Angela Kapalko, PA-C, MS, AAHIVS
Education Coordinator for APC Students
The Jonathan Lax Treatment Center
Philadelphia FIGHT Community Health Centers
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 Community Health Centers, 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, two nurses, four MAs, two phlebotomists, and other ancillary staff.
For the first 10 years of Ms Kapalko’s career at FIGHT, she served as the Senior Research Coordinator. Says Kapalko, “Half of my job was running all of our clinical trials. The other half of my job was 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.” In May of 2017, Ms. Kapalko decided she needed a change and more of a challenge. “I realized that when I was in the clinic seeing patients, I was at my most happiest. I felt I was able to do more for patients who were in crisis, out of care, acutely ill, than seeing research patients. Not that I didn’t love research, it just wasn’t challenging enough for me!” Kapalko now has a growing practice, treating everything from chronic health issues like diabetes, obesity, and hypertension, HCV treatment for HIV/HCV co-infected patients, and substance abuse treatment with medication assisted treatment (MAT), all while working HIV treatment into their care. “My normal clinic day is anything but normal. My schedule is filled with new patients, follow up routine visits, acute care visits, HCV treatment, suboxone visits, surgical clearance, and throw in some diabetes medication management for good measure!”
With the change to full time clinician at the Lax Center, she also decided to formalize the education program at FIGHT for Advanced Practice Clinician students, specifically NP and PA students. Kapalko is the main preceptor for all APC students who rotate through the Lax Center, as well as organizing student schedules with other clinicians, coordinating didactic programs for the students, and coordinating rotations at the other health centers at FIGHT. “I love education, not just student education but patient education, staff education, and self education. I was fortunate as a student to have amazing preceptors and mentors, and I want my students to feel that same way. I want to give them the best educational experience possible, and help train the clinicians whom we desperately need in this area of healthcare.”
Kapalko has been with Philadelphia FIGHT’s Jonathan Lax Treatment Center since graduating in 2007. Says Kapalko, “I found my perfect job! 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. I now know I need to pass on my passion to the next generation of clinicians so we can continue to do the great work we do.”
There are two primary elements about Kapalko’s work that she finds extremely rewarding. The first is her new found love for diabetes treatment in her practice and getting to help patients manage another chronic illness other than HIV. “A few years ago while looking at our data, I realized that our HIV data was some of the best in the country! I was shocked to see that we had a fair number of patients with poorly controlled diabetes and knew this needed to change. I made it my new mission to re-educate myself on all things diabetes, including all of the newer agents, how they interact with HIV medication, and how I could incorporate our current HIV services with my diabetic patients.” Kapalko assists other providers in the practice with complicated diabetic patients, not just in medication management but coordination with other healthcare team members at the clinic to improve patient care. “I really do believe diabetes is far more complex than HIV, but as HIV providers, we are the perfect providers to troubleshoot barriers to care because that is what we do all of the time. Although it is a challenge, it is a great reward when a patient is more confident with their health and feels like they have a better understanding and ability to make meaningful changes themselves.”
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 patient 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 ten 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, “Education is extremely important to me, and has become more important as my career progresses. Being able to speak at a national conference as an expert in HIV/HCV Coinfection was incredible”. Since then, Kapalko was able to present at the Pennsylvania Society for PAs (PSPA) Annual Conferenc in 2016, providing an HIV Update, including PrEP for the primary care providers. In addition to CME lectures, Kapalko guest lectures at multiple physician assistant graduate programs in the Philadelphia area on a variety of topics.” 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, or even just in my clinic! 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.”
Kapalko now serves on both the Pennsylvania Steering Committee as well as the Physician Assistant Steering Committee for AAHIVM. “I find it such an honor to be a part of these two amazing groups that are constantly expanding the reach of AAHIVM and improving healthcare and policy. No matter how busy we all are, we put our individual worlds aside to come together as a team to make change. “
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