About the HHSCC
Helena
Hatch was a dedicated and active volunteer with many community organizations in
the St. Louis area. Helena was already involved as a volunteer in the HIV/AIDS
community when she discovered that she was HIV-positive. She continued to work
tirelessly as a volunteer and community activist until ultimately losing her
battle to AIDS. As one of the first women with HIV treated by Dr. Fraser at
Washington University, Helena made a lasting impact on the medical staff as
well as her fellow patients. Upon her death, the Center was named in her
memory.
The Helena Hatch Special Care
Center (HHSCC) began as a five-year, federally funded demonstration project to
find underserved women with HIV and bring them into medical care. Between 1994
and 1999, the Center became nationally renown as a Ryan White CARE Act
sponsored Special Projects of National Significance (SPNS) program for
providing comprehensive health care needs to adolescent and adult women living
with HIV. Beyond primary HIV and subspecialty care, we learned that the
one-stop, one shop model of care allowed for integrated service delivery and a
program with high rates of patient satisfaction and low rates of vertical
(mother to child) transmission of HIV. Since the completion of the SPNS
demonstration project, the HHSCC has continued as a university-based HIV
program for adolescent and adult women within the Division of Infectious
Diseases HIV Clinic at the Washington University School of Medicine.
The mission of the Helena Hatch Special Care Center is to
serve as a university-based center for excellence in the provision of
comprehensive medical and supportive care, education, and related research
focusing on women living with HIV infection. We address physical and
psychosocial needs through visits with an expert team of health professionals
in a pleasant, friendly, caring, and culturally-sensitive environment. As a
national model for comprehensive care focused on the challenges faced by women
with HIV/AIDS, we investigate options, obstacles, and components of effective
holistic HIV treatment. We are committed to facilitating comprehensive care for
women and their families, community collaborations for understanding and
controlling HIV, and efforts to reduce and prevent HIV infection.
Current research efforts include but are not limited to health outcomes
studies, evaluation of adherence to antiretroviral therapy among women eligible
for services through the Ryan White CARE Act, and biological studies of HIV
replication among women.
HIV is the third leading cause of
death for women aged 24 to 44 years in the United States. Worldwide, women
represent approximately 47% of the 37.2 million adults infected with HIV.
Consistent involvement with HIV medical care can prevent complications, expand
the range of therapeutic options, and promote secondary HIV prevention efforts.
However, access to and retention in HIV medical care may be more complex for
women than men due to competing priorities (e.g., child care, sustenance needs
), lower education, barriers to care (e.g., lack of transportation, especially
with young children or in rural areas, mental health issues, substance abuse),
and insurance problems.
Some investigators have found that women were
more likely to delay care, as were adults with a child in the household, or
with CD4 >500 cells/mm3, regardless of gender. Others have shown
that women who were African American or injecting drug users were less likely
to have any HIV outpatient care than Caucasian women.
The five-year
SPNS demonstration project that led to the inception of the Helena Hatch
Special Care Center identified that the one-stop, women-specific model of
university-based care allowed women with HIV to have their multiple and
competing priorities met. Our mission is to provide comprehensive medical care
with wrap-around support services, train health care providers, and participate
in various research efforts.
Current services include: HIV specialty
care, OB/GYN services focused on perinatal HIV prevention, cervical cancer
screening and the screening and treatment of sexually transmitted diseases,
patient education, medication monitoring, support from professional case
management and social workers, adolescent services, and mental health/substance
abuse counseling and referral, family planning, and support with medication
adherence. This multidisciplinary approach to women with HIV also includes
on-site childcare, transportation, and bagged lunches to facilitate attending
scheduled medical visits. The program's success received special recognition
from the former Secretary of Health and Human Services in the January 2000
Federal Register.
By focusing on women with HIV,
the HHSCC meets a very important and specific need in the complex arena of
HIV/AIDS care and research. Beyond what women and men equally encounter living
with HIV/AIDS, women often face unique social and economic concerns that vary
greatly from those often encountered by their male counterparts. The HHSCC
provides a supportive environment in which women can make one-stop visits to
address all of their HIV-related medical care. To help facilitate visits, the
HHSCC provides childcare, bagged lunches, and transportation to those who need
any of these services.
Since 1994, over 475 women have received care at
the HHSCC. At any given time, approximately 300 women are in active care. Most
of the women are from St. Louis City and surrounding Missouri counties, the
Metro East in Illinois, or the Missouri Bootheel, with some women traveling
from further in Missouri in order to receive their care at the HHSCC.
Responding to a call by the federal government to examine and treat
specific populations impacted by HIV, Dr. Victoria Fraser developed the grant
proposal that first envisioned the HHSCC. When Washington University was
awarded a five-year, non-renewable Special Projects of National Significance
(SPNS) grant, the HHSCC concept became reality. Dr. Fraser led the efforts of
the HHSCC until 1997 when Dr. Linda Mundy was named Medical Director. The SPNS
funding to "find the underserved" ended in September 1999, although recognition
of federal support has continued with a four-year SPNS award to Dr. Linda Mundy
to evaluate adherence support to women eligible for HIV antiretroviral
therapies. Overall, the HHSCC has continued to operate through multi-stream
support from Ryan White CARE Act contracts, grants from private foundations,
and contributions from private individuals.
A specific aspect of medical care
that has set us apart from others in the region and in all of Missouri is our
great success in reducing perinatal, or mother-to-child, transmission of HIV.
From 1995 through 2000, a full 36% of all HIV-exposed births from Missouri
residents have been cared for at the HHSCC. In 1999, perinatal care for 66.7%
of all HIV-exposed births in the state of Missouri was provided at HHSCC.
Additionally, we provide perinatal care for HIV-exposed pregnancies from the
Metro East in Illinois. Since 1995, the rate of perinatal transmission at HHSCC
has been 1.7%--with an amazing 0% transmission rate for women served from the
state of Missouri. For all other combined sites in Missouri during 1995 through
2000, the rate of perinatal transmission was 9.8%. Overall, the HHSCC helped to
bring the state perinatal transmission rate down to 6.3%
The HHSCC is a
unique program that is a model for care of HIV-infected women.
Division of Infectious
Diseases
Department of Medicine
Washington University School of
Medicine