Location/Telephone Number: Ann Arbor, MI 888/224-7939

Year Program Started: 1996           Principal RD: Emily Cartmill, RD

Web Site: http://www.med.umich.edu/hivaids/    Hours on Site:  5 days/40 hours

Patient Referral Source: Community testing and counseling agencies, in-house physician's, website (self-referrals), and patient-to-patient referrals 

Number of Clients and Population Served: This treatment program consists of 359 total active patients all above the age of 15 (Program Data Report, 2001). Of those patients, 79% are males; 20% of the males are African American, 75% White, 3% Hispanic or Latino and 0.4% are Asian. Twenty-one percent of the patients are female with 43% of them African American, 51% White, 1.3% Hispanic or Latina and 1.3% Asian.

Funding Source: The program is funded through Ryan White, Title 3.

How often are patients seen?  Patients are seen depending on their individual needs, by their physician every 2 weeks to every 6 months.

Are all patients screened for nutritional risk? Every patient sees the RD at least once a year for a nutritional screening.

How often do you provide nutritional assessments and follow-ups? Depending on the particular patient, follow-ups may be as often as every visit or only 1-2 times per year. 
 

What has been your most difficult issue? Ms. Cartmill notes, “When I started this job there had not been a dietitian in the clinic for about six months, and I was also the first full time RD to fill the position. I literally had to start from the beginning to set up the way nutrition services were done in the clinic as well as see to many issues that had gone unattended for that time.”

Who is your best ally?  According to Ms. Cartmill, “I consider my coworkers my best allies. They are all very supportive, and I rely on that since I'm the only nutrition-minded person in the office!”

What differences exist between current clientele and that of the HIV-positive person in the early 1980s?  Ms. Cartmill sees lipodystrophy as a very discouraging new issue. “Now that most people with AIDS don't have to worry about wasting due to better disease management; they are having body shape changes instead. What's even more discouraging is that there's no effective treatment (yet)”. In her experience, diet hasn't appeared to have the ability to change it much either.

Are there any differences in clinical care within your population group? The nutritional care given to patients can be divided up into 3 different categories.  1. Healthy with stable HIV - this group works on making their diet and exercise habits as good as can be to help keep them healthier longer.
2. HIV stable but there is another diagnosis (such as diabetes, heart disease, kidney disease, etc) - nutrition therapy is based on their circumstances.
3. Ill with more advanced HIV/AIDS - patients tend to be wasted and cachectic and need greater nutrition support and thus are seen more frequently. If supplements, specific diet plans, or finding alternate meal sources do not work, tube feedings, medications for increasing appetite, and anabolic steroids are discussed. 

Is someone involved in program operation actively involved with the local HIV/AIDS Health Services Planning Council? Yes

Do you participate regularly in HIV/AIDS networking groups? “I attended the ANSA nutrition and HIV conference last year... Otherwise not really.”

What have you found to be most useful in helping to keep up with the current research on nutrition and HIV? Ms. Cartmill notes, “I do a lot of reading. BETA magazine, Medscape's Medpulse (AIDS), and other medical journals are what I seem to read the most of. “