Shivani Garg, MD, PhD

I am a physician‑scientist in Rheumatology, Director of the Lupus Clinical Research Program and co‑Director of the Lupus Program at Yale School of Medicine, and founding Director of one of the nation’s earliest interdisciplinary Lupus and Lupus Nephritis (LN) clinics at the University of Wisconsin-Madison. My work advances personalized care and precision medicine by integrating target‑site pharmacokinetics (TPK), interferon‑driven immune signatures, and patient‑centered qualitative methods to improve outcomes in lupus. My Plenary‑highlighted work at the 2019, 2020, and 2025 American College of Rheumatology (ACR) Annual Meetings has demonstrated that nonadherence, risk aversion, and fear of toxicity related to fixed dosing, even with life‑saving therapies such as hydroxychloroquine (HCQ), are major drivers of poor outcomes. These concerns remain largely unaddressed in routine care. Therefore, my long‑term goal is to leverage immunopharmacology and patient‑