The Clinician Consultation Center and HIV
The Clinician Consultation Center (CCC) at San Francisco General Hospital/UCSF has provided telephone consultations with clinicians on preventing and managing HIV/AIDS for more than twenty years. These case and topical discussions have been inspiring, challenging, and at times, even discouraging. But now more than ever, great strides in HIV care make these conversations uplifting and rewarding. The CCC is looking forward to continuing its role of supporting clinicians and working side by side toward the goal of eliminating HIV in our generation.
A Crisis and the Birth of Collaborative HIV Consultation
In the early era of HIV/AIDS, healthcare providers in the U.S. were confronting what some called a “medical and spiritual crisis” as they faced this terrifying disease. San Francisco General Hospital was the early epicenter for HIV treatment, and providers who worked there were at the forefront of this battle. The AIDS crisis turned medicine upside down and led to new interventions to support and encourage the best possible care for those infected.
One of the programs to arise out of the national response to this epidemic was the Clinician Consultation Center (CCC), originally called the National Clinicians’ Consultation Center. The CCC’s founder and director, Dr. Ron Goldschmidt, as well as some of the CCC’s still current consulting staff, were in the thick of providing HIV care during the initial clinically baffling period of the epidemic. These providers began to think creatively about how to best respond to the crisis in a way that would be broadly useful and supportive of all healthcare providers. It was out of their effort to quickly and accurately collate, discuss, and disseminate clinical information, in an arena where new information was constantly emerging, that the clinical consulting service eventually to become the CCC was born.
The consultation service, which was multi-disciplinary and multi-specialty, was a way for clinicians to get state-of-the-science advice. Additionally, it provided an open environment for clinicians to learn from their peers. The goal upon the service’s implementation was improving care for patients across the country by sharing rapidly developing information from the epicenter. “Although there was so much we did not know about HIV and AIDS,” Dr. Goldschmidt said, “the simple fact that we had developed ways of helping providers was comforting as clinicians heroically did their best to manage their very ill patients. Recommendations on dosages, routes of delivery of medications, and a range of new approaches we were developing at SFGH were helpful in the face of the many treatment challenges. For us, that has always been so rewarding, knowing we could help.”
The CCC Warmline Becomes a Leader in the HIV Field
The CCC pioneered distance-based consultation with the Warmline, now the HIV/AIDS Consultation Service. This service was originally funded in 1992 by the American Academy of Family Physicians. A main initiative was to provide advice on diagnosing and treating the opportunistic infections that dominated the clinical landscape for HIV-infected persons. In 1993, the Warmline was established as a national service of the Health Resources and Services and Services Administration (HRSA) AIDS Education and Training Center (AETC) program. The Warmline was in full operation with a staff of experienced HIV clinicians at the peak of AIDS deaths in 1993 and continued to provide support as antiretroviral drugs were established as a course of treatment. CCC consultants worked with clinicians across the nation to implement these early antiretroviral drug treatments for adults, children, and in pregnancy, and remained a clinical support lifeline as AIDS deaths finally began to decline.
Adapting to a Changing HIV-Treatment Landscape
The CCC expanded what began as a single project, the Warmline, into a full-fledged program with the addition of a second consultation service, the Post-Exposure Prophylaxis Service, or PEPline, in 1997. With the addition of the PEPline, the CCC would provide immediate expert advice on management of occupational exposures to bloodborne pathogens such as HIV and hepatitis B and C. The service quickly became recognized as the national needlestick hotline. In 1999, the Warmline and PEPline were consolidated into a formal organization, the National Clinicians’ Consultation Center. The Perinatal HIV Hotline was added in 2004 to address consultation and education needs for the care of HIV-exposed or infected pregnant women and their infants. In 2006, the CCC added the Perinatal Referral Service to help clinicians connect their perinatal HIV patients with local co-management clinicians and resources. In 2014, the CCC added a Pre-Exposure Prophylaxis Hotline (the PrEPline) to provide consultation to clinicians seeking advice on providing PrEP as a prevention tool. The CCC’s latest service, the Substance Use Warmline, was launched in late 2015 to assist clinicians seeking advice on substance use evaluation and management in their patients. Continuous support from HRSA’s Ryan White Program, with additional support from the Centers for Disease Control and Prevention (CDC), has allowed the CCC to provide more than 250,000 clinical consultations since its inception. You can learn more about the Center’s funding partners on Our Partners page.
Expanding to Improve Access to Expert Consultation
The CCC’s mission is to improve patient health outcomes by building the capacity of healthcare providers through expert clinical consultation and education. The Center is continuously expanding to additional management areas and disease models as needs arise in the healthcare community. The CCC also developed the Compendium of State HIV Testing Laws to aid providers in navigating changing state laws. Additionally, the Center’s ability to provide consultation has expanded to a new modality — online consultation. The CCC’s prominence in supporting and guiding HIV care nationally is evident in its faculty presence on national Guidelines committees, in major publications, and in HIV and AIDS working groups around the country.
The CCC works closely with HRSA programs, such as the training and education programs provided by the AETCs, and with the CDC to continue to enhance access to best-practice care and prevention models, and provides special consultation to federal and state groups such as the Federal Bureau of Prisons, the Department of Veterans’ Affairs, and the Indian Health Services, as well as the New York State Department of Health AIDS Institute, to address unique needs. And most importantly, as clinicians’ consultation and education needs change with the changing face of HIV and the changing structure of health care, the CCC strives to seek ways to meet new needs.
All of our services are free of charge. You can help with individual donations and contributions of any size. You can make a donation through the University of California San Francisco Foundation.