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The AETC Capitol Region Telehealth "Power Podcast" series allows you to listen to experts in the field from your computer or mobile device. Designed for the busy professional, you can learn about cultural competence in the treatment of HIV/AIDS from your office or "On-The-Go."

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Lunch and Learn: A Case Study Webinar


John I. McNeil, MD
Maxi Med Associates
HIV Faculty Expert

John McNeil, MD is currently in Private Practice in Silver Spring, Maryland with Maximed Associates and an HIV specialist with Total Health Care in Baltimore. Dr. McNeil is a board certified Infectious Diseases Physician and was previously a faculty member at Howard University College of Medicine. He has been the Principal Investigator of several projects including the National Minority AIDS Clinical Trials, the Howard University ACTG, and the CDC ARTUS Project. He served as a Co-Principal Investigator for the DC Local Performance site of the Pennsylvania Mid-Atlantic AIDS Education and Training Center.

Learning Objectives

Case Studies

Case Study #1

John is a 34 year old AA male. He is MSM and has been with his current partner for seven years. They are both in several sexual relationships outside of their relationship. John has been on and off Atripla since his diagnosis in 2004. He reports difficulty with adherence due to on and off employment and struggles to pay for his medication. He was recently hospitalized and treated for disseminated HSV and Syphilis. He presents with his partner today stating that his partner was recently diagnosed with HIV.

1. Despite offering intensive medical case management and financial support to allow for prescription assistance the client continues to have adherence issues. What could be other causes of his difficulty adhering to a regimen?

2. What interventions, other than risk reduction counseling, could assist this patient with making better choices about safe sex practices?

Case Study #2

Dorothy is a 54 year old AA female presenting as a new patient for HIV care. Diagnosed in 1991 she has been in and out of care and on several HIV medication regimens. She acquired the virus either via intercourse or IV drug use.  She has a long history of drug (mainly cocaine) and alcohol abuse. She last used in December 2013 and currently in an intensive outpatient treatment program. She suffers multiple medical problems including diabetes, COPD, arthritis and hyperlipidemia.  She is now taking Stribild and while virally suppressed her most recent CD4 level is 47 cells. During her first visit to the clinic her primary complaint is that of oral pain, lesions and tooth pain. On exam she has numerous (>10) plaque-like lesions on her gums and inner lips.

1. Is Stribild the best HIV regimen considering her co-morbidities?

2. Most recent labs reveal mild hyperthyroidism and she will undergo thyroid ultrasound this week. How might hyperthyroidism impact her HIV treatment?

3. The patient is already in an intensive outpatient treatment program and lives in a group home where this program takes place. How can we (her medical team) best support her efforts to remain sober?

Case Study Author

Tammie Blair, NP, has been a nurse since 1994 and a nurse practitioner for 18 years. She received her undergraduate degree in nursing and psychology at Indiana University of Pennsylvania, followed by her Master’s degree in 1996 at University of Alabama at Birmingham.

Ms. Blair spent much of her care in Women’s Health and Primary Care working in Atlanta, Georgia and Southern California. She has been working with HIV / AIDS patients for just over two years and has been at Howard University since October 2011.

In addition to patient care Ms. Blair serves on the Continuous Quality Improvement Committee for Ryan White sponsored programs and helps to write grant submission for Ryan White funded projects.

Tammie enjoys reading, music, and travel.

Organizational Summary

Howard University’s Center for Infectious Disease Management and Research (CIDMAR) is Howard University Hospital’s Infectious Disease Clinic and also home to Ryan White Funded Programs Part A and C.

Roughly ninety percent of clients seen at the clinic are living with HIV / AIDS. We serve over 400 District residents living with HIV/AIDS. Our population is predominantly African American and of lower socioeconomic status presenting with multiple physical and social challenges.

The clinic has six exams rooms and staff includes two case managers, a therapist, a substance abuse counselor, and a data team. There are four attending faculty physicians, two fellows, a Doctor of Pharmacy and a Nurse Practitioner that see patients five days a week.

CIDMAR provides routine HIV care along with highly specialized care for clients with co-morbidities, multiple medications and resistance mutations to ARVs.