Cristina Gruta has been a clinician education specialist with the National Clinician Consultation Center (NCCC) since 1996. Starting her impactful career as a clinical pharmacist during the peak of HIV mortality in the U.S., Dr. Gruta champions the fundamentals of evidence-based, compassionate care while mentoring the next generation of HIV care providers.

If you have ever called the NCCC, there’s a good chance you have spoken to Cristina Gruta, PharmD, AAHIVP.

A deeply knowledgeable and compassionate clinician, Dr. Gruta has been a trusted “phone-a-friend” for generations of clinicians, offering thoughtful guidance, warm regard, and expert insights. As a self-proclaimed “NCCC OG,” her dedication to education and mentorship has shaped the clinical practice of healthcare professionals across the country and improved the health outcomes of countless patients, making her an invaluable resource at the University of California, San Francisco (UCSF) and beyond.

Recent testimonials from Dr. Gruta’s callers speak for themselves:

“Cristina went above and beyond to try to clarify questions about my case, even calling me back with additional information. From a human level, this was very reassuring to the patient, as well as myself as a clinician,” wrote one recent caller.

“Dr. Gruta was very professional; she clarified all my doubts and gave me treatment options for my patient. I really appreciate her support,” wrote a caller to the National Post-Exposure Prophylaxis (PEP) Line.

“Cristina Gruta was exceptionally knowledgeable and helpful. She was able to guide me through my decision-making. She even reminded me of things that I forgot to include in my workup,” wrote another.

“Dr. Gruta has been so helpful in so many ways as I care for HIV patients in rural Colorado. My patients have indirect access to the best care possible because I can consult with Dr. Gruta,” wrote another.

These clinicians and countless others have found comfort in the decades of expertise and empathy Dr. Gruta brings to her work. While HIV interventions have evolved, her roots in empathetic care have remained the same, showing that her career is one of resilience, advocacy, and unwavering dedication to the communities and clinicians she supports.

The Humanity in HIV

When Dr. Gruta moved in the early 1990s to attend pharmacy school at UCSF, AIDS was rapidly becoming the leading cause of death for all Americans ages 25-44 – and San Francisco was an epicenter of the epidemic.

Despite having never left San Diego (her home since she moved from the Philippines at 4 years old), she quickly acclimated to her new city and got to work. Almost immediately, her rotations at San Francisco General Hospital (SFGH) and the renowned Ward 86 brought her face-to-face with the devastating realities of HIV.

“Patients were dying left and right. I saw young people, so vulnerable, often stigmatized, and from different places across the country, all dying of opportunistic infections,” Dr. Gruta said.

She says this early experience inspired her calling in HIV care. After finishing a year of post-graduate training in Philadelphia, where she saw patients in privately insured clinics, she returned to Ward 86’s safety net setting and noted how similarly HIV impacted both communities.

“While I saw folks at SFGH with additional needs, the privately insured patients I saw were just as vulnerable as anyone to the ravages of HIV,” she said. “HIV, in many ways, was an equalizer. It struck people regardless of socioeconomic stance in the world.”

In 1996, after completing a 2nd post-graduate year focusing on HIV primary care, Dr. Gruta was sought out and hired by the NCCC’s late founder, Dr. Ron Goldschmidt, and began her career as a clinical education specialist, sharing her knowledge with callers as she learned from her colleagues at UCSF who had established themselves as some of the best HIV care providers in the country.

A Career Built on Advocacy and Innovation

Dr. Gruta’s early career coincided with major advancements in HIV care. When she started as a student, the inefficacy and toxicity of antiretroviral therapy (ART) often meant that she could only focus on adverse effect management or end-of-life interventions which focused on comfort.

“Even before the medications really worked, I just felt like I could do something as a caregiver, anything, to help them succeed at whatever that meant at the time, so their quality of life could be at least a bit better,” she said.

However, medications advanced rapidly. By 2000, AIDS-related deaths had plummeted.

“Medications got better and better with respect to potency, tolerability, and diminished pill burden, so much so that if persons with HIV can adhere to their usual once-daily regimens, HIV itself becomes more of a background issue. It’s not over, but these days if someone acquires HIV, they can live more-or-less normal, full lives,” Dr. Gruta said.

Dr. Gruta provides guidance to Jonathan Van Nuys, RN, MS, ANP-BC, in the NCCC’s old call center, dubbed “clinician’s alley” (Photo for UCSF Magazine)

Still, her roots in caring for vulnerable populations set the tone for Dr. Gruta’s understanding of the healthcare system. Whether people are impacted by substance use disorders (SUD) or mental illness, many face challenges within our system, she says.

“It’s no easy feat to navigate our healthcare system, and when you are already vulnerable with a stigmatized condition and may have limited health literacy, it’s much harder. As providers, the least we can do is help people to connect the dots,” she said.

To Dr. Gruta, that means assisting people outside of prescribing medications – helping them organize their doses, navigate communications with their pharmacy and other healthcare team members, or get inspired to understand and adhere to their regimens.

“To give advocacy and support to patients, it gives me a spark. After nearly 30 years, the patients are still my greatest inspiration,” she said.

