Description of Clinical Expertise

Representative for Maryland Chapter of American Academy of Pediatrics to the Maryland General Assembly, HB781 and SB746 Work Group to review the CDC Revised Recommendations for HIV Testing, 2007.

Response to WHO, 2022-2030 Global Health Sector Strategies on HIV, Viral Hepatitis and Sexually Transmitted Infections, IAS GC Person-Centered Consensus Statement, July 19, 2021.

Moving Beyond Change Efforts: Evidence and Action to Support and Affirm LGBTQI+ Youth. SAMHSA, A comprehensive review, roadmap, and guidance for providers to advocate and provide care that is affirming and not focused on conversion therapy and replaces the prior publication, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth. Served on the subject Matter Expert Consensus Panel to develop this document. https://store.samhsa.gov/sites/default/files/pep22-03-12-001.pdf; March 31, 2023.

Current Clinical focus: My clinical focus has been on improving the sexual health outcomes among adolescents and young adults through the provision of excellent clinical services and support during the vulnerable transition into adulthood. My primary area of interest is the prevention and treatment of HIV in adolescents, with a particular focus on HIV testing, pre-exposure prophylaxis (PrEP), and expansion of clinical services for sexual and gender diverse youth, including adolescent transgender women and men. I served over the last decade as the Adolescent and Young Adult Medicine Subspecialty Director, Medical Director of the Pediatric and Adolescent HIV AIDS Program, Director of the PrEP Program, co-Director of the Emerge Gender and Sexuality Clinic the Harriet Lane Clinic at Johns Hopkins Children’s Center.

Clinical Productivity: As the Chief of Adolescent Medicine, I am committed to improving the physical and mental health and well-being of adolescents by providing the highest quality clinical care; conducting innovative, rigorous research; and educating youth using developmentally appropriate techniques. With twenty-eight faculty, 5 advanced practitioner providers (nurse practitioners, physician assistants), 7 adolescent medicine fellows, and 8 administrative staff and support the division is one of the largest adolescent medicine practices in the nation and the only dedicated adolescent inpatient service in the tri-state region. The Division runs robust interdisciplinary programs, including an Inpatient Adolescent Medicine Service, Adolescent Specialty Clinic, Adolescent Primary Care Clinic co-located with Title X Family Planning, and an on-site clinic at Covenant House PA which serves homeless youth. The Division also has a longstanding track record of collaboration with national, regional, and local organizations to develop/implement positive youth-development programs that are trauma-informed and infused with resilience-building strategies. Drs. Marne Castillo and Nadia Dowshen serve as faculty in the division. Faculty and staff are specialized in the complicated interaction between an adolescent’s developmental changes and healthcare needs. The Gender and Sexuality Development Program provides care to over 3,000 transgender and gender diverse youth and their families in Pennsylvania, Delaware, and New Jersey, and referrals from around the world; one of the largest gender programs in the country. The Research within the division explores a wide range of adolescent health issues using quantitative and qualitative methodologies and involves local, national, and international collaborations. Successful in securing federal, state, local government, and private funding, the division’s Adolescent HIV Clinic has been one of the sites of the NICHD-funded Adolescent Trials Network (ATN) since its inception.

Description of Other Expertise

Testimony to the Maryland General Assembly in favor of SB819 which proposed removal of written informed consent for HIV testing, 03/07

Expert testimony, HB216 Hearings Maryland House of Delegates on expansion of Minor Consent for Adolescents. 2/10/16

Description of Research Expertise

Society for Adolescent Health and Medicine Position Paper. HIV Pre-Exposure Prophylaxis Medication for Adolescents and Young Adults: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health 2018; 63:513-516. [Role: Senior author of position statement]

Society for Adolescent Health and Medicine Position Paper. Promoting Health Equity and Nondiscrimination for Transgender and Gender-Diverse Youth: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health 2020; 66:76-765. [Role: 2nd author of position statement]

Adolescent Initiative: The Adolescent Initiative (Al) which is part of the Craig-Dalsimer Division of Adolescent Medicine is an integrated system of clinical care, research, training, and prevention for adolescents at-risk for or infected with HIV. The program helps bring HIV-positive and high-risk adolescents into an environment where they can feel comfortable receiving healthcare. At the heart of all Adolescent Initiative services is a commitment to outreach. All programs are designed to reach adolescents and young adults ages 12 through 24, in their own communities. Since 1993, the Adolescent Initiative at Children's Hospital has been a leader in the evaluation, prevention and care of adolescents living with HIV and prevention to high-risk youth. The clinic currently provides comprehensive, interdisciplinary HIV treatment to 100 and HIV pre­exposure prophylaxis (PrEP) care to 75 adolescents and young adults age 13 to 24. A team of physicians, nurse practitioners, nurses, social workers, peers, and mental-health professionals creates a seamless continuum of service. The clinic is nationally recognized as a center for research, treatment, and community-based prevention and receives funding from the NIH, CDC, HRSA and foundations for its work.

Research Focus: My current research focus seeks to improve the health of the community and world of Black and Latinx sexual and gender diverse youth. My research has focused on developing community-based structural strategies (policies, practices) that target young Black men who have sex with men (YBMSM) living in Baltimore. I have received 2 NIH R01, 2 supplement awards, CDC, and K23 funding to identify, recruit and link HIV infected and uninfected high-risk YBMSM to care and understand how early sexual experiences impact risk for sexually transmitted infections, HIV testing, and uptake of health preventive behaviors, including PrEP. Through the expansion of clinical services for black and Latinx sexual and gender diverse youth, including adolescent transgender women and men, my research additionally translates clinical research into the community practice and implementation. I have served as co-principal investigator of the Adolescent Trials Network C2P® Baltimore Site, the SMILE Linkage to Care (LTC) Program for HIV-infected youth, and member of the Baltimore City PrEP Working Group to develop structural interventions for high-risk YBMSM age 15 to 24 years old. I have training in adolescent medicine and HIV care, to effectively communicate with institutional review boards and institutions about consent and human subjects protections of adolescents, and provision of PrEP for high-risk YBMSM age 15 to 24 years old. As one of the co-Directors of the Adolescent and Young Adult Scientific Working Group, I co-led the group to identify key areas of focus including adolescent HIV prevention and treatment; assist with grant applications focused on this population; develop community-based linkage to address the epidemic; and identify policies and practices that can improve the care of adolescents at-risk for or living with HIV in the US and abroad.