UCSF Family and Community Medicine faculty members have responded to more than 50,000 calls from health care workers across the country seeking information from the National HIV Telephone Consultation Service (Warmline) and the National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline).
The services are provided through the National HIV/AIDS Clinicians’ Consultation Center (NCCC), a joint collaboration between the UCSF Department of Family and Community Medicine, the Health Resources and Services Administration (HRSA), and the CDC.
The Warmline’s primary goal is to support clinicians nationwide by providing readily available expert HIV/AIDS clinical consultation.
The PEPline provides immediate consultation to assist in managing occupational exposures to blood-borne pathogens. Eleven UCSF physicians, three clinical pharmacists and a nurse practitioner comprise the core Warmline/PEPline team that responds to phone calls from around the country.
Callers include physicians, nurses, pharmacists, and other health care professionals. “The work we do can be an invaluable resource for a wide range of clinicians,” said Ronald Goldschmidt, UCSF professor and vice chair of the Department of Family and Community Medicine, and director of the NCCC.
“Many do not have the experience or expertise needed to provide comprehensive care to their HIV positive patients, yet they may be the only ones available to provide their medical care,” Goldschmidt said. “Callers often present a specific question that contains a number of complicated underlying questions. We strive to understand ‘the question behind their question’ by getting a more extensive history, such as previous opportunistic infections, antiretroviral drug use histories, and resistance test results to understand the overall clinical situation, not just the answer to a specific question. In this way, we respond to the full context of the question and the caller’s underlying need, whether it is potential drug side effects or treatment options that may not be apparent initially.”
The Center receives an increasing percentage of calls from expert clinicians who need to discuss the subtleties in choosing alternative antiretroviral treatment strategies in the face of emerging concerns regarding antiretroviral drug resistance, Goldschmidt said.
Many NCCC faculty members have been involved with the treatment of HIV/AIDS patients since the beginning of the epidemic. Their familiarity with the epidemic and how it has evolved over the past two decades enriches their clinical consultations, gives them an acute understanding of Warmline/PEPline caller needs and enables them to anticipate educational trends. Warmline callers are also linked to a national network of education, training and consultation services available from their regional AIDS Education and Training Centers (AETCs).
Ann Harvey, MD, UCSF associate physician in Family and Community Medicine, explained that responding in a non-judgmental way is the most effective method of working with clinicians to provide the most beneficial patient care. “Working out the dosage of a given medicine or discussing treatment options is just one part of that job,” Harvey observed.
Nina Birnbaum MD, UCSF assistant clinical professor, said that calls to the PEPline are different than the Warmline.
“There is a responsibility to have a calming influence on the callers because there is often a significant level of concern when a health care worker believes he or she has been exposed to a blood-borne pathogen. In the vast majority of exposures, the worker is not at significant risk,” she explained. “We make an effort to obtain all available information about the exposure and the source patient before considering recommending post-exposure prophylaxis to make sure potentially unnecessary treatment options that may have adverse side are not haphazardly initiated.”
Birnbaum emphasized the importance of communicating honest, informed and current information to the caller. Birnbaum explained that PEP consultation has three components: exposure risk assessment; decisions about whether to provide prophylaxis and if so, which agents to use; and counseling. About two-thirds of PEPline callers are emergency room, occupational health, and other treating clinicians caring for possibly exposed healthcare workers and one-third of calls are from the health care workers themselves.
The Warmline (800-933-3413) is available 6 am to 5 pm (PST) Monday through Friday and the PEPline (888-448-4911) is available 24 hours, seven days per week. Both are free and confidential services.
The NCCC is part of the AIDS Education and Training Centers (AETC) Program funded by the Ryan White CARE Act of the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau in partnership with the Center for Disease Control and Prevention (CDC). For additional information, visit the Center website at www.ucsf.edu/hivctr.