23 July 2024
In our latest Meet the Members interview, we meet Dr. Sarah M. Kattakuzhy. She shares her journey into hepatitis C, including her involvement in the first clinical trials in the US for HCV DAAs. Dr. Kattakuzhy also discusses the crucial role of implementation science in getting treatment to those who need it most and reflects on the question – after ten years in the field – are we failing people who use drugs?
Sarah is an Associate Professor of Medicine and Psychiatry at UMSOM, Associate Director of the Kahlert Institute for Addiction Medicine, and Co-Director of the Research Initiative on Infectious Disease and Substance Use Disorder (RIIS) at UMSOM’s Institute of Human Virology (IHV). She was also recently named a 2023 Women to Watch winner by The Baltimore Sun.
Can you tell us a bit about yourself and your journey into working with hepatitis C?
My journey into this field began with some happy accidents during my medical training. I initially chose to specialise in internal medicine – with a focus on HIV. After my training, I took a year to work at the National Institutes for Allergy and Infectious Disease (NIAID). I only ever planned to stay one year and learn about HIV from the people who wrote the consensus guidelines.
But I arrived just as the first studies on direct-acting antivirals (DAAs) for hepatitis C were being tested. I witnessed firsthand a disease that had been a death sentence, especially for black patients, become curable in eight weeks. This was a lightning bolt moment for me, showing the revolutionary power of clinical research to transform lives. I became deeply involved in DAA work, participating in the first human clinical trials and implementation science studies.
How did you transition from hepatitis C to integrating a focus on substance use disorders?
As the evidence of the efficacy and safety of DAAs for hepatitis C grew, I began to see patients getting reinfected or dying of overdose. This was around 2014, when illicit fentanyl began appearing in Washington, D.C., and Baltimore, where I was practicing.
Despite the success of DAAs, I realised that hepatitis C was often a secondary consequence of underlying addiction. In my medical training, I learned the importance of source control in the treatment of disease. In this case, the hepatitis C was just the symptom of the underlying source, which is the addiction.
This realisation shifted my career towards focusing on populations with substance use disorders, strongly influenced by my colleagues and mentors. The constellation of clinical research, the timing of hepatitis C medications and direct-acting antivirals, and the unfortunate increase in overdose in the United States came together and led me on this path. Now, I’ve been a faculty member at the University of Maryland School of Medicine for 10 years. This is my life’s work.
Over the past decade, have you seen improvements in the collaboration between hepatitis C treatment and addressing substance use disorders?
From a ground-level perspective, we are failing people who use drugs in America. We have not made common sense policy. We have not scaled evidence-based treatments. We have not centred harm reduction. And we have not centred the voices of people who use drugs. So, I think in that important, vital, primary perspective, we’ve really failed.
But from a scientific perspective, we’ve made good inroads. Research is always linked to funding, and federal funding from the National Institute of Drug Abuse in the United States has exponentially increased in the last 10 years. I’m also really happy to see a focus on implementation science, on recovery science, on practice-based solutions that are focused on expanding our sense of what recovery means.
Recovery is not just preventing death, but about helping people live meaningful lives in whatever form they define. Not just drug abstinence. I think there has been a lot of progress from that regard.
Can you explain what implementation science is and why it’s important?
Implementation science is the final step in the scientific process, focusing on how to deploy effective treatments to the people who need them. For example, with hepatitis C, we knew DAAs were safe and effective, but we needed to determine if non-specialists could successfully prescribe them. Our studies showed that non-specialists could treat hepatitis C just as effectively as specialists, which lead to broader access to treatment.
What advice would you give to someone looking to enter this field?
If someone is interested in the field my advice would be to start with your curiosity and think about where your skills can make the most difference. Whether it’s research, harm reduction, clinical work, or public health policy, there’s a need for passionate individuals at every level. Find a good mentor or organisation, and don’t hesitate to reach out and put yourself out there. Researchers are also always looking for dedicated individuals willing to roll up their sleeves and work on the ground.
What is a typical day like for you now?
My days are very varied. I spend part of my week treating people who use drugs, providing medications for opioid use disorder, and supporting their mental health. I also co-manage a research team of about 20 people, working on various studies. Additionally, I’ve been involved in building the Kahlert Institute for Addiction Medicine, which aims to bring together experts in addiction from various fields to serve our at-risk patient population better.
If you could implement one change to improve the treatment and support for people with substance use disorders, what would it be?
This is not a very scientific answer, but I would focus on changing hearts and minds to recognise the inherent dignity and worth of people who use drugs. Understanding this could lead to common-sense solutions, increased funding, and policy changes that prioritise health and wellbeing.
Why should someone join INHSU as a member or attend the INHSU conference?
The INHSU conference is my favourite conference to attend because it brings together experts from around the world who do the work I am passionate about. It fills me with hope and new ideas, helping me stay open-minded about what’s possible despite the challenges in the United States. It’s an ideal place for anyone interested in the health of people who use drugs to learn, be inspired, and hear balanced perspectives, that includes the voice of people who use drugs.
Would you like to share your experiences working with people who use drugs? We’re always interested in interviewing INHSU members and network. Contact us at [email protected]
