Grant Program: Collaborative Health Sciences Program

Lupus is one of the most common autoimmune diseases, causing lifelong burden for 1.5 million U.S. and 28,000 Wisconsin residents. Currently, gaps in care for people with lupus contribute to more kidney failure, more cases of early death, and greater disease damage. Notably, in the US, those with lupus who are Black suffer greater disease burden when compared to other countries, likely indicating disparities in the U.S. healthcare system. Research shows that similar care gaps, disparities, and negative health consequences experienced by people with HIV were reduced by more than 20 percent through targeting key steps to control the disease: diagnosis, linkage to care, retention in care, retention on therapy and low disease activity/ damage to body. Using cutting-edge gap-closing data analysis methods, Dr. Bartels, Dr. Elwert and team will first study retention in care and retention on immune therapy, and then will further examine gaps and predictors in all five key steps for lupus care to identify which steps offer the most potential to eliminate health disparities and improve outcomes. Healthcare and patient partners will help select, adapt and pilot-test strategies that successfully reduced HIV outcome disparities. The results will provide a foundation for future studies to improve damage-free survival and health equity for people with lupus. This project includes collaborators from UW–Madison and the Medical College of Wisconsin.

Human papillomavirus (HPV) is the most commonly sexually transmitted disease in the United States – an estimated 79 million Americans are currently infected— and the number one risk factor for developing anogenital cancers, such as squamous cell carcinoma of the anus (SCCA). In Wisconsin, HPV-positive SCCA disproportionately affects underserved populations, particularly those living with HIV. Once HPV-driven anal pre-cancers are diagnosed, there are few treatment options that are effective or well-tolerated. This project builds on recent findings that show select FDA-approved protease inhibitors, previously used orally to treat HIV infection, can also be used topically to prevent HPV-associated cancers, in particular SCCA. This team of interdisciplinary researchers will work to determine the molecular mechanisms supporting these effects and repurpose these drugs as an approach for anal cancer prevention in Wisconsin. The long-term goal of this research is to develop a new strategy to prevent HPV-associated cancers, particularly SCCA, especially in high-risk patients such as people living with HIV. This project also includes collaborators from UW–Madison.

This project, Leaving Prison and Connecting with Medical Care, aimed​​ to evaluate the impacts of two changes to Wisconsin Medicaid policy on health care access, health outcomes and reincarceration for formerly incarcerated individuals. Incarcerated populations have high rates of hepatitis C virus (HCV) and opioid use disorder (OUD), and untreated HCV and OUD lead to severe health and social consequences. Medicaid coverage could reduce adverse health outcomes and reincarceration in former prisoners by improving access to treatment. In 2014, Medicaid eligibility was extended to all poor adults, and in 2015, pre-release Medicaid enrollment assistance was introduced within state prisons, though there has been little research done to assess the effects of these changes on criminal justice-impacted individuals. The project successfully achieved its goals, demonstrating that expanded eligibility and pre-release enrollment assistance increased the number of Medicaid applications before and enrollments at the time of release. The policies improved coverage for both the general population and those with histories of substance use, and they were associated with a 2.5 percent decline in reincarcerations and a 5.2 percent increase in employment procurement. Additionally, the changes to Medicaid policy significantly increased the likelihood of outpatient visits post-release for individuals with substance use histories, although overall substance use disorder-related care remained low.

Through a unique partnership between UW–Madison and the Wisconsin Department of Corrections, this study will provide group cognitive processing therapy to prison inmates. The study will also evaluate the impact of the therapy, with the goal of improving mental health and outcomes for prison inmates as well as informing public policy related to mental healthcare in prisons.

This project, Evaluating a Novel Follow-up Intervention to Improve the Delivery of Follow-up Care for Low-Risk Breast Cancer Survivors in Wisconsin, will implement a novel patient-centered intervention, known as REASSURE, to optimize the delivery of follow-up care to early-stage breast cancer survivors who are at low risk of recurrence. Early-stage survivors comprise 60% of Wisconsin’s more than 70,000 breast cancer survivors. This intervention is designed to better prepare and support early-stage breast cancer survivors while also reducing the burden of unnecessary medical visits that are especially difficult for patients who are socioeconomically disadvantaged or reside in rural areas. The study has the potential to advance cancer care more broadly through adaptation to other cancers where frequent follow-up clinic visits have limited benefit.

High stress levels and obesity both have consequences for immune cell function and inflammation. This project, led by David Beebe, PhD, professor, Department of Pathology and Laboratory Medicine, aimed to explore the intersection between lifestyle factors, like diet and meditation, and inflammation. High stress levels and obesity both have consequences for immune cell function and inflammation. Previous work at UW–Madison has shown how immune cells respond to injury and help resolve inflammation and that the immune response can be influenced by stress and meditation. However, little research has focused on linking these findings. The research team investigated the links between sugar consumption and stress on immune response by studying blood samples before and after sugar intake. Within one hour of ingestion, the immune cells exhibited heightened activity, suggesting that sugar intake can significantly impact the function of these cells. The team studied mindfulness practices in lupus patients and found initial evidence that these interventions may influence immune response and offer non-pharmacological insights for managing autoimmune conditions.

This research team will investigate a novel potential mechanism underlying interstitial lung disease (ILD), a collection of diseases that produce progressive scarring, or fibrosis, of the lung. ILD, which remains largely untreatable and poorly understood, impacts more than 250,000 patients in the United States and causes a staggering 40,000 deaths each year. Since the onset of the COVID-19 pandemic, incidence of ILD has risen sharply. Nearly all patients intubated for COVID-19 have evidence of ILD. This study focuses on understanding how epithelial injury remodels its extracellular matrix microenvironment through the hexosamine biosynthetic pathway. The findings have the potential to advance the mechanistic understanding of how lung injury triggers scarring and identify therapeutic targets for stabilizing this progressive and intractable disease.

This project, led by Dr. Jennifer Weiss, aimed to characterize factors at the system, clinic, provider and patient levels that influence colorectal cancer (CRC) screening rates at rural and urban clinics. CRC is the second leading cause of cancer-related deaths for adults in Wisconsin, and it the most preventable yet least prevented cancer due to low uptake of screening. Recognizing that many rural, low-income, and racial/ethnically diverse communities have disproportionately low screening rates, the National Colorectal Cancer Roundtable announced a campaign to achieve screening rates of 80 percent and higher in every community. Wisconsin has a screening rate of 73.4 percent; however, there is wide geographic variation among rural and urban clinics. The research team successfully developed a novel rural-urban geodisparity model that revealed significant disparities in CRC screening rates between rural and urban clinics. High-performing clinics, particularly those serving subpopulations with historically low screening rates, utilized stool-based screening tests more frequently, likely due to fewer resources and less access to colonoscopy facilities in rural areas. Additionally, the research team conducted interviews with clinic staff who highlighted the critical roles of medical assistants and primary care providers, shared decision-making and the need for stratified screening rate information to inform interventions aimed at reducing disparities and improving CRC screening practices.