The Epidemiology of Antimicrobial-Resistant Bacteria
Dr. Erika D'Agata studies the epidemiology of antimicrobial-resistant bacteria in a variety of settings, including the hospital, out-patient dialysis units, and long-term care facilities. Mechanisms of transmission and acquisition are investigated in these settings using classic epidemiological study designs, mathematical modeling and molecular typing techniques. Other areas of study focus on developing prediction rules to identify patients at high-risk of harboring these resistant pathogens and studies focusing on patient outcomes.
Epidemiology of Nosocomial Infection
Drs. Erika D'Agata and Dr. Sharon Brodie Wright pursue studies directed at the epidemiology of nosocomial infection and the spread of resistant organisms in the hospital environment. Dr. D'Agata, in addition, is studying the epidemiology of resistant bacteria in the hemodialysis and elderly population and the factors associated with the emergence and spread of multidrug-resistant gram-negative bacilli. Dr. Wright also focuses on quality improvement in infection control and education of staff, specifically related to surgical site infections, hand hygiene, and isolation precautions.
Dr. Shapiro is an Associate Professor in Medicine at Harvard Medical School and Harvard School of Public Health. His primary research interests are in the prevention of mother-to-child HIV transmission (PMTCT) and the reduction of morbidity and mortality among infants born to HIV-infected women. Since 1999, Dr. Shapiro has studied infant outcomes and PMTCT strategies in several large NIH-funded clinical trials in Botswana. He was a co-investigator of the Mashi Study, which evaluated several PMTCT interventions among 1200 mother-infant pairs, and the principal investigator of the Mma Bana Study, which compared 3 different antiretroviral combinations during pregnancy, delivery, and breastfeeding among 730 mothers-infant pairs. Dr. Shapiro is the co-principal investigator of the Mpepu Study, which is evaluating strategies for reduce infant mortality among over 3,000 HIV-exposed uninfected infants. Dr. Shapiro is also the principal investigator for a CDC funded study of birth outcomes in Botswana that has evaluated more than 33,000 deliveries among HIV-infected and HIV-uninfected women, and he a co-investigator for other HIV prevention studies in Botswana. Dr. Shapiro works closely with the Botswana PMTCT Programme, and is a member of the PMTCT Advisory Panel for the World Health Organization. Dr. Shapiro is an Associate Director for Education at the Harvard Global Health Initiative, and helps to mentor Infectious Disease fellows, residents, and students who are interested in research projects related to international HIV. Dr. Shapiro has established a clinical teaching and training program at the Scottish Livingstone Hospital in Molepolole, Botswana, to support fellows and junior faculty starting careers in international HIV. He also serves as the Co-Director of the Global Health Program within the Department of Medicine at Beth Israel Deaconess Medical Center.
Dr. Christopher Rowley is an Assistant Professor of Medicine at Harvard Medical School and a member of the Essex Laboratory at the Harvard School of Public Health. His primary research interests are related to HIV drug resistance in southern Africa. He is currently the principal investigatory of an NIH-funded study to monitor for transmitted HIV drug resistance in Botswana and to test techniques allowing for low cost alternatives for resistance testing. He also serves as the Co-Director of the Global Health Program within the Department of Medicine at Beth Israel Deaconess Medical Center.
Dr. Michael Wong has held various NIH/CFAR grants in collaboration with investigators at the MGH, Harvard School of Public Health, Partners Health care, and the William J. Clinton Foundation to better identify best-practices in HIV prevention and testing, and early intervention in resource poor areas of the Caribbean. He is also involved with a USAID grant to further develop public health policies for the City and Region of Pskov, Russia.
Dr. Kenneth Mayer has been conducting bio-behavioral studies of HIV prevention in high risk populations in the US at Fenway Health, and in several international studies overseas, particularly India. He has led studies of HIV chemoprophylaxis (PEP, PrEP, and topical microbicides), vaccines, as well as social and structural interventions. He is the New England site Principal Investigator for the NIH's HIV Prevention Trials Network (HPTN) grant. He is also funded by NIMH to work with behavioral scientists to develop adherence interventions for PrEP users.
