Addictions; Gastroenterology; Internal Medicine; Liver (Hepatology); Infectious Disease
I care for patients with liver disease and addiction disorders, including opiate dependency, viral hepatitis, alcoholic and fatty liver disease, in an outpatient setting at Erie County Medical Center where I am the medical director of hepatology. In collaboration with the division of infectious diseases, I also evaluate and treat patients with hepatitis C virus (HCV) and HIV co-infection. I also treat veterans with opiate dependency at the Buffalo VA Medical Center, in the addiction medicine unit. My patient-care efforts include digital outreach: I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My research involves improving hepatitis C treatments in populations disproportionately affected by HCV but with limited access to health care (including many American veterans, ethnic minority groups, injection drug users, and patients with psychological disorders) as well as developing novel modalities to deliver care. The goal of my research is to expand HCV treatment services to a wide-ranging group of patients, especially those without immediate access to care, in an effort to reduce global disease burden. This may include training primary care or other providers to treat HCV and using telemedicine and co-localization as a way to increase treatment uptake in areas such as rural primary care clinics and methadone clinics. My team is also investigating barriers to hepatitis C screening and treatment. Using the data we collect (e.g., patients’ knowledge of the disease, their perceptions regarding treatment, their willingness to be treated), we can design initiatives to improve patient-based HCV education and work toward the goal of increasing treatment uptake. This component of my research also looks at the same issues on the provider side: provider HCV knowledge and screening, referral and treatment practices. These data will help us understand what the provider-level barriers are to disease control, and we can design provider-based HCV educational initiatives to improve screening and referral for care. I am also a co-investigator on numerous clinical trials related to new therapeutic agents for hepatitis C and fatty liver disease, including a study funded by the Centers for Disease Control and Prevention (CDC) to evaluate the use of telemedicine to treat HCV in methadone maintenance clinics. I present and lecture nationally about hepatitis C with an emphasis on opiate dependence and special populations. I am a member of the New York State Hepatitis C Demonstration Project expert panel. I teach medical students in small group settings in the area of gastroenterology and hepatology. I also precept internal medicine residents and gastroenterology fellows in the outpatient clinics.
Gastroenterology; Liver (Hepatology); Infectious Disease
I am a leading expert in liver disease. My work through UBMD at Erie County Medical Center’s liver clinic has tripled the clinic’s capacity to treat patients with viral hepatitis and other forms of liver disease. Colleagues and I also have established comprehensive liver clinics at Buffalo General Medical Center to evaluate patients with liver disease referred from throughout Western New York. In addition, we provide clinical support to the Buffalo VA Medical Center in order to deliver uniformly excellent clinical care to patients with liver disease cared for at hospitals and clinics affiliated with UB’s medical school. We offer trial therapies to patients with viral hepatitis and other forms of liver disease if they meet the protocol criteria of our clinical trials. Our patient-care efforts include digital outreach: my colleagues and I co-authored an article for the inaugural issue of the patient-oriented online magazine “HCV Next.” My lab has received multi-year funding for its research programs in translational and clinical research. During the course of our translational research, members of my lab and I developed techniques for animal and human liver sampling that will enable sorting of liver cells in order to understand drug distribution in the liver during treatment and to develop ways to measure liver drug concentration. These translational research techniques will enable physicians to base drug dosing on the data gathered from the site of antiviral action in the liver instead of measuring the plasma concentration that is more reflective of systemic exposure. This may be an important breakthrough because of the fine line between drug efficacy and toxicity: the techniques will help physicians pinpoint the precise amount of drug needed for maximum benefit to the patient. In the area of clinical research, we are studying care models for viral hepatitis. We are conducting a study sponsored by the Centers for Disease Control and Prevention (CDC) Foundation to assess telemedicine to treat hepatitis C (HCV) in patients who are in treatment for substance use. By creating processes that simplify testing and improve provider and patient awareness and by expanding recommendations for HCV screening, patients can receive more timely care and treatment. I teach GI fellows, residents and students in outpatient and inpatient settings. I also teach first- and second-year medical students in small groups and research seminars with pharmacology graduate students. I am very interested in mentoring, and I supervise residents and fellows in clinical research as well as in my laboratory. The enriching experience my trainees receive affords them excellent placement opportunities once their training is complete. A number of my former trainees so valued their work with my lab that they joined our division as faculty members.