Oct. 16, 2023
The Southern Alberta Clinic (SAC)
The Southern Alberta Clinic (SAC) was established in 1989 and it currently provides care to approximately 2400 people living with HIV (PLWH) in southern Alberta. SAC is the sole health care provider, under universal health care of provincially funded ART, for all those living with HIV in southern Alberta. The SAC serves a catchment area of ~2.25 million, and is multidisciplinary, with in-house team physicians (multiple disciplines), nurses, social workers, pharmacists, clerical staff and researchers. The care team at SAC prides itself in being able, over 34 years, to provide and document its provision of excellent clinical care as well as being an active participant both locally and collaboratively in generating knowledge through research.
SAC provides care using a comprehensive longitudinal relational database that was established in 1990. This database has provided the opportunity for SAC to be a center for clinical excellence, facilitating many quality improvement initiatives and novel research that has impacted and improved care for PLWH. The database routinely collects clinical, laboratory and demographic data on patients in the clinic. The database is also linked with the Southern Alberta HIV specimen repository that is located at UCalgary and is one of the most extensive and longest running HIV repositories globally. The specimen repository was established in 1988, by the Medical Director of SAC, Dr. John Gill and with patient consent and ethics approval has soared to over 47,000 samples. Currently there is at least one stored specimen for 85% of the total active patients in care. The repository is an integral component of the SAC care structure, linking basic science on specimens with epidemiology, phylogenetics, coinfections, pathogenesis, outcomes analyses and costing studies. This unique system allows for a comprehensive, clinically relevant, and extremely efficient platform to conduct both retrospective and prospective research to improve care.
HIV care has evolved rapidly since the description of AIDS in 1981. The SAC centralized care model, using comprehensive database and longitudinal biobank, has allowed “real time” monitoring of outcomes and costs and identification of additional supports/interventions for vulnerable populations for both HIV prevention and care. It has enabled us to participate in several global collaborations evaluating changes, epidemiology challenges, successes and costs as the HIV pandemic shifts over time. This is an excellent tool for quality assurance in local care and international research collaborations. Recently research is addressing the aging process in persons living with HIV, including examining the impact of co-infections and comorbidities and the optimal approaches to providing care. Further research is looking into use of injectable antiretroviral therapy and also brain function in those with long standing HIV.
To address current and future needs for optimal patient care, research always has and continues to be an important contributor in the clinic. Physician services have expanded substantially over time from initially being infectious diseases management of HIV and its opportunistic infections, to embed within routine HIV care services such as care of aging HIV persons, metabolic consequences of HIV, gay men’s health, palliative care, hepatic comorbidities, comorbidity care of addictions and mental health and refugee/travel medicine. The multidisciplinary approach offers many opportunities for research to improve routine care.
A Multidisciplinary Health Care Team
SAC consists of a multidisciplinary health care team beyondphysicians including nursing, pharmacy, social work,dietitian as well as grant funded researchers. Within HIVphysician services, several DOM members have focusedareas of interest:
- Dr. McMillan (geriatrics)
- Drs. Gill (care costs and outcomes)
- Dr. Lang (HIV epidemiology)
- Dr. Vaughan (migrant and tropical diseases)
- Dr. Luft (adolescent female health and fertility)
- Dr. Larios (viral hepatitis)
- Drs. Shukalek and Farjou (gay men’s health).
This is in addition to addictions services and palliativecare, transgender and pregnancy/pediatric careprovided by other medical departments.
Future Developments
Following the first description of AIDS in 1981, animmense global research effort has provided potenttreatments allowing most newly diagnosed personsin 2023 to anticipate a close to normal life expectancy.While achieving a vaccine has remainedremarkably elusive, current care now consists formost persons in taking a single pill once a day.Further advances in treatment include bimonthlyintramuscular injections for those unable to reliablytake daily oral therapy. In the future even a subcutaneousinjection every six months is a realistic goal.Unfortunately, achieving a sterilizing cure remainsvery challenging. Finding those with HIV but notdiagnosed and then engaging them consistently incare to have an undetectable viral load are WHOtargets for every program. Locally some or ourresearch is focused on aging in HIV, comorbiditycare and on identifying and managing the manysocial determinants of health impeding early HIVdiagnosis and subsequent continuous care.
Research Spotlight: Dr. Jacqueline McMillan
Dr. Jacqueline McMillan is a geriatrician involved inthe care of older persons living with HIV (PLWH).As a clinician-scientist she divides her time betweenclinical care and research focussed on older PLWH.She is co-chair of the CIHR Canadian HIV TrialsNetwork Aging Research and Development Team, anational network of clinical investigators, physicians,nurses, people living with HIV/AIDS, pharmaceuticalmanufacturers and others who facilitate HIV clinicaltrials of the highest scientific and ethical standards.She is also Principal Investigator for three currentCIHR-funded grants designed to improve the careof aging persons with HIV. One study is designed toinvestigate falls: frequency, risk factors and potentialinterventions to reduce falls in older PWH. Anotheris a national symposium to be held in Calgary,Alberta, October 18-20, 2023 which will bringtogether clinicians, researchers and communitymembers titled the “4th Canadian HIV and Agingsymposium: HIV and Aging WELL: WE Live & LearnTogether". The last is a survey and interviews ofolder PWH to hear their perspectives of continuingcare, from home care to long-term care. She haspublished on polypharmacy, frailty, comorbidity and tailoring care for older persons with HIV.
Research Spotlight: Dr. Raynell Lang
Dr. Raynell Lang is an Assistant Professor inInfectious Diseases at the ɫ andmember of the O’Brien Institute of Public Health andSnyder Institute of Chronic Diseases. She specializesin providing care for people living with HIV. Shecompleted a Masters in Epidemiology from LondonSchool of Hygiene and Tropical Medicine and finisheda post-doctoral fellowship in HIV Epidemiology atJohns Hopkins University with the North AmericanAIDS Cohort Collaboration on Research and Design(NA-ACCORD). The NA-ACCORD is a comprisedof over 20 collaborating cohorts and is representativeof HIV care across United States and Canada. Her research involves evaluating risk factors andoutcomes associated with coinfections and comorbiditiesin people with HIV, and characterizingimmunity, inflammation and virologic associations.She is co-leading a CIHR funded project evaluatingthe COVID-19 antibody response among people withHIV. She continues to work with the NA-ACCORDevaluating hematologic parameters among peoplewith HIV as well as the impact of HCV-HIV coinfectionon cardiovascular risk. With her research she aimsto integrate laboratory-based and patient-orientedresearch that can help facilitate a greater understandingof the impact of HIV over a patient’s lifespan.
Research Spotlight: Dr. Caley Shukalek
Dr. Caley Shukalek, a Clinical Assistant Professor, has had an interest in HIV medicine since his undergraduate years that stems from a love of the biology and awareness of how the infection has disproportionately affected gay men. His first clinic at SAC was in his second year of residency and he made a habit of being present at the clinic during clinic blocks and the occasional post-call day. Dr. Shukalek's specialization in General Internal Medicine is well suited for the aging population living with HIV and comorbidities - allowing him to assist in the management of active or complex medical issues alongside HIV for patients without access to regular specialist providers. He was also fortunate to do additional clinical training related to HIV during his advanced clinical and academic training at Johns Hopkins and The San Francisco General Hospital (UCSF). Dr. Shukalek's combined clinical and academic interests have allowed him to partake in multiple active academic trials at SAC spanning therapeutic RCTs to mixed methods inquiry to STI prevention. He also led Connect Care electronic medical record specific efforts to ensure the over 30-year-old database of patients receiving care through SAC was preserved and continued despite the changes in electronic data collection and care provision.