Westergaard Research

• Sarah Krechel, Vivent Health Research Coordinator
• Cameron Liebert, Vivent Health Research Specialist
• Sowmya Adibhatla, Viral Hepatitis Outreach Specialist
• Ryan Rhode, HIV Peer Navigator

• Karli Hochstatter, PhD Student
• Kristen Brunsell, PhD Student
• Quinton Taylor, MD Program Student
• Amy Baltes, Graduate Student
• Ali Moellner, Graduate Student
• Maggie Seis, Graduate Student
• Misbah Zaeem, Graduate Student
• Emma Klein, Graduate Student
• Josh Wilke, Shapiro Student
• Becca Case, Shapiro Student
• Abi Boeck, Shapiro Student
• William Henry Bull, Shapiro Student
• Shruti Rajan, Shapiro Student
• Emma Gill, Shapiro Student
• Johanna Brotz, Research Intern
• Brittany Pufall, Research Intern
• Leah Deshler, Research Intern
• Brooke Beidel, Undergraduate Student
• Staci Ikeri, Undergraduate Student
• Giovanni Hanstad, Undergraduate Student
• Coleman Fine, Undergraduate Student
• Rita Simpson, Undergraduate Student
• Queila Griffin, Undergraduate Student
• Ella Welsh, Undergraduate Student

Our clinical research program focuses on preventing fatal opioid overdose and reducing transmission rates and gaps in the continuum of HIV and Hepatitis C care for people who inject or otherwise use drugs.

• Injection Drug Use and Viral Infection in Rural Wisconsin: We are implementing an innovative yet widely replicable service delivery model, which we have named the Community-Based, Client-Centered Prevention Home, to deliver essential prevention services for people who misuse opioids in rural Wisconsin communities.
• Continuum of Care for People Who Inject Drugs: We have found that HIV and HCV virologic outcomes for people who inject drugs are inferior to general clinic populations at numerous steps.
• Health Care Utilization and Transitioning out of Prison: Recently incarcerated adults have a high risk of death from opioid overdose and frequently report HIV/HCV transmission risk behaviors, making them a high priority group for health system-based interventions aimed at improving engagement in primary care and utilization of evidence based prevention and treatment services.

Selected Publications:

• Sun S, Crooks N, Kemnitz R, Westergaard RP. Re-entry experiences of Black men living with HIV/AIDS after release from prison: Intersectionality and implications for care. Soc Sci Med. 2018 Aug;211:78-86. doi: 10.1016/j.socscimed.2018.06.003. Epub 2018 Jun 12. PMID: 29913303; PMCID: PMC6364300.
• Hochstatter KR, Stockman LJ, Holzmacher R, Greer J, Seal DW, Taylor QA, Gill EK, Westergaard RP. The continuum of hepatitis C care for criminal justice involved adults in the DAA era: a retrospective cohort study demonstrating limited treatment uptake and inconsistent linkage to community-based care. Health Justice. 2017 Oct 30;5(1):10. doi: 10.1186/s40352-017-0055-0. PMID: 29086078; PMCID: PMC5662522.
• Hochstatter KR, Hull SJ, Sethi AK, Burns ME, Mundt MP, Westergaard RP. Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial. J Med Internet Res. 2020;22(9):e19703.
• Hochstatter KR, Akhtar WZ, Dietz S, Pe-Romashko K, Gustafson DH, Shah DV, Krechel S, Liebert C, Miller R, El-Bassel N, Westergaard RP.Potential Influences of the COVID-19 Pandemic on Drug Use and HIV Care Among People Living with HIV and Substance Use Disorders: Experience from a Pilot mHealth Intervention. AIDS Behav. 2020:1-6.
• Akhtar WZ, Mundt MP, Koepke R, Krechel S, Fiore MC, Seal DW, Westergaard RP. Prevalence of Tobacco Use Among Rural-Dwelling Individuals Who Inject Drugs. JAMA Netw Open. 2020;3(3):e200493.

We have demonstrated that the use of technology is feasible and acceptable for vulnerable HIV infected and substance using populations, and the data collected are reliable in comparison to traditional methods.

