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David Bangsberg, MD, MPH

About David Bangsberg, MD, MPH
David Bangsberg is the director of International Programs at the Ragon Institute of MGH, MIT and Harvard, Associate Professor of Medicine at Harvard School of Medicine, and the director of the International Program for the Harvard University Center for AIDS Research. Dr. Bangsberg received his medical degree from Johns Hopkins University and holds a Master of Science from Kings College at the University of London and a Master of Public Health from the University of California, Berkeley. Dr. Bangsberg has researched and published extensively on adherence to antiretroviral medications in treating HIV/AIDS and has collaborations across sub-Saharan Africa.

Research: Focused on HIV in impoverished populations. In 1996, Dr. Bangsberg launched a series of studies in HIV+ homeless and marginally housed individuals in response to concerns that poor adherence to HIV antiretroviral treatment in the urban poor would create new strains of drug resistant virus. He described the challenges in providing antiretroviral therapy to the urban poor, developed valid measures of adherence, defined the risk of antiretroviral resistance by level of adherence, and developed effective interventions to improve adherence in the HIV+ urban poor. These studies mitigated what we now recognize were exaggerated concerns regarding HIV drug resistance in the urban poor and helped shift the debate from withholding treatment to maximizing treatment effectiveness.

Role(s) / Profession(s)

Academic
Director (Site, Program, Project)

Organization

Harvard Initiative for Global Health - HIGH
Website: http://gid.globalhealth.harvard.edu/icb/icb.do Type: Academic Institution Country: United States About: The Harvard Initiative for Global Health (HIGH) is a university-wide initiative whose mission is to educate and train the next generation of global health leaders, and create and disseminate new knowledge to address the major challenges in global health.
Harvard Medical School
Website: http://hms.harvard.edu/hms/home.asp Type: Academic Institution Country: United States About: Harvard Medical School’s (HMS) mission is to create and nurture a diverse community of the best people committed to leadership in alleviating human suffering caused by disease. Students and more than 7,500 full-time faculty in 11 academic departments located on the School's Boston campus, in one of 47 hospital-based clinical departments at 18 Harvard-affiliated teaching hospitals and research institutes, or at 30 research centers, divisions, and institutes, advance the School’s mission every day. Within HMS, the Department of Global Health and Social Medicine (DGHSM) works in close collaboration with the GHD project teams, from participating in GHDonline communities to developing the GHD academic platform.
Massachusetts General Hospital - MGH
Website: http://www.mgh.harvard.edu/ Type: Medical Institution Country: United States About: Founded in 1811, Massachusetts General Hospital (MGH) is the third oldest general hospital in the United States and the oldest and largest in New England. The 900-bed medical center offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. Each year, MGH admits more than 46,000 inpatients and handles nearly 1.5 million outpatient visits at its main campus and at its four health centers: in the Back Bay, Charlestown, Chelsea and Revere. Its Emergency Department records nearly 80,000 visits annually. MGH is the only hospital in the United States to hold concurrent Level 1 verification for adult and pediatric trauma and burn care. The surgical staff performs more than 35,000 operations and the MGH Vincent Obstetrics Service delivers more than 3,500 babies each year.

Work Location(s)

United States

David's Communities

Adherence & Retention Moderator
Health IT

Language(s)

English

Recent Contributions

David Bangsberg, MD, MPH started a discussion "Pharmacy refill data to detect ARV treatment failure" in the Adherence & Retention community.

Dear Colleagues, I am interested in how people are using pharmacy refil data to inform decisions around ARV treatment failure in the absence of HIV RNA testing. I will post a paper by Greg Bisson and colleagues suggests that pharmacy refil data performs better than CD4 monitoring at detecting viral failure. I think it is one of the most important papers in 2008 and curious if others agree. Best regards, David Bangsberg
David Bangsberg, MD, MPH replied to "Using mean corpuscular volume (MCV) to assess drug exposure" in the Adherence & Retention community.

Dear Ziad, The best paper I know of this subject suggest that a normal MCV confirms adherence below 70%, but a elevated MCV does not confirm adherence above 70% to AZT or D4T. Citation, below. Best, David Int J STD AIDS. 2002 Nov;13(11):748-54. Mean cell volume (MCV) changes in HIV-positive patients taking nucleoside reverse transcriptase inhibitors (NRTIs): a surrogate marker for adherence. Steele RH, Keogh GL, Quin J, Fernando SL, Stojkova V.
David Bangsberg, MD, MPH replied to "Pharmacy refill data to detect ARV treatment failure" in the Adherence & Retention community.

Dear Ziad, Yes I noticed the Bisson paper looking at treatment failure at high levels of adherence. The first time I read it, I was a bit skeptical and thought the VL rebound events were undetected interruptions in treatment that were missed by pharmacy refil data. Curious if others find this tenable. I am reconsidering my skepticims, however. More later.... Best, David
David Bangsberg, MD, MPH replied to "Different ways to score adherence questions" in the Adherence & Retention community.

Dear Ziad, the classic ACTG measure paper is: Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG Adherence Instruments; by Chesney, M. A., Chambers, D. B., Ickovics, J. R., Gifford, A. L., Neidig, J., Zwickl, B., Wu, A. W.; AIDS Care; Jun2000, Vol. 12 Issue 3, p255, 12p (abstract available on Pubmed here: http://www.ncbi.nlm.nih.gov/pubmed/10928201) and the recent work from Ira Wilson that suggests rating scales may also be informative (Optimal Recall ...
David Bangsberg, MD, MPH replied to "To count lost to-follow-up (LTFU) as part of adherence denominator?" in the Adherence & Retention community.

This is an important question which is often confused in the literature. I think treatment access, treatment adherence, treatment failure, and LTFU should be treated differently because they have different root causes and require different interventions. The definitions below may help distinguish these concepts, and hopefully guide strategies to improve each component of successful treatment. These definitions are loosely based on work by Giordano[1] who has conceptualized adherence into a range of behaviors from HIV ...

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