Launched by the American Academy of HIV Medicine with support from ViiV Healthcare, the Dr. Dawn K. Smith HIV Prevention Clinical Fellowship (DKS) is a vital effort to close gaps in HIV prevention and care. Named in honor of Dr. Smith, a public health pioneer regarded as the “mother of pre-exposure prophylaxis (PrEP),” the fellowship aims to increase understanding, address inequities, and provide clinicians with the resources they need to effectively fight HIV.1
The program trains physicians, pharmacists, nurse practitioners, and physician assistants from various practice specialties to provide comprehensive HIV prevention services, emphasizing increasing access and awareness of PrEP. To bridge disparities and provide fair access to this life-saving intervention, the program prioritizes training for clinicians who serve under-resourced populations who encounter racial, economic, and geographic barriers to care. The program includes leadership development and several activities designed to enhance clinical skills and understanding of PrEP. Such programming equips the Fellows with the necessary tools to develop and lead creative HIV prevention initiatives in their local communities and health care systems.
The program enables everyone, especially those in Ending the HIV Epidemic (EHE) priority regions, access to efficient HIV prevention strategies by incorporating evidence-based practices into clinical and community health settings.1 The EHE campaign is an ambitious initiative intended to drastically reduce the number of new HIV infections, with the goal of a 90 percent reduction by 2030.2 Core pillars include improving linkage to care for those with HIV, increasing viral suppression rates among those currently receiving treatment, and expanding access to PrEP.
Preventing HIV is Critical
Due in large part to ongoing disparities in health care access, Black and Hispanic/Latino groups are particularly impacted by HIV. Black Americans make up only 13 percent of the U.S. population, but account for almost half of all HIV-related deaths. This discrepancy highlights the pressing need for specialized initiatives to address these injustices and offer impacted communities focused assistance.3
People with HIV frequently face additional hurdles in managing their health, including food hardship, housing instability, and unemployment. For instance, one in five individuals with HIV are unhoused. Housing instability poses serious obstacles to medication adherence and accessing care, and maintaining good health becomes difficult. Additionally, stigma and discrimination discourage many people from accessing HIV testing and engaging in treatment. People do not get adequate treatment because of a shortage in culturally appropriate care. Fear of being judged also prohibits the most vulnerable populations from seeking HIV services. For target populations, which include young people, transgender persons, and those with substance use disorders, this problem is particularly urgent. To overcome the obstacles, care must be given that honors cultural diversity and considers the unique requirements of different groups.3
As part of efforts to lessen the burden of HIV, some states are expanding Medicaid, which makes health care more accessible for those with low incomes. Furthermore, community initiatives are leading the efforts in providing support and increasing awareness in regions with the greatest rates of new infections. By ensuring that people feel empowered to get the care they require without feeling ashamed or afraid, these programs are also attempting to fight stigma. These initiatives seek to create a more effective and equitable response to the HIV epidemic by tackling systemic barriers and promoting inclusive care.4
How the Fellowship Bridges Gaps in Knowledge and Access
Fellowships allow professionals to get specialized training in fields where they might not be as knowledgeable. These programs provide targeted education in disciplines such as medicine or pharmacy that extend beyond standard practice. For example, a health care fellowship may focus on cutting-edge research methods, novel patient care models, or developing therapies—areas that practitioners might not normally encounter daily. Individuals can acquire comprehensive knowledge and skills through this focused instruction, which keeps them at the forefront of their respective fields.
Fellowships allow recipients to work on pioneering studies that expand their knowledge of intricate pharmaceutical or medical subjects. DKS Fellows obtain mentors and access to resources that are often unavailable in their primary positions. Thanks to support, individuals can contribute to improvements in their professions, which creates an atmosphere conducive to discoveries and ideas. In addition to expanding their knowledge, Fellows actively contribute to the direction of research and health care through this experience.