‘The Question Behind the Question’ – PEP Insights

Outside of her clinical practice, one of Dr. Gruta’s most impactful roles is working on the NCCC’s National PEPline, which offers real-time guidance to clinicians managing bloodborne pathogen exposures (BBP).

According to Dr. Gruta, the PEPline is a crucial resource that greatly impacts worker safety and infection prevention. From supporting the occupational health efforts at large medical centers, the military, and other institutions to assisting individual clinicians in settings that lack these resources, the PEPline is crucial for reassuring providers around the country, she says.

“The beauty of the NCCC is that we’re able to support folks whether they’re in a big city, suburban areas, or rural America,” she said. “We serve as a glue helping to bridge gaps in care and ensuring exposed individuals get the support they need.”

As a clinical educator, she says the teleconsultation format at the NCCC is the most effective option for understanding the needs of providers.

“The best part of teleconsultation is the conversation. It’s not just about answering the initial question – it’s about uncovering the context behind it. You have to make sure to ask the question behind the question,” Dr. Gruta said.

This approach allows providers to address root issues and provide holistic support to fellow clinicians and their patients. When it comes to occupational post-exposure prophylaxis (oPEP) for HIV and viral hepatitis, Dr. Gruta knows that exposure incidents in work settings are often highly emotionally charged moments – whether it’s a needlestick or body fluid splash.

As Dr. Gruta explains, in the case of needlesticks exposures, the estimated risk of transmission via sharp device injury from a source person with HIV is 0.23% (or 1 in 435) and is likely far lower if the source persons with HIV have undetectable viral loads at the time of the exposure (AIDS Journal).

“While we do not have occupational exposure data to say that ‘undetectable equals untransmittable’ (U=U), we have robust sexual exposure data to say that U=U,” Dr. Gruta said.

Most cases on the PEPline, whether occupational or non-occupational, come down to these conversations: effective risk/benefit counseling between the PEPline clinician consultant, the provider, and the exposed person. This often requires having the latest data available on exposure management, which Dr. Gruta is always happy to provide.

“There’s an art to doing risk/benefit counseling when faced with a decision to take PEP or not,” she said. “For instance, if it’s a sharps injury, transmission risk depends on the mechanics of the injury, like how deep the stick is, how bloody the device, and, if known, the viremia of the source person with HIV.”

The exposure risk is then balanced against the likelihood of side effects of the PEP medications, and this information is communicated by the caller to the patient. PEPline clinicians often refer to these conversations as “shared decision-making,” a person-centered approach that ensures the clinician and their patient have clear and confident communication about their options, she says.

Dr. Gruta often dispels common misconceptions about prescribing PEP, which usually involves a combination of three antiretroviral medications taken over a 4-week course after an exposure.

“There’s a perception that PEP medications are highly toxic, but today’s regimens are much more tolerable, with some manageable side effects. Another myth is that PEP must be started within two hours to be effective. While starting PEP within hours of an exposure is associated with optimal efficacy, we don’t want exposed persons not presenting to care because their exposure happened more than two hours ago. Data suggests protective benefit within 72 hours of exposure,” she said.

Watch Dr. Gruta – Webinar: HIV Prevention Strategies for Health Care Providers

Lastly, Dr. Gruta says she sees systemic challenges in healthcare delivery through her work on the PEPline. She often encounters cases in which exposed individuals face delays in medical evaluation due to the absence of body fluid exposure protocols in their practices, or they face insurance issues and/or pharmacy errors that lead to delays in dispensing PEP medications.

“It’s crucial for practices to establish protocols and connect with resources like the NCCC to ensure appropriate care,” she said.

A Lasting Impact

From her first days in Ward 86 to her work today at UCSF’s 360 Wellness Center and the NCCC, Dr. Gruta’s career reflects a deep commitment to supporting patients and the clinicians caring for them.

Her work on the PEPline has guided countless clinicians during moments that are stressful and uncertain. By offering clear, empathetic advice, she ensures they feel prepared to address exposures with confidence and care. Dr. Gruta’s consultation techniques are so lauded, in fact, that she has been responsible for teaching new NCCC clinicians the best practices for consultation for more than 20 years. In this way, she not only supports the next generation of providers but also teaches the NCCC’s next generation of consultants, leaving her indelible influence on the culture and quality of the program.

Dr. Gruta (middle right) poses with NCCC clinician consultants in support of End Hep C SF, an initiative to improve health outcomes in San Francisco (Photo from End Hep C SF)

Through nearly three decades in the field, Dr. Gruta has shown that effective healthcare is as much about listening and connecting as it is about medical knowledge. Her dedication to mentoring, educating, and advocating for both the community and providers has left an enduring mark. “The longer you’re in any field, the clearer it is that very few things are black and white,” Dr. Gruta said. “Be curious, ask questions, and be kind.”

She has been a trusted resource and steady presence for those who turn to her in critical moments, reminding us of the importance of thoughtful, compassionate support in medicine.

Dr. Gruta provides clinical education on HIV and hepatitis C management, perinatal HIV, and pre-exposure prophylaxis (PrEP) in addition to post-exposure prophylaxis (PEP).