ICTS News Success Stories

WashU Investigator utilizes and nurtures community-based relationships to propel research and serve local communities

For investigators, there is much to be considered when choosing how to conduct research projects. Which demographics will you target? Which funding mechanisms should you apply for? How long will it take you to accomplish your aims? One of the most important considerations that seems simple enough, though it can sometimes appear unfamiliar to investigators, is the involvement of one’s community.

One WashU Medicine faculty member seems to have mastered the formula of engaging with community members and organizations in order to advance clinical and translational science, specifically in the area of sexual healthcare. Hilary Reno, MD, PhD, WashU Medicine Professor of Medicine in the Division of Infectious Diseases, has also served as the Medical Director of the St. Louis County sexual health clinic since 2007, having recently stepped down from this role in late 2024 to focus on running the clinic QI programs.

Tackling Tough Issues

Reno stresses that when conducting research on issues that greatly impact the local community, it is important to involve a diverse representation of groups and people from community-based organizations (CBOs) in the work you do. One issue Reno has worked towards finding a solution to is the high incidence of STIs in St. Louis. To tackle this issue, WashU joined with several other public health agencies, community and advocacy organizations, and academic researchers (reaching about 50 at its height) in 2015 to form a group called STIRR – St. Louis Regional Response Coalition.

Reno

“Over time at STIRR, I have built relationships that have lasted, so that when opportunities for future collaborations have come up, those have been the organizations that I’ve wanted to work and engage with,” says Reno. “It is very important to engage with that community aspect of your field, because it allows you to build relationships that can develop and come together for projects down the road, and you just never know where those will come from or where they will lead.”

Reno’s ease at creating and nurturing these community-based relationships and then channeling those efforts into real scientific progress has been noticed by colleagues, as well. Anne Trolard, MPH, Assistant Director at the WashU Center for Community Health Partnership & Research (CCHPR), has supported Reno’s research efforts and says Reno never targets the lowest-hanging fruit and always goes for the most pressing issues.

Trolard

“She’s ambitious in her vision and pragmatic in her approaches,” says Trolard. “She has the audacity to tackle a very complex challenge (i.e. a public health issue that is chronic and highly stigmatized) and she has the commitment to keep going despite slow progress and constant setbacks. The thing I admire the most about her is that she is not afraid to challenge the power structure or the status quo, which can sometimes be the biggest impediment to change.”

Boots on the Ground

In 2022 and 2023, Reno volunteered to provide COVID-19 vaccinations with the CCPHR team at partnership sites across under-resourced communities. Reno says this effort, known as Our Community-Our Health, was something she volunteered to help with as soon as it began, without hesitation. This volunteer role demonstrated what it looks like for researchers to be working directly in the community, having conversations with community members.

“I enjoy giving people vaccines,” says Reno. “And after having spent the worst days of the pandemic working in the hospital with very sick patients, it felt like every vaccine I could put in someone’s arm with Our Community-Our Health was doing what I could to help people.”

It was while working at one of these vaccination clinics that Reno met Joan Ferguson, a certified community health worker who was working as a consultant with the CCPHR at the time. Ferguson and Reno worked so well together that Reno decided to hire Ferguson to play a large role in her newly CDC-funded grant called ESSHCI (Enhancing STI and Sexual Health Clinic Infrastructure).

Reno says that for the first year of the grant funding, they examined the ID clinical services for sexual health at the WashU Multi-specialty Clinic at Village Square in Hazelwood, MO, and thought about how they could redesign them to better serve the community, but they knew they needed community input to do this the right way.

“Those of us in academic medicine are very dedicated to our research, our methods, and our work,” says Reno. “But the reality is that it’s not about us – it’s about what is best for the patients and the community. You have to set yourself aside, be humble, and recognize that you don’t know everything, which is ok. In fact, it’s a good thing, because it should make you curious and interested in talking to and hearing from other people.”

