Angela Kapalko, PA-C, MS, AAHIVSPhiladelphia FIGHT
Angela Kapalko completed her undergraduate work at the University of the Sciences in Philadelphia. She was in the Physician Assistant Studies program, which is a sister program of the Philadelphia College of Osteopathic Medicine. Kapalko completed her studies at PCOM in 2007 with a Masters in Science in Physician Assistant Studies. Recalls Kapalko, “One of my rotations was with a local private practice provider who, although he was Internal Medicine trained and not Infectious Diseases trained, had a fair amount of HIV patients. His name was Dr. Mark Watkins and he was my mentor in HIV care. He started during the beginning of the epidemic and was one of the first HIV-treaters in the city of Philadelphia. He taught me an immense amount on how to care for HIV patients. He was the reason I got into this field.”
Today, Kapalko is in practice at Philadelphia Field Initiating Group for HIV Trials, or Philadelphia FIGHT, an FQHC in the heart of downtown Philadelphia. Originally started as a stand-alone AIDS Service organization, FIGHT has been able to expand recently to not only care for HIV+ patients, but also to serve HIV- patients, specifically targeting people who are in high risk groups for HIV. One health center of FIGHT, the Jonathan Lax Treatment Center, is a specialty clinic serving roughly 1700 HIV+ patients each year. They provide primary care for adults living with HIV/AIDS. The clinic is made up of four physicians, two physician assistants, and two nurse practitioners. Additional staff include two onsite pharmacists, one nurse, four MAs, two phlebotomists, and other ancillary staff.
Says Kapalko, “I have a very unique patient population as I have a unique job. I am the Senior Research Coordinator. Half of my job is running all of our clinical trials. The other half of my job is being in the clinic seeing patients, mainly as the clinician who sees walk-in patients and sick visits when they can’t get in to see their regular provider. I have retained a few of my own patients who I follow regularly, about 40 of them, but mostly, I consider all 1700 patients as ‘mine’ as I see many of them for a number of reasons. Additionally, I co-direct our HIV/HCV Treatment Clinic, so some of the providers refer their co-infected patients to me for treatment. I will see them for the duration of the treatment, then return them to their original provider, hopefully HCV free! This also happens when I have research patients. While patients are on the trial, I become their main provider as I see them more often than their regular PCP. As a physician assistant, I am able to do all of the assessments for clinical trials, which helps the workflow and our ability to enroll more study patients. I would say half of my own patients are African American and I do have a fair amount of patients over the age of 50, about 40 percent.” Kapalko has been with Philadelphia FIGHT’s Jonathan Lax Treatment Center since graduating in 2007. Says Kapalko, “I found my perfect job! It marries my love of research with the ability to see and care for one of the more marginalized and stigmatized populations. I got into medicine to be in public health and to take care of people who no one wants to take care of. I always knew my mission was to serve the underserved.”
There are two primary elements about Kapalko’s work that she finds extremely rewarding. The first is being able to participate in clinical trials with new and state of the art medicine for both HIV and HCV. “It’s thrilling,” says Kapalko, “Getting to put patients on these trials and watch them thrive and teach them good medication adherence practices is always a highlight. I am a bit sad when the trial ends because I feel like we spent so much time together, sometimes years, but it is always a joy to see my research patients do well.” The second thing about her work that Kapalko finds most rewarding is being able to tell an HIV/HCV co-infected patient that one of their viruses is cured. When she starts treatment with co-infected patients, Kapalko tell them, “You have two viruses right now. One I can’t cure at this moment. We have amazing medicines that you take every day that have no major side effects that will keep you alive. But you have this other virus that can be cured. It might be hard work to cure it. It might even take a while, but it will not take a lifetime. I will be with you throughout the process and we will do this together.” Then, when treatment is done, and weeks later it is proven to have worked, Kapalko is always the first to call the patients and give him or her the good news. Says Kapalko, “Hearing my patients cry tears of joy is the best feeling ever. From that moment on, we are and always will be connected.”
When it comes to motivating her patients to adhere to treatment regimens, Kapalko first finds out what their lives are like. She likes to know their routines. Additionally, knowing how they feel about their HIV and who in their lives knows about their HIV is critical. Kapalko tailors her discussions with each patient. Instead of asking a patient “why don’t you take your medication,” Kapalko will ask “tell me about your week and which days you were able to take your medication.” She finds that this approach works better as it is less threatening and also more informative. Kapalko likes to learn how her patients see their future. “Trying to tie their medication and adherence to their future is key. I always want them looking forward.”
One thing that has been a success for the last six years at Kapalko’s clinic is something they affectionately term the “Pap-a-Thon.” Back in 2008, they realized their women patients did not want to get pap smears. As an ASO/FQHC and an organization receiving Ryan White funding, hitting the indicators is always important. In 2008, they designated two days as Women’s Health Days. The schedules were cleared for the female clinicians and only women who needed pap smears were scheduled. Friends, family, and pharmaceutical representatives donated gently-used purses that would be given to any woman who got a pap smear during the “Pap-a-Thon.” Says Kapalko of the initiative, “We were able to pap some women who hadn’t had a pap in many years and were also able to reengage them in care. Over the years we have added things to the ‘pap-a-thon’ like a mammogram van, lunch lectures given by female providers in the area about women’s health, and support groups. ‘Pap-a-Thon’ is now done two to three time a years and women wait for a ‘pap-a-thon’ so they can get their pap and then a purse! We have had the highest numbers in the state for a few years running now; anywhere between 75 to 80 percent of our women papped.”
In 2014, Kapalko had the unique opportunity of speaking at the American Association of the Study of Liver Diseases (AASLD)’s Associates Course on the topic of HIV/HCV co-infection. Says Kapalko, “A big goal of mine is to write my own studies and present them at large conferences to show others the amazing work Philadelphia FIGHT does. Also, as a physician assistant, it is very important for me to show that PAs are out in force and can do research well. Not many PAs do research or, if they do, they are always second in command. I want to be the one that writes the studies as well as collects the data.” Looking to the future of HIV care, Kapalko holds out hope for advancements towards cure and envisions a more complete and inclusive health system that breaks down barriers to care for all people.
One thing Kapalko is known for is being the clinician with the very colorful and visible tattoos. Says Kapalko, “I stand out in a crowd at conferences or meetings. I am not just someone who likes tattoos, but I am very integrated in the body modification community. This is a very diverse community of people who are about healthy and safe body modifications such as piercings, tattoos, scarifications and implants. I use my medical background to help this community with safe practices and use my knowledge of infectious diseases and blood borne pathogens to ensure the body modification community stays free of these illnesses while getting the body alterations they strive for.”
When asked why she is an AAHIVM Member, Kapalko says, “As a physician assistant, I did not have a residency or fellowship as physicians did. PAs are trained in all areas. Because of this, I felt the need to be credentialed as an HIV Specialist™ by AAHIVM, which holds the standard in HIV care in the USA. Once I was credentialed, becoming a Member was a no-brainer. I am able to connect with other like-minded colleagues who have the same drive and passion as myself. AAHIVM is great for fostering this kind of connection.”
To read previous Member Spotlight arcticles click here!