Spotlight on…Meg Sullivan

Taken from an interview with Meg Sullivan, MD, Co-Investigator of the Boston ARCH Cohort, Director of HIV Clinical Programs, and Assistant Professor of Medicine at the Boston University School of Medicine.

Can you tell us a little about what your research interests are? What experiences have led you to these interests?
I’ve been an HIV clinician at BMC for about 20 years. Very early on, I became involved with HIV in women and reproductive health because I cared for the HIV-infected women who became pregnant. The model of care in our clinic now is HIV primary care so I’ve always been interested in the continuum of health of our patients. About 6 years ago, I became the Medical Director of the ID clinic so I started looking at things on an operational process level. It made me much more aware of the things that affect the provider’s ability to care for patients and the patient’s ability to engage and stay in their care. I had more to think about beyond my practice, such as all of the other clinicians’ practices and all of the patients that go through the clinic. I had to think about how to improve things from the patient’s side and the provider’s side in a more systematic way.

What kinds of things impact the clinician’s ability to care for patients?
Things like, the amount of time to see patients, a certain number that a clinician can see in a certain session period, and the barriers that the patients have in coming to care. It can be concrete things like transportation or repeating obstacles in their lives that are potentially modifiable by clinicians. It affects their care if they can’t come to the clinic and to engage in care effectively. Also, our ability to care for as many people as we can effectively is affected because if patients don’t show up for their visits, then we can’t actually provide care.

How does your research impact you as a clinician?
A lot of the projects that we have been doing over the past few years are models of care and interventions to improve uptake of effective care by patients. This has made me think more in-depth and be very much aware of all of those barriers that could affect a patient’s ability to reach their ultimate goal of having an undetectable viral load. I think about how it starts back in the community, with what affects their daily life and other social determinants. Sometimes, when the clinicians try to manage the process, they may not think with that in-depth level.

What is unique about working on Boston ARCH as a part of the URBAN ARCH Consortium as compared to the many other studies that take place in CID?
I think that one of them is having colleagues and counterparts within GIM. It is a pleasure especially because colleagues such as Rich [Saitz], Jeffrey [Samet], and Alex [Walley], have such a refined expertise on substance use that we can then have access to their specific expertise for our patients in CID. This includes an in-depth group that is assessing that aspect of our patients’ care. This study will also look at other factors that are essential to treatment. I know in this study, we’re focusing more on outcomes in bone health but obviously, there’s a lot of other things that are being assessed. Plus, substance use is such a major part of our patients’ lives.

Do you feel like working with Rich, Jeffrey, Alex, and all of the other people with substance use experience and expertise really reflects back into care that you’re able to give to your patients?
Yes, especially with Alex since he works with us in the clinic. Although with studies, we’re looking at logistics and concrete things like recruitment, there are obviously many things that we discuss that are relevant to the care of these patients. Identifying, engaging, and retaining people in a cohort study is in many ways similar to all of those same things in clinical care.

What is the most encouraging development you’ve witnessed over the years that you have been working with patients living with HIV?
The onset of antiretroviral therapy (ART) and the reduction in morbidity and mortality because no matter at what point patients start quite ill and debilitated, they can actually recover their health and go live a full life. That’s very much reflected in the work that I’ve done. It has shifted from when women often received their initial diagnosis of HIV during pregnancy and the outcome would be very unclear regarding infection in the unborn child to where women are actively choosing to become pregnant and maintaining their pregnancy because HIV-infected women are healthier than before. Couples are also recognizing that they are discordant and at risk of acquiring infection, if they try to conceive. There are a lot of models of care that women can look into and incorporate preconception training. When I was training 25 years ago, we weren’t thinking so much in the future of a patient’s life.

I’ve told this story when talking about women and reproductive health with HIV – that when I was a fellow, when a woman became pregnant and we didn’t really have any antiretrovirals to treat her, it was a tragedy. We didn’t know anything about perinatal transmission, and we knew that her life was going to be short and potentially presumed that the child’s would be too. Now, we’re telling people that they can potentially have their child without being perinatally-infected; they will likely “with their restored health” be able to live to see their grandchildren. To me, that’s tremendous especially since I’m a mother and I know what it’s like to want to have a family. That’s an important part of regular life.

What do you think could be done better in a clinical or policy level to help patients living with HIV and substance use?
Having more essential services embedded in primary care, like our model of having Alex come to clinic with his whole team to provide substance abuse support. This gives patients the ability to have counseling in the setting where they get their primary care and other services, such as suboxone treatment. Expanding and maximizing what’s been going on with the medical homes models important. This gives the patients access to services in one spot and, care teams are able to communicate and cross reference how the patients are doing.

What do you like to do in Boston when you’re not working?
Spend lots of time driving around New England to tournaments with my kids! My kids are very active, sports-wise. My daughter plays basketball so we find ourselves every weekend all over New England. Or at hockey tournaments for my younger son and rugby tournaments with my older son.

Are they all in high school?
One’s a senior, one’s a freshman, and one’s in 7^th grade. Right now, there’s nothing more fun than to watch them play because knowing that they’re engaging in something that’s good for their heart and soul is great!

Do you have any additional comments to readers?
Our patients have the potential to live full lives and our job is to help them. If substance abuse is getting in the way of that, we’ll need to see how we can improve that, to the best of our abilities.

Interview by: Tali Schiller, Project Coordinator, Admin Core.  The interview has been condensed and edited.