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Breaking through barriers to HIV care

cache-10486-0x0 April Kimmel expands KL2 research in recently awarded R01 grant

By Sydney Bernstein-Miller
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Thursday, Feb. 16, 2017

“Global is local and local is global.”

April D. Kimmel, Ph.D., applies this simple, but impactful notion to her work daily as an applied decision scientist. A researcher who has had one toe dipped internationally and the other nationally since she first attended the XIII International AIDS Conference in Durban, South Africa, in 2000, Kimmel has shaped her researcher lens to consider how the scientific questions she poses can be applied across global settings.

Kimmel lends her unique perspective to her position as an assistant professor. The Virginia Commonwealth University Department of Health Care Policy and Research initially recruited her in 2011 before merging administration efforts with the VCU Department of Social and Behavioral Health to become today’s VCU Department of Health Behavior and Policy.

“I joined this department at an evolving time that offered me the chance to build and contribute to something new,” Kimmel said.

Through her department, Kimmel learned of the C. Kenneth and Dianne Wright Center for Clinical and Translational Research’s KL2 scholar program for faculty-level clinical and translational scientists near the beginning of their investigative careers.

“The protected time and mentorship I received through the KL2 program was critical for my research,” Kimmel said. “The leadership had very high expectations of success, but with those high standards came the resources and support to really achieve all that they expected from us.”

"The research process is not a straight line from point A to point B."

Kimmel recalls that the promise of protected research time allowed her to develop and hone skills she didn’t already possess, such as mapping and learning geographic information systems.

“The research process is not a straight line from point A to point B,” Kimmel said. “You zigzag, experience successes and failures and regroupings. You need that protected time in order to fully engulf in the research experience and have time to think through problems to find solutions.”

Structural obstacles to the quality of HIV care

Kimmel dove into research of HIV treatment and access to care from a public health perspective.

A passionate advocate for transforming HIV clinical policy, Kimmel first became involved in HIV research in 1998 when she joined the Boston Medical Center as a project manager on a study using mathematical modeling to analyze the economic value of HIV clinical policies.

She went on to earn a Master of Science degree in public health in 2004, followed by a Doctor of Philosophy in 2010, both from Harvard University.

“As a student researcher, I really began to feel as if I was forging my own way and beginning to tackle some really difficult questions,” Kimmel said. “It solidified my passion for work that exists at the intersection of efficient, but also equitable policies. HIV research is challenging work at both the research level and publishing level, but I consider it to be incredibly important.”

Kimmel recently collected the work she began as a KL2 scholar and submitted a grant application to the National Institute on Minority Health and Health Disparities. She was awarded a four-year R01 by NIMHD to expand her KL2 studies and examine the influence of structural barriers on the quality of HIV care and population health in the U.S. south.

“The CCTR is very fortunate to have Dr. Kimmel as a KL2 scholar,” said F. Gerard Moeller, M.D., director of the VCU Wright CCTR. “Her hard work and persistence paid off with her NIH R01, which is a major credit to her, her mentors in the KL2 program, and the CCTR.”

Be persistent and patient

Kimmel is using her R01 grant to analyze the many contributing factors that affect the quality of care HIV participants receive, which includes the pay for services provided by HIV clinicians, and the proximity of HIV care.

Through her research, Kimmel has unveiled that in Southern areas with a high prevalence of HIV and AIDS, a third of participants report having to travel more than an hour to receive comprehensive HIV care. Her work suggests that though the medical community has made huge strides in the treatment of HIV, the disease remains a complex and chronic disease where care can be affected by structural barriers such as rurality, care proximity and stigma.

“Much of the public doesn’t realize how dire the HIV epidemic continues to be in Southern states today,” Kimmel said. “The number on effective HIV treatment in the U.S. as a whole is in line with what we see in some of the lowest income countries. There is a lot of uninsurance, poverty and rurality setting the backdrop of the Southern HIV epidemic.”

Kimmel is also investigating whether people from racial and ethnic minority groups systemically have to travel farther for HIV care and whether policies can be put in to place to alleviate some of these access to care barriers. As a decision scientist, her goal is to use a variety of methods to contribute to and inform the decision-making process, whether in terms of clinical policy or public policy.

When asked what recommendations she would give to junior clinical researchers, Kimmel offers that they should reflect upon if this challenging, but rewarding field is what they want, and they should be persistent, but not stubborn. Most of all, she recommends patience.

“Once you become a faculty member, there are small successes along the way,” Kimmel said. “You live for those little successes because little successes later become bigger successes, but you must have a lot of patience along the way.”


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