University of Wisconsin–Madison

Opioid Abuse & Viral Infections: UW SMPH Support of Rural Prevention Programs

As an Associate Professor of Medicine and Population Health Sciences, Ryan Westergaard, MD, PhD, MPH, is an infectious disease physician and epidemiologist who specializes in the treatment of HIV and viral hepatitis. He has a particular focus and passion to improve treatment of HIV in vulnerable, underserved populations.

Notably, drug abuse from injecting heroin and other opioids is commonly complicated by HIV or viral hepatitis infection. This risk is especially high in rural communities lacking adequate public health infrastructure, medical homes, and/or effective prevention programs. In Wisconsin, treatment admissions for heroin and other opioids tripled between 2005 and 2014 and Hepatitis C virus (HCV) infections increased at the same time.

Since 2011, Westergaard and his interdisciplinary team have created a research program to evaluate the role of non-clinical settings in coordinating delivery of essential prevention services. The team particularly concentrates on six contiguous rural counties of Wisconsin with peak opioid injection and HIV/HCV infection rates. With an NIH R01 award in 2016, the team began implementing and evaluating a novel community response model to support prevention services for high risk clients. Westergaard comments,

Ryan WestergaardOur project, the Client Centered Prevention Home model, reflects a partnership with the Aids Resource Center of Wisconsin. Much of our work is done through their field sites in northern Wisconsin and we observed that a considerable number of Native American participants were enrolling. We knew we wanted to explore a collaboration with one or more of the tribal communities.

Because our work is so community focused, we have received a lot of support over time via the UW Community Academic Partnerships core and the Collaborative Center for Health Equity (CCHE). So we knew who to turn to for advice.

Westergaard and Assistant Scientist, Wajiha Akhtar, PhD, contacted CCHE Administrative Director, Sarah Esmond, to introduce the research and explore how best to raise visibility about the project with tribal leaders. She promptly connected with Gail Nahwahquaw, Wisconsin Department of Health Services Office of the Secretary and Tribal Affairs Director. Nahwahquaw confirmed time for the project team to present at the next Wisconsin Tribal Health Directors meeting. Esmond then notified Melissa Metoxen, a community and academic support coordinator with the UW Native American Center for Health Professions (NACHP). As a member of the Oneida Nation, Metoxen was able to provide insight about how to prepare the team for their presentation to the Directors. Metoxen notes,

Melissa MetoxenWestergaard worked with NACHP to seek knowledge around working and pursuing partnerships with tribal communities. We appreciated his awareness in knowing that our communities are unique, especially given we are sovereign nations. Working with our communities often means working with tribal leadership, tribal governance bodies, and more. We were happy to assist in this effort and look forward to Westergaard creating sustainable relationships with some of our communities.

Esmond adds,

Sarah EsmondWestergaard’s work with NACHP and CCHE is an exciting case study of the efficiencies and partnerships that can result when investigators are willing to prepare for working in community settings in advance. This approach is always important when creating trusting community-academic partnerships, but is particularly significant when projects involve sensitive topics, stigmatizing behaviors, and/or engage communities from which individuals have been underrepresented in or treated poorly as part of research.

Another important step will be to establish collaboratively with our tribal partners how to share the research data with communities. For Westergaard’s project, tribal clinic staff and health directors will have a strong interest in understanding the data and strategizing how to use it to advance positive community health outcomes.

Westergaard’s work would not be possible without ICTR support. The project received an ICTR Type 2 Pilot Award in 2013, and expert guidance from the Community Academic Partnerships core and the Collaborative Center for Health Equity, which both promote work that strives for health equity through community partnership. His projects also use the services of the ICTR Scientific Review Committee, as part of review by the UW Institutional Review Boards.

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