A-Z List of ARI Programs Adult AIDS Clinical Trials Group (AACTG) AIDS Action Network (UCSF student AIDS advocacy group) AIDS and Cancer Specimen Resource (ACSR) AIDS Education and Training Centers (AETC) National Resource Center AIDS Health Project AIDS Policy Research Center AIDS Research Institute at UCSF Laboratory of Clinical Virology AIDS Specimen Bank

ASPIRE (AIDS Services—Prevention, Interventions, Research, and Education) Bay Area Perinatal AIDS Center (BAPAC) Blood Systems Research Institute (BSRI) Center for AIDS Prevention Studies (CAPS) Center for HIV Information (CHI) Cochrane Collaborative Review Group on HIV Infection and AIDS Community Consortium Craik Laboratory Drug Research Unit at San Francisco General Hospital FACES (Family AIDS Care and Education Services) Francis J. Curry National TB Center General Clinical Research Center (GCRC) at SFGH Gladstone Institute of Neurological Disease Gladstone Institute of Virology and Immunology HIV InSite Intl Center of HIV/AIDS Research & Clinical Training in Nursing International Training and Education Center on HIV (I-TECH) Junior Faculty AIDS Researchers Laboratory of Raul Andino Laboratory of Tumor and AIDS Virus Research Moffitt/Mt. Zion General Clinical Research Genter (GCRC) National HIV/AIDS Clinicians' Consultation Center (NCCC) Options Project Osher Center for Integrative Medicine Pacific AIDS Education and Training Center (PAETC) Pediatric Clinical Research Center Positive Health Program at SFGH Positive Health Program Education Unit Prevention and Public Health Group San Francisco Area (UCSF) AIDS Education and Training Center (AETC) San Francisco Department of Public Health, AIDS Office San Francisco Department of Public Health, HIV Research Section 360: The Positive Care Center at UCSF UCSF Global Health Sciences UCSF Nursing HIV/AIDS Center UCSF-GIVI Center for AIDS Research (CFAR) Veterans Affairs Medical Center HIV Clinical Research Program Women's HIV Interdisciplinary Network Women's HIV Program at UCSF Women's Interagency HIV Study (WIHS)

ari scientists

David Bangsberg, MD, MPH

Dr. Bangsberg is an associate professor of medicine in residence in the Division of Infectious Diseases and the San Francisco General AIDS Division at UCSF. He directs the Epidemiology and Preventions Interventions Center, an infectious disease epidemiology research unit at San Francisco General Hospital, and is a primary care physician for HIV positive patients in the Ward 86 Clinic at SFGH. He completed medical school at Johns Hopkins and an internal medicine residency at Columbia Presbyterian Hospital, where he was a chief resident; an infectious disease fellowship at UCSF; and an AIDS prevention fellowship at the UCSF Center for AIDS Prevention Studies. He also received a master's degree in public health from the UC Berkeley School of Public Health and a master's degree in the history and philosophy of science from Kings College, University of London.

Dr. Bangsberg’s research program focuses on treatment outcomes in impoverished populations domestically and internationally. The REACH cohort of HIV positive homeless and marginally housed individuals forms the basis of his domestic research program, and the Uganda Antiretroviral Treatment Outcomes (UARTO) cohort of individuals on generic therapy in Uganda forms the basis of his international research.

Domestic Program. The research in access to care in the homeless (REACH) cohort is a representative cohort of HIV positive urban indigent individuals. Dr. Bangsberg has described the challenges in providing antiretroviral therapy to the urban poor, has developed valid measures of adherence, and has demonstrated that adherence is a primary predictor of viral suppression and AIDS-free survival. Recent findings from this study have determined that each class of antiretroviral medications has different adherence-resistance relationships and that these relationships are determined by regimen-specific differences in the virologic fitness of resistant virus. Dr. Bangsberg has expanded the focus of these investigations into the following areas:

1. Intervention studies to improve adherence. Dr. Bangsberg is principal investigator on two NIMH-funded interventions: (1) Depression treatment to improve access and adherence to HIV antiretroviral therapy. This is a randomized controlled trial of directly observed antidepressant therapy among HIV positive, depressed individuals to increase treatment rates and improve adherence to antiretroviral therapy; (2) Modified directly observed therapy and adherence case management. This is a randomized controlled trial to test the two leading approaches to adherence intervention.
2. Pathophysiology of incomplete adherence. These studies are using state-of-the-art immunologic and virologic techniques combined with full pharmokinetic characterization to explain virologic and immunologic consequences of incomplete adherence.
3. Adherence–drug resistance relationships for different antiretroviral classes. Dr. Bangsberg published the first description of objectively measured adherence and resistance to combination antiretroviral therapy. These investigations have determined specific adherence-resistance relationships for different antiretroviral classes, with the expectation that regimens can be tailored based on individuals' risk of nonadherence in order to minimize the development of drug resistance.
4. Hepatitis C treatment and outcomes. Dr. Bangsberg found that HCV prevalence is 75% and incidence is 4 per 100 person-years among the HIV positive urban poor and that these high rates of infection are complicated by low rates of treatment.
5. Health service use and health outcomes in the urban poor. Dr. Bangsberg has published on the impact case management services have on adherence to HIV therapy and subsequent improvements in HIV treatment outcomes among the HIV positive urban poor.

Uganda Program. Dr. Bangsberg leads the NIMH/NIAAA-funded Mbarara University of Science and Technology HIV Research Training Program, dedicated to training junior faculty in research design, grant writing, and manuscript preparation. The program has led research that President Bill Clinton described as the “nail in the coffin” as to whether poor people in developing countries would be able to take their medication as directed. The ongoing research program consists of a 500-person cohort to examine biologic and behavioral determinants (adherence, T cell activation, pharmacogenomics, and HIV clade of drug resistance) in a resource-limited setting. This cohort is nested in a prospective clinical cohort of over 11,000 individuals managed with a prospectively collected electronic database of medical treatment and clinical outcomes. Additional research projects are examining the bioequivalency of generic antiretroviral therapy, the impact of household economics on sustaining self-pay treatment, and novel Internet HIV prevention strategies for Ugandan adolescents.

Dr. Bangsberg also helped establish an inpatient HIV testing and counseling program in Mulago Hospital in Kampala, Uganda. This program has since become the national model for hospital-based HIV testing and counseling in Uganda. Current studies are addressing the impact of HIV testing and counseling on HIV risk behavior and subsequent linkage to HIV medical care in a resource-limited setting.

Selected Publications PDF