As mentioned previously, Fellows in the DKS program acquire advanced skills, leadership qualities, and a thorough awareness of health care policy, all of which support system-wide reforms and increase access to care. Their fellowship experiences provide them with the skills they need to better advocate for marginalized communities and use that expertise to reform systems that increase access to critical health care services. In addition to improving their practice, these enhanced abilities enable them to influence more significant reforms in the health care system, which will ultimately help underserved communities and advance universal access to quality care.
Meet the Fellows
A pharmacist by training, Tessa Rife-Pennington is Harm Reduction Coordinator at San Francisco Veterans Affairs Health Care System and volunteer clinical assistant professor at University of California, San Francisco, School of Pharmacy. Tessa is passionate about expanding harm reduction resource access to Veterans and community members with lived/living expertise of housing insecurity, substance use, and overdoses. During outreach efforts, Tessa identified HIV testing and PrEP as an access gap, as substance use and infectious disease services often operate in silos. Tessa pursued this fellowship to bridge the gap and increase availability of HIV prevention services to Veterans.
Frank North is a pharmacist and educator at the Irma Lerma Rangel College of Pharmacy at Texas A&M University in College Station and director of interprofessional education in the office of interprofessional practice, education, and research in the Health Science Center. He was drawn to the fellowship to increase his practice-based experiences, as much of his work has been centered around compliance, advocacy, etc. He hopes to implement or support a service line providing student access to PrEP awareness, education, and treatment with the University Health Services.
Nimish Patel is a pharmacist/epidemiologist by training and is faculty at the University of California San Diego. While primarily a health outcomes and economics researcher, his motivation for pursuing the fellowship program was to develop more clinical and administrative proficiency surrounding PrEP delivery. His implementation site will be the university’s student health clinic where he hopes to improve awareness, uptake and persistence on PrEP.
Ruby Nzoma is a Board-Certified Family Nurse Practitioner practicing at a Federally Qualified Health Center (FQHC) in Detroit, Michigan. Her desire to mitigate the disparate burden of HIV on the community to which she belongs and in which she serves was the impetus to her pursuit of this fellowship. Increasing awareness, access, and uptake of HIV prevention tools including PrEP for communities shouldering the adverse ramifications of the HIV epidemic, especially African American Women, is the driving factor for the care she provides.
Melissa Chruscinski, PharmD, BCACP, AAHIVP, is a clinical pharmacist at a Federally Qualified Health Center in north Florida. She is always working to expand pharmacists’ role in health care while providing the highest quality of care to the underserved population. Melissa has a robust program for Hepatitis C at the FQHC. She realized there was also a need for increased HIV testing and PrEP prescribing. Melissa joined the fellowship to bring increased education and access to the communities she serves.
Lauren Judd is a Family Nurse Practitioner working alongside a mobile syringe service program in Detroit. Recognizing that people in the community who access harm reduction services also need HIV care, she decided to take on treatment and prevention. This ultimately led her to apply for the DKS Fellowship. Lauren also serves as Clinical Adjunct Faculty at the University of Michigan School of Nursing, providing nurse practitioner students the opportunity to work with this underserved population.
Bernard Royal, MSN, ARPN, FNP-C, is a board-certified Family Nurse Practitioner and the owner of Royal Nursing and Training Institute in Atlanta, Georgia. His practice specializes in providing treatment and preventive services for HIV and STIs, along with comprehensive primary care. Bernard joined the fellowship to gain advanced knowledge and skills to enhance awareness and increase PrEP uptake among underserved populations, particularly Black and Latino cisgender women.
Jinga Oglesby-Brihm, DNP, APRN, ANP-C, AAHIVS, is the Founder and CEO of Empower Healthcare, Inc., a nonprofit clinic that specializes in primary care and women’s health in Pahokee, Florida. She is also a Contributing Faculty member for Walden University’s Adult-Gerontology Nurse Practitioner Program. Recognizing the limited access to HIV education, prevention, and treatment services in the rural area she serves, she applied for the PrEP Fellowship. Dr. Oglesby-Brihm is passionate about empowering communities to live healthier lives by breaking strongholds of past health care disparities and myths to help families cultivate a healthier future.
