The Women's Interagency HIV Study (WIHS) in Northern California is the product of active multi-disciplinary collaborations between academic, public health and community-based investigators. Consortium investigators are affiliated with the following institutions: the University of California at San Francisco (UCSF), California State Viral and Rickettsial Laboratories, San Francisco Public Health Department AIDS Office, Alta Bates Medical Center in Berkeley, and the Alameda County Medical Center (Highland Hospital) in Oakland. UCSF, the sponsoring institution, is renowned as both a research facility and a medical center. The consortium is directed by a Steering Committee which functions as the basic governing body for the local research group. Its structure and function were established via a memorandum of agreement. The consortium is also advised by a sizable group of scientific investigators and a Community Advisory Board (CAB). WIHS staff are divided into five operational sections (field operations, statistics and data management, specimen banking, fiscal administration, and CAB) organized under five team managers who report directly to the Project Director.
The WIHS has offices located within four blocks of the main UCSF campus. WIHS field operations occur at four institutions: 1) the Women's HIV Specialty Clinic and the NIH-funded General Clinical Research Center at UCSF, 2) in the NIH-funded General Clinical Research Center and Ward 86 at San Francisco General Hospital (SFGH), the well-known SFGH HIV outpatient facility, 3) the Adult Immunology Clinic at Highland Hospital, Alameda County Medical Center in Oakland, and 4) East Bay AIDS Center (EBAC), at Alta Bates Medical Center in Berkeley. Each of the four institutions has a program director and physician consultant and offices for WIHS field operations.
Field activities take place at the four institutions, each of which has substantial expertise in providing care to HIV patients. Referrals for the ongoing care of HIV+ WIHS participants who were not previously in care (or wish to transfer care) are accepted. Each site is able to provide care for any participant identified as in need of acute medical attention during the course of a study visit. The unique characteristics of these sites are as follows:
- The Women's Specialty Program at the UCSF Medical Center: is part of the AIDS Clinic at UCSF, which serves approximately 600 HIV+ patients, 150 of whom are women. Eight physicians, eight nurse practitioners and midwives, three social workers, two vocational nurses, one nutritionist and one child psychologist are affiliated with the program. This broad representation of expertise permits provision of a variety of on-site services, including full primary, pediatric, gynecological and obstetrical care, case management, support groups, benefits counseling, nutrition counseling and psychotherapy services. In addition, volunteer legal counseling is available on-site once a month. WIHS Principal Investigator Dr. Greenblatt directs this award-winning program.
- The Positive Health Program, located in Ward 86 at SFGH, serves 3,000 HIV+ patients, approximately 300 of whom are women. The program has 20 physicians and five nurse practitioners and physician's assistants who provide HIV-related medical care to patients. There are comprehensive psychosocial services provided by five psychiatrists, five social workers and one social work associate. In addition there are on-site specialty clinics in pulmonology, oncology, neurology, gastroenterology, dermatology and endocrinology (wasting clinic).
- The Adult Immunology Clinic at Highland Hospital serves 450 HIV+ patients, 120 of whom are women. The program has six medical providers and two social workers. In addition there are on-site substance abuse programs and a Rape Crisis/Domestic Violence Program.
- The East Bay AIDS Center serves about 530 HIV+ patients, approximately 150 of whom are women. The program has three physicians and two nurses.
The Steering Committee, chaired by the Principal Investigator, meets monthly, with ad hoc meetings arranged as needed. The committee routinely addresses issues of project space, staffing, site-specific proposals, and participant retention. In addition, the Steering Committee has reviewed WIHS data collection instruments and protocols, and drafted statements back to the WIHS EC. The field management group (Principal Investigator, Associate Principal Investigator, Project Director, and Site Coordinator) meets weekly to discuss issues regarding participant retention, field staff, and scheduling. WIHS team managers meet with the Project Director on a weekly basis and review implementation of new protocols and procedures, discuss the flow of operations across the five operational sections (i.e. field specimen collection to processing of specimens by the Specimen Bank), and address personnel and work space issues. The local CAB, chaired by the Community Liaison, meets monthly and is made up of study participants and community-based organization (CBOs) representatives, and is attended by the Principal Investigator, Project Director, Site Coordinator, Associate Principal Investigator, and Senior Project Assistant. At each CAB meeting there are announcements of general interest and a review of the progress of the local WIHS. Full WIHS project staff meetings, chaired by the Project Director, occur 1-2 times per month and include reports from the five study sections, training's for new protocols and procedures, and discussions of current and future events. Field team meetings, chaired by the Site Coordinator, occur 1-2 times per month, and cover issues specific to field operations.
Communication with study participants occurs at many levels. Calls are made to schedule and confirm appointments, update address and phone information, screen for interest in and eligibility for substudies, and follow up on laboratory results. A newsletter, The WIHS Woman, is distributed to all study participants, National Community Advisory Board (NCAB) members, and Project Directors. The WIHS Woman is produced quarterly and gives updates on study progress, substudy initiation and eligibility and information concerning project staff. The WIHS CAB meets at alternating locations, San Francisco and Oakland, for greater participant participation. Transportation for participants is provided and refreshments are served at all CAB meetings.