Dr. Mayer is also involved with several natural history studies of HIV, including the CFAR Network of Clinical Integrated Systems (CNICS), which follows more than 25,000 HIV-infected patients in care at 8 US centers. He is also leading an effort to train other community health centers to use their electronic health records to conduct clinical research. His recent papers have appeared in the Annals of Internal Medicine, Lancet, New England Journal of Medicine, AIDS, Journal of AIDS, Clinical Infectious Diseases, and other journals. He continues to work with several centers in India, and is part of the leadership of the HPTN, working on developing combination HIV prevention interventions.
HIV Transplant Program
Dr. Michael Wong along with Dr. Douglas Hanto, Chief of Transplantation, are the BIDMC co-PIs for the NIAID/UCSF multisite liver and kidney transplantation in HIV+ recipients. This multi-year, multi-site study is designed to better characterize the effects of HIV on transplantation and those of transplantation on HIV. BIDMC is the only site in New England involved in this study, and has the most experience in transplantation in this population next to UCSF.
Dr. Lori Panther is the clinical director of the Infectious Diseases High Resolution Anoscopy (HRA) Clinic, which provides management and longitudinal follow up of patients with HPV-related anogenital disease. The HRA Clinic was created in 1999 and provides multispecialty care in the screening and treatment of high-grade anal dysplasia (the precursor to anal cancer), as well as follow-up care of patients who have been diagnosed with anal cancer. The HRA Clinic follows over 2000 individuals with a history of HPV-related anogenital disease. The HRA Clinic has supported several IRB-approved clinical studies, including 1) epidemiologic investigations of clinical and pathological risk factors for the presence of high-grade anal dysplasia; 2) early-phase studies of topical agents for the treatment of high-grade anal dysplasia; 3) early-phase studies of novel methods used to ablate high-grade anal dysplasia; and 4) a late-phase randomized clinical trial of the effectiveness of quadrivalent HPV vaccine in HIV-infected men. The HRA Clinic is a study site for trials conducted through the AIDS Malignancy Consortium (AMC) and the AIDS Clinical Trials Group (ACTG). In addition, Dr. Panther is principal or co-investigator at The Fenway Institute in several HIV prevention trials conducted through the HIV Vaccine Trials Network (HVTN), the Microbicide Trials Network (MTN), and the Adolescent Trials Network (ATN).
Patient Safety and Transparent Communication to Improve Quality of Care
Interested in understanding what patients, families, and clinicians experience following medical error, Dr. Sigall Bell's research focuses on improving communication after harmful events. She studies doctor, nurse, student, trainee, and patient/family experiences with disclosure of medical error. As a recipient of the Arnold P. Gold Professorship, her research also probes the effects of organizational culture and the "hidden curriculum" - the customs that shape communication and moral decision-making in the clinical learning environment - on patient safety and professionalism. She is a co-investigator on an AHRQ project examining specific barriers to implementation of Disclosure and Offer programs in Massachusetts, and aims to help develop systems that promote the healing process by supporting and compensating patients and families in the aftermath of medical error. She is Co-Director of Patient Safety and Quality Initiatives at the Institute for Professionalism and Ethical Practice, Children's Hospital Boston, whose mission it is to promote relational learning that integrates patient and family perspective and the everyday ethics of clinical practice. There she is part of a team that has trained over 600 interdisciplinary clinician-leaders in medical error disclosure nationally, and is currently developing a new educational paradigm for "Patients as Teachers" in inter-professional training sessions on patient safety. Her interest in involving patients directly in medical education and transparent medical care also extends to her research efforts on OpenNotes, a clinical technologic innovation that allows doctors to share their visit notes directly with their patients..