Grace B. Penaranda, APRN, AGNP-C, is a Nurse Practitioner at the Dallas County Health and Human Services – Sexual Health Clinic, where she spearheads efforts to increase PrEP awareness and utilization. Grace has become a champion for HIV/STI prevention, focusing on improving health outcomes for marginalized communities. Her role in the fellowship has allowed her to expand her impact, particularly in promoting PrEP as a crucial tool in HIV prevention strategies at the Sexual Health Clinic.
Wren George, DMS, PA-C, is a physician assistant working in primary care at an FQHC in western North Carolina. They are passionate about lowering barriers to care, decreasing stigma, increasing access, and providing substance use disorder treatment and gender-affirming care in the primary care setting. In their spare time, they serve on the LBGT PA Caucus Board of Directors. Most recently, they were the recipient of the Dean’s Award for their doctoral work at Shenandoah University on inclusive and trauma-informed STI testing and prevention in the primary care setting. Unfortunately, due to natural disasters in their area, this Fellow was unable to complete the program.
Diverse Perspectives
The Fellows represent diversity in multiple different ways. Racial, ethnic, sexual and gender diversity exists within this cohort. Most belong to groups that have been historically under-represented, and over half were assigned female at birth. They are also spread out geographically, with over half working in the Southern part of the United States, a region disproportionately affected by HIV. Additionally, there is geospatial diversity, with Fellows located in both urban and rural settings.
Professionally, the Fellows come from a variety of health care disciplines. They are pharmacists, nurse practitioners, and physician assistants. The presence of different disciplines allows for varying perspectives and interprofessional collaboration.
Diversity is also exhibited in the types of specialties and practice settings in which the Fellows work. Some practice in mobile clinics, hospitals, or FQHCs. Others have ventured into academia and entrepreneurship. Collectively, these diverse perspectives are essential to advancing the fellowship goals.
How Unique Experiences Shape Their HIV Advocacy
Both personal and professional experiences shape how each of the Fellows approach HIV advocacy in their clinical practices. In this cohort, over half of the Fellows represent groups classified as racial/ethnic minorities in the United States. Research continues to assert the effectiveness of racial concordance in improving patient experiences and outcomes. It can also lead to increased authenticity in the patient-provider relationship. Thus, representation among clinicians is significant.
Moreover, the Fellows recognize how stigma associated with HIV negatively impacts care. Some Fellows identify as members of sexual and gender minority populations, which allows for a unique perspective and can increase relatability to the populations they serve. One Fellow has lived experience with substance use and recovery. Such personal familiarity with various types of stigmas further motivates the Fellows’ collective drive for change.
The experience two Fellows gained in shaping health policy around harm reduction has been impactful throughout their careers. They understand that it often takes significant time to realize positive change but now see the impacts their advocacy efforts made in the real world. As a next step, these Fellows are taking a similar approach to HIV advocacy efforts.
Notably, one of the Fellows works in a region of North Carolina devastated by the recent hurricanes. Due to these impacts, they unfortunately were unable to complete the fellowship. This highlights how environmental factors, i.e. natural disasters caused by climate change, create additional barriers to care. An issue such as this raises the demand for advocacy around climate impact on care access.
Another Fellow has significant experience in clinical research. They have leveraged these skills to systematically evaluate “dropped patients” or those who initiated PrEP but did not return for follow-up testing or medication refills. This allowed them to develop a patient-centered program focused on re-engaging these individuals in PrEP care and helping dismantle the modifiable barriers that led to their initial non-persistence. This is vital because ending the HIV epidemic is much more involved than merely starting individuals on PrEP; it also requires innovative strategies to keep individuals engaged.
Impact on HIV Awareness & Raising Public Understanding
One of the fellowship projects was to collectively develop a presentation that could be adapted and presented to a variety of audiences, such as community members, patients, and health care team members. Core components included background data about HIV, EHE goals, modes of transmission, prevention strategies, and reducing HIV stigma. Tessa has presented this collaborative work to students, providers, and patients. The fellows also developed an electronic survey that captures demographics, feedback, and knowledge uptake from the audience. This data can then be analyzed for future work and used to identify additional opportunities for increasing public awareness.
