patient-centered care,” said Julie Petrini, president and CEO of Sutter Bay Hospitals.

Clark is an accomplished healthcare executive with more than 25 years of leadership, including 15 years as CEO in various hospitals and health systems spanning rural, urban, academic medical centers, and integrated health systems.

Prior to joining Sutter, Clark served in executive roles at three different integrated health systems: Intermountain Healthcare as regional vice president and CEO in Provo, Utah; Trinity Health as regional president and CEO in Philadelphia, Pennsylvania; and CHRISTUS Health as senior vice president/chief administrative officer in Corpus Christi, Texas. Clark has provided interim healthcare leadership, executive coaching and consulting for hospitals, health systems, physician groups, and other organizations. Before his interim CEO position at Alta Bates Summit, Clark was interim chief operating officer for El Camino Health in Mountain View.

Clark grew up in Chico, California. He earned an MBA in Health Organization Management from Texas Tech University and a B.S. in Finance from Brigham Young University.

Stroke and Heart Attack Rapid Response: Timing is Everything!

Posted on May 13, 2020 in Affiliates, Alta Bates Summit Medical Center, Mills-Peninsula Health Services, Scroll Images, Uncategorized

May is National Stroke Awareness Month

If you or a loved one is experiencing a medical emergency, call 911 or visit your nearest emergency room.

SAN FRANCISCO –Fear of exposure to COVID-19 shouldn’t keep you away from the emergency department – especially if you’re experiencing signs of stroke or heart attack.

Sutter emergency departments have COVID-19 precautions in place and the capacity to treat those in need. Safety measures include masking patients; keeping patients with COVID-19 symptoms away from common waiting areas, entrances and other patients; arranging for environmental service staff to perform extra cleaning and disinfecting; visitor restrictions (with a few exceptions) and requiring all staff to have their temperature taken before each shift. (Read more here.)

Each year, thousands of people come to Sutter emergency departments with stroke or heart attack symptoms.

David Tong, M.D., director of the Mills-Peninsula Medical Center Stroke Program and regional director of stroke programs for Sutter’s West Bay Region said in a recent interview with The Mercury News, that as a result of people avoiding hospitals for fear of exposure to the coronavirus, some things like CAT scans or MRIs may be easier to schedule now than they were six months ago.

Time is of the essence for treatment of strokes and heart attacks in order to forestall long-term consequences.

With Stroke, Time = Brain
“For strokes in particular, the faster you treat the patient, the better the outcome,” Tong says. “This is not the time to ignore important symptoms because you’re going to miss the opportunity for treatment. We have all appropriate emergency department and hospital protocols in place to keep patients safe.”

According to the Centers for Disease Control and Prevention (CDC), an easy way to remember the most common signs of stroke and how to respond is with the acronym F.A.S.T.:

F = Face drooping: Ask the person to smile. Does one side droop?
A = Arm weakness: Ask the person to raise both arms. Does one arm drift downward?
S = Speech difficulty: Ask the person to repeat a simple sentence. Are the words slurred?
T = Time to call 9-1-1: If a person shows any of these signs, call 9-1-1 immediately. Stroke treatment can begin in the ambulance.

With Heart Attack, Time = Muscle
Experts warn “time is muscle” with heart attacks. The longer treatment is delayed, the more damage can occur to the heart muscle – and the chances for recovery decrease.

According to Brian Potts, M.D., medical director of the emergency department at Alta Bates Summit Medical Center’s Berkeley campus, the most common symptom of heart attack for men and women is pain or discomfort in the chest or in other areas of the upper body (in one or both arms, back, neck, jaw or stomach). Other symptoms include shortness of breath (with or without chest discomfort); breaking out in a cold sweat; nausea or lightheadedness.

“It’s vital to treat heart attacks as soon as possible. Our best-case scenario is a patient who comes to the emergency department as soon as symptoms begin. Many people rationalize away chest discomfort or jaw pain as a momentary digestion issue, but it’s better to be safe than sorry,” says Potts. “If you’re in so much pain or discomfort that you’re wondering, ‘should I go to the emergency department?’ the answer is probably yes.”

An Unintended Side Effect of Sheltering in Place

Posted on May 8, 2020 in Affiliates, Alta Bates Summit Medical Center, Cardiac, Safety, Scroll Images

Fears of the coronavirus are causing some patients to delay or avoid seeking emergency care for a stroke or heart attack. Doctors say every delayed second could put patients at risk for a worse outcome.

If you or someone you know is experiencing an emergency, seek care immediately by calling 911 or going to the nearest emergency department.

OAKLAND, CALIF. – For some people, fear of exposure to COVID-19 outweighs the risk of a heart attack. In “Afraid of going to the hospital,” the San Francisco Chronicle describes how patients like Oakland resident Hany Metwally are delaying critical evaluation and care for fear of the virus. Says Metwally, “I was afraid to have communication with anybody because I am 64 and at high risk for the coronavirus.”