• Optimizing HIV care for patients with substance use disorders using predictive analytics in a mobile health application is a two-stage, crossover clinical trial designed to address the problem of lapses in antiretroviral treatment. The study will test the effectiveness of an innovative mobile health (mHealth) system designed to support people living with HIV and substance use disorders who are receiving HIV care. The mHealth intervention, call A-CHESS, is an evidence-based smartphone application previously shown to reduce substance use and improve retention in addiction treatment by improving social connectedness, intrinsic motivation, and coping competence.
• Impact on Opioid Use of Bundling Medication-Assisted Treatment with mHealth pairs medication-assisted treatment with a proven relapse-prevention system delivered via smartphone. The goals are to improve patients’ long-term recovery from opioid dependence, reduce the risk of infection from hepatitis C and HIV, and understand how medication-assisted treatment and mobile health interventions can be improved.

Selected Publications:

• Westergaard RP, Genz A, Panico K, Surkan PJ, Keruly J, Hutton HE, Chang LW, Kirk GD. Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders. Addict Sci Clin Pract. 2017 Apr 26;12(1):11. doi: 10.1186/s13722-017-0076-y. PMID: 28441962; PMCID: PMC5405459.
• Gustafson DH Sr, Landucci G, McTavish F, Kornfield R, Johnson RA, Mares ML, Westergaard RP, Quanbeck A, Alagoz E, Pe-Romashko K, Thomas C, Shah D. The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial. Trials. 2016 Dec 12;17(1):592. doi: 10.1186/s13063-016-1726-1. PMID: 27955689; PMCID: PMC5153683.

Our program strives to build bridges and foster collaborations between academic medicine and public health agencies at the local, state and federal levels. We have a close partnership with the Bureau of Communicable Diseases within the Wisconsin Division of Public Health, jointly completing projects aimed at improving control of viral hepatitis within criminal justice settings, and leveraging public health surveillance data to inform novel strategies for care coordination to support people living with HIV.

Selected Publications:

• Westergaard RP, Hochstatter KR, Andrews PN, Kahn D, Schumann CL, Winzenried AE, Sethi AK, Gangnon RE, Sosman JM. Effect of Patient Navigation on Transitions of HIV Care After Release from Prison: A Retrospective Cohort Study. AIDS Behav. 2019 Sep;23(9):2549-2557. doi: 10.1007/s10461-019-02437-4. PMID: 30790170; PMCID: PMC6703963.
• Schumann CL, Westergaard RP, Meier AE, Ruetten ML, Vergeront JM. Developing a Patient Navigation Program to Improve Engagement in HIV Medical Care and Viral Suppression: A Demonstration Project Protocol. AIDS Behav. 2019 Jan;23(Suppl 1):5-13. doi: 10.1007/s10461-017-1727-4. PMID: 28283775; PMCID: PMC6249125.
• Schumann C, Kahn D, Broaddus M, Dougherty J, Elderbrook M, Vergeront J, Westergaard R. Implementing a Standardized Social Networks Testing Strategy in a Low HIV Prevalence Jurisdiction. AIDS Behav. 2019 Jan;23(Suppl 1):41-47. doi: 10.1007/s10461-018-2146-x. PMID: 29766328; PMCID: PMC6249107.
• Hochstatter KR, Stockman LJ, Holzmacher R, Greer J, Seal DW, Taylor QA, Gill EK, Westergaard RP. The continuum of hepatitis C care for criminal justice involved adults in the DAA era: a retrospective cohort study demonstrating limited treatment uptake and inconsistent linkage to community-based care. Health Justice. 2017 Oct 30;5(1):10. doi: 10.1186/s40352-017-0055-0. PMID: 29086078; PMCID: PMC5662522.

We are implementing enhanced services including peer support and a mHealth application into an existing care model, known as the HIV Medical Home. The integrated intervention aims to increase the proportion of patients with viral suppression and reduce missed clinic appointments by supporting their needs.

This project seeks to characterize the most important mechanisms through which harm reduction influences overdose risk behaviors by offering a suite of internet and mobile phone-based tools for reducing overdose risk.