Ruby and Melissa serve as champions at their respective practices, educating peers on PrEP prescribing, and raising awareness on the impact of PrEP being an effective HIV prevention tool. Additionally, they educate other providers on the importance of HIV testing as part of a status neutral approach to care provision.
In Lauren’s work, her harm reduction coworkers conduct rapid HIV testing on the mobile unit at sites all throughout Detroit. Her team also provides HIV education and PrEP counseling. Should anyone test positive or want to engage in PrEP services, Lauren is available right there on the mobile unit to get that care started. She has been teaching coworkers more about who could be a candidate for PrEP, how the medication works, and the importance of adherence and follow-up. She also takes measures to combat HIV stigma by posting anti-stigma posters in the vehicle and in her office; speaking plainly to patients about how the virus is and is not spread; counseling patients on their risk; and educating on the effectiveness and safety of PrEP.
Bernard served as an expert panelist for the Real Talk with the 100 events at Kennesaw State University, hosted by the National Coalition of 100 Black Women, Inc. Northeast Georgia Chapter, where he educated over 150 women. During the event, he also shared his original music single, Break the Stigma, a song he wrote and self-produced. The upbeat track delivers a powerful message about combating stigma and discrimination against all diseases or conditions that impact communities. Break the Stigma was created as part of an art contest held during the Stigma Conference at Howard University, where it was selected and played throughout the conference.
Nimish’s community presentation occurred in the context of a university health fair held to commemorate World AIDS Day. At the health fair, student attendees were able to receive an HIV test. During the presentation, Nimish provided education on each of the commercially available PrEP options, their safety/effectiveness, and information on how students can access PrEP through the university’s student health clinic.
Jinga presented at a World AID’s Day event, where she was able to discuss the impact of lack of access to meaningful HIV education, prevention and treatment in rural communities and strategically plan on how to successfully implement positive change. Within her clinic, Empower Healthcare, she hosted an event that included a pharmaceutical company that focuses on HIV related medications, Florida Atlantic University College of Population Health, and local HIV community health workers and advocates. During this event, participants were provided accurate resources on HIV. She was also able to engage with the community and discuss new trends in the prevention and management of HIV. Most individuals present did not know what PrEP is and how easy it is to advocate for their sexual health.
Community Engagement
Engaging the communities most impacted by HIV is key to ending the epidemic. Building trust and gaining buy-in are vital to such efforts. The fellows have each found ways to understand their community needs, and provide direct care, education, and resources to patients, providers, and the general public.
Lauren works with people who are often unhoused, injecting drugs, doing survival sex work, and struggling with psychiatric comorbidities. When this vulnerable population accesses harm reduction services with her organization, Lauren is then available to provide health care – including HIV testing, treatment, and prevention. It is a critical access point for a group of people who most often avoid “typical” health care spaces, even in cases of severe illness or injury.
Ruby has been conducting testing in a variety of non-traditional settings to engage underserved populations in Detroit. With her team, she has been conducting rapid point-of-care testing at a local park where members of the LGBTQ population often get together. She also coordinated a “Galentine’s Day” event focused on PrEP education for Black women in the area.
In rural communities, it is important to meet the community where they are. This helps foster an environment of trust, effective communication, and adherence to new knowledge. Therefore, to support the EHE’s initiative and to increase awareness of strategies used to prevent HIV transmission, Jinga has been conducting lunch and learn group educational session in the housing developments in the surrounding communities of the rural area that she serves.