Being Humble and Listening

Joan Ferguson (right) with Reginald Wilson (left) at Centennial Christian Church OCOH pop up event.

Through the ESSHCI grant, Ferguson and Reno worked together to form the Community Member Advisory Group (CMAG), which currently has 7 active members from the North County & North St. Louis City areas, as those are the locations with the highest rates of STIs in the region.

Ferguson says that working with these types of advisory groups and community health workers in general can work towards effectively bridging the gap between researchers and the community they are studying.

“As trusted members of the communities they live in and serve, community health workers bring immeasurable value to a research team through their deep understanding of local contexts and social dynamics, by facilitating access to hard-to-reach populations, building trust with participants, and ensuring research is culturally relevant and responsive to local needs,” says Ferguson.

Reno says one of the most memorable moments of working with the group so far came when they first introduced a community-based survey the team was planning to send out, and community members gave feedback that the survey was too long. At the next monthly meeting, Reno and her team had edited the survey based on the group’s suggestions, and the CMAG expressed pleasant disbelief that their suggestions were actually listened to and implemented.

“I get emotional at every meeting with our CMAG,” says Reno. “I have worked in sexual healthcare for 18 years and I have dreamed of building clinical services this way – hand in hand with dedicated community members, bringing about new ideas and new pathways.”

Lawrence Hudson-Lewis, LCSW, Director of Prevention in the WashU Medicine Pediatrics Adolescent Medicine, works with Reno on the ESSHCI project. Hudson-Lewis says Reno is a true champion for the voice of the community, and he has directly observed the passion and commitment she has to social justice and high-quality health care.

Hudson-Lewis

“CMAG members know when they work with her that it is more than symbolic,” says Hudson-Lewis. “She ensures they can see the progress and follow up. Future efforts with CMAG will include leadership development so they can become more than just advisors but true advocates.”

ICTS/CCPHR Funding

Reno was the recipient of a Partnership Development & Sustainability Support (PDSS) award in 2021-2022 to work with the Regional Health Commission to create a regional sexual health data platform in efforts to gather data on STI testing and HIV testing in order to improve healthcare methods and address health inequities.

Reno says that funding from the PDSS award allowed them to compensate community members for several meetings where they asked for input on how to help translate this data in a way that community members can use it and be able to answer their own questions about their healthcare.

“What these meetings did was made us put our messaging together effectively,” says Reno. “We had to really think about this data platform and what was contained within it, and how to best present it. The community has different priorities than we do, in terms of either quality improvement or research, and we recognize that it’s their data and there needs to be an involved, long-term relationship to help community members feel comfortable and empowered in using their data.”

Reno also received ICTS/CCPHR funding in July 2024 with a Pitch Partners award to start and build a Community Health Worker Sexual Health Learning Collaborative. Pitch Partners awards aim to bring local university researchers and community organizations together to tackle challenging issues. Reno stresses that working directly with these community organizations and establishing long-term relationships is of utmost importance because researchers can learn so much from them and can share knowledge in return.

“The really important part about having this Pitch Partners funding is to be able to design a special certification for community health workers in sexual healthcare to improve the availability of knowledgeable workforce members,” says Reno. “As a medical professional, it is important to share and learn from and with people who live in the community you are serving.”

Changing the System

Reno says that in the area of sexual healthcare, it is not as difficult to recognize there is room for improvement. STI rates in the St. Louis region remain incredibly high, and Reno says researchers can learn more by involving and partnering with the community. Reno points out that this involves not giving them what you think they need – it’s about opening up, welcoming and accepting their input, and actually implementing it.

“Our whole team is committed to taking in what community members tell us, and being held accountable for it,” says Reno. “We need a revolution in how we do these things, and I don’t know of any better way to come up with ideas rather than to listen to the people who receive these services and do what they tell us to do. That is going to be totally revolutionary to how things have been done before in sexual healthcare, and it will completely change our system, and that’s what we need, because what we have now doesn’t work.”