Metwally suffered severe chest pain at home for four days before his son Mohammed Metwally finally convinced him to seek care at Sutter’s Alta Bates Summit Medical Center in Oakland. When he arrived at the Alta Bates Summit emergency department in Oakland, the senior Metwally was impressed with how patients with upper respiratory symptoms are kept separate from those experiencing non-respiratory symptoms like himself.

Ronn Berrol, M.D., medical director of the emergency department at Alta Bates Summit in Oakland, understands why some patients may be concerned but, “We want to reassure people that Sutter hospitals and emergency departments have plenty of capacity to care for them and we are taking every precaution to maintain stringent safety guidelines. So if you or a loved one are experiencing severe pain or illness or have a serious injury, please don’t delay care. We are prepared to care for you and protect you from the virus while you are receiving care.”

Junaid Khan, M.D., director of cardiovascular services at Alta Bates Summit, who performed a successful triple bypass on Metwally, says it’s critical for patients to continue to seek care for serious conditions without delay, despite the virus. “People are correct to be afraid, but their risk of delaying cardiac or stroke care puts them at much greater risk than the risk of acquiring COVID-19.”

Read more about the steps Sutter hospitals and emergency departments have taken to protect patients.

Healthcare Hero Salute: Alta Bates Summit Honored by First Responder Parade

Posted on May 8, 2020 in Affiliates, Alta Bates Summit Medical Center, Scroll Images

OAKLAND, CALIF. –Members of local fire and police departments lead a grand procession of first responders to four hospitals to show their appreciation and highlight the dedication of the healthcare professionals working on the front lines of the coronavirus pandemic.

Staff at Alta Bates Summit Medical Center’s Summit and Alta Bates campuses were saluted by a mile-long parade featuring dozens of fire trucks and police vehicles, ambulances, motorcycles, two helicopters –and even two mounted police at the Summit campus. The first responders represented local fire departments, law enforcement agencies and medical transport teams from the cities of Oakland, Berkeley and Piedmont, plus Alameda county and U.C. Berkeley.

Sirens wailing, lights flashing and posters waving, the first responders cheered enthusiastically to show their appreciation and respect for Alta Bates Summit staff, nurses and physicians who have worked selflessly to care for our patients and the community in this unprecedented emergency.

“We are thrilled and humbled that the Oakland fire and police departments are honoring Alta Bates Summit Medical Center staff and physicians with this very special salute. We are all in this together and it is our honor to serve our community alongside the first responders during this unprecedented time,” said David Clark, CEO of Alta Bates Summit.

As partners in our collective work to keep the community healthy and safe, a the Oakland Fire Department is honored to join first responders from the East Bay to show our appreciation for all the dedicated health care workers and staff who provide essential care every day, and especially as we grapple with the local impact of the Covid-19 global pandemic,” said Oakland Fire Department Interim Chief Melinda Drayton

Oakland Police Chief Susan E. Manheimer said, “This is our way of showing appreciation to our frontline medical personnel during this health pandemic. We appreciate the hard work being done each day during this challenging time.”

The procession began at Highland Hospital in Oakland, proceeded to Kaiser Oakland, and then visited Alta Bates Summit’s Oakland and Berkeley campuses.

Don’t Let Fear of COVID-19 Deter You from Getting the Care You Need

Posted on Apr 28, 2020 in Affiliates, Alta Bates Summit Medical Center, Safety, Scroll Images

Sutter Hospitals and Emergency Departments are Prepared to Treat You, Keep You Safe

If you or someone you know is experiencing an emergency, seek care immediately by calling 911 or going to the nearest emergency department.

OAKLAND, Calif. – Given scenes of overwhelmed hospitals on the East Coast, many people are delaying going to the emergency department—even if they are experiencing severe chest pain, stroke symptoms or have sustained a serious injury—out of fear they will be exposed to the COVID-19 virus.

Ronn Berrol, M.D., medical director of the emergency department at Sutter’s Alta Bates Summit Medical Center in Oakland, understands the concern. “We’ve seen a decrease in patients with less-urgent conditions coming to hospitals and emergency departments—this has allowed us time to build up resources to deal with a potential surge of COVID-19 patients and helped to prevent the spread of the virus,” he says. “But we want to reassure people that Sutter hospitals and emergency departments have plenty of capacity to care for them and we are taking every precaution to maintain stringent safety guidelines. So if you or a loved one are experiencing severe pain or illness or have a serious injury, please don’t delay care. We are prepared to care for you and protect you from the virus while you are receiving care.”

Berrol explains Sutter facilities have put in place safety measures for masking patients and visitor restrictions (with a few exceptions); keeping patients with COVID-19 symptoms away from common waiting areas, entrances and other patients; arranging for environmental service staff to perform extra cleaning and disinfecting; and requiring all staff to have their temperature taken before each shift.

Unsure if you should make a trip to the emergency department?
If your symptoms don’t seem to rise to the level of an emergency, contact your doctor. Your doctor will determine whether it’s best to schedule you for a video visit or have you come in to a care center or clinic for evaluation.

Check this guide for more information about when to seek emergency or urgent care.

Still have questions?
Visit Sutter’s website to find out more about the steps Sutter facilities have taken to prepare for COVID-19 and answers to frequently asked questions.