Tessa leads group classes and offers individual clinical care to Veterans with substance use disorder(s) engaged in an Intensive Outpatient Program (IOP). As part of the fellowship and within IOP, Tessa launched a new HIV prevention group class, pathway for patient referrals (sexual health discussions, sexually transmitted infection testing [STI], PrEP), and will be training interdisciplinary staff about HIV prevention. In addition, Tessa is precepting two post-graduate year-1 pharmacist resident projects aiming to increase access to STI testing, PrEP, and condoms. For these projects, Veterans who may inject drugs and young women Veterans were identified via clinical performance dashboard and contacted via phone call or in-person outreach at supportive housing to offer resources. Finally, Tessa obtained a supply of free HIV and chlamydia/gonorrhea self-tests to distribute during outreach days with Project Homeless Connect, an organization dedicated to connecting San Franciscans experiencing homelessness with the care they need to move forward.
Impactful Connections Made During the Fellowship
Melissa presented the fellowship group project to 25 providers across nine counties in North Florida. Numerous providers have reached out for more information and have started asking patients about PrEP. One provider specifically thought that she would not have to think about PrEP for her patients since she has an older patient population, but she was the first provider to prescribe PrEP to someone after the education session.
Jinga has been able to network with the local nurse practitioner council (whose Chairwoman is an HIV Specialist). When their chair heard that one of its members (Jinga) is trying to expand access to quality HIV prevention and care in the rural underserved area of the county, the chair helped to reach out to other organizations that provide HIV related services, such as coalitions, nonprofits, and other clinics in the county to support the implementation of Empower Healthcare’s PrEP program. Furthermore, through participation in the fellowship, Jinga has found a mentor who is an expert in HIV education on PrEP and access to care. This mentor knows well the rural community that Jinga serves because they were at the forefront of creating programming and providing care in the same area that was once known as the HIV capital of the U.S.
Quotes and Anecdotes
Ruby: “I entered this fellowship feeling like I was the only one at my organization that cares about the work I’m doing. Participating in this fellowship has empowered me to be an agent of change at my organization, very grateful for the transformation that is taking place at DCHC.”
Tessa: “I go door to door and visit Veterans residing in supportive housing to get them connected with harm reduction resources, like sterile syringes, overdose education and naloxone, and fentanyl test strips. Many do not engage in health care due to mistrust and past negative experiences. Regularly showing up where they live and bringing free resources to help them stay safe and alive has allowed me a unique opportunity to get to know these Veterans and develop rapport and trust. Adding HIV prevention services, including sexual health discussions, HIV testing, and PrEP, was a natural fit and has helped take our harm reduction services to the next level.”
Grace: “As a Nurse Practitioner at the Dallas County Health and Human Services – Sexual Health Clinic, one of my biggest challenges during the PrEP fellowship was reaching underserved communities with limited resources and awareness about HIV prevention. Despite our clinic’s efforts, initial turnout for testing and education events was sparse. Many people were hesitant or unaware of PrEP services. To address this, we implemented small incentives like goodie bags and gift cards to encourage participation.”
“Our breakthrough came during a brief but productive collaboration with the Abounding Prosperity Clinic. There, I witnessed firsthand the impact of targeted education. A patient who came for STI screening initially hesitated to watch our PrEP video. After viewing it, her perspective changed dramatically. She said, ‘I can’t believe there is a medication that can prevent you from getting HIV. I wish my brother knew about this before he acquired HIV.’”
“This moment at the Abounding Prosperity Clinic highlighted the power of combining education with accessibility. While incentives brought people in, the knowledge we shared kept them engaged. It reinforced the importance of community-based approaches in HIV prevention and showed how we can empower individuals to take control of their health through PrEP utilization. This experience has since informed our strategies at the Sexual Health Clinic, where we continue to focus on meeting people where they are, offering both tangible support and hope to change lives beyond a single interaction.”
Long-Term Goals
The fellows all share one common goal: To change the HIV care landscape to help end the epidemic. The goal is being accomplished in a variety of ways and settings. Nimish and Frank are working to inform public policy and improve PrEP access at university settings. Lauren and Tessa are focusing on increasing PrEP awareness and access among people who inject drugs. Ruby and Melissa are working to train clinicians to provide PrEP to patients in primary care settings. The fellows are not only affecting the lives of the individuals they touch, but also are improving policy and educating other providers to have a lasting change in the HIV care landscape.
Each fellow’s long-term goals
Nimish: Inform public policy and improve PrEP access through real-world patient experiences.
Lauren: Increase PrEP uptake in people who inject drugs, and improve health care providers’ perception of contingency management for increasing PrEP adherence and retention.
Tessa: Increase HIV testing and PrEP access for Veterans residing in supportive housing who inject substances, are in substance use treatment, young women less than 25 years of age, those with recent STIs, and who reside in rural and northern California.
Melissa: Increase PrEP awareness, HIV testing, and PrEP uptake for patients who have recently tested positive for an STI.
Ruby: Continue to increase PrEP awareness, access, and uptake in communities most affected by HIV, with an emphasis on African American women in Detroit and the surrounding metropolitan areas.
Jinga: Continue working with the housing authorities in rural communities to increase efforts to expand the knowledge base of the residents on the importance of knowing their status and on PrEP through lunch and learn programs. Also, to increase the numbers of individuals using PrEP in the community, and equip the community with accurate information to not only help themselves but also others.
Grace: As a Nurse Practitioner at Dallas County, her long-term goal is to significantly increase PrEP awareness, uptake, and retention among underserved populations. She aims to establish a comprehensive PrEP program that integrates education, access, and follow-up care, leveraging tools like the Linktree platform she developed during the fellowship. She hopes to create a model of care that contributes to ending the HIV epidemic in Dallas County and can be replicated in other urban settings facing similar challenges.
Bernard: Increase awareness and uptake of PrEP among cisgender women by
focusing on expanding access and education for PrEP among cisgender women, with a targeted emphasis on Black and Latina women in Metro Atlanta. Also, to address barriers such as stigma, misinformation, and health care access disparities by implementing culturally competent outreach and education initiatives.
How Fellowship Fosters Leadership and Innovation in Public Health
The DKS fellowship fosters leadership in that each fellow has to create their own project from the ground up. Educating peers and patients about HIV prevention and raising awareness around this topic are also requirements. Each fellow has to be creative with how to reach their target population and accomplish the fellowship goals.
Some examples of this creativity include the Linktree website that Grace developed to enhance her PrEP education and efforts in Dallas, and the contingency management model Lauren is using to incentivize patients who get on injectable PrEP with gift cards.
Inspiring the Next Generation
The DKS Fellowship represents a transformative initiative that unites nine dedicated Fellows, each committed to inspiring future generations in the battle against HIV. Through their collaborative efforts, they underscore the significance of education, advocacy, and care in addressing this persistent epidemic. By sharing their experiences and expertise, these fellows encourage meaningful discussions surrounding HIV prevention and treatment. Their objective is to empower individuals and communities to take proactive measures in their health journeys, cultivating an environment where awareness and understanding can thrive. Collectively, they advocate for change and generate a ripple effect that motivates others to participate in this essential cause.
Conclusion
The Dr. Dawn K. Smith HIV Prevention Clinical Fellowship has demonstrated significant success in its inaugural year thanks to the support of the Academy and its partners. While the current funding from the Academy and ViiV Healthcare only allows for ten fellows, this highlights a substantial opportunity for expansion. To amplify the fellowship’s impact and reach, interested parties are encouraged to consider becoming mentors, applying for the fellowship, collaborating with fellowship alumni on local initiatives, spreading awareness about the fellows’ projects and outcomes, and supporting the fellowship financially.
Supporting the DKS Fellowship honors Dr. Dawn K. Smith’s legacy and drives innovation in HIV prevention. This collaborative effort can engage high-risk communities in meaningful ways, reduce health disparities, and move closer to ending the HIV epidemic. The success of this inaugural cohort serves as a foundation for future growth, potentially inspiring a new generation of HIV prevention specialists who will carry this vital work forward. Individuals and organizations are invited to prioritize HIV awareness and access, joining this crucial effort to create lasting change in communities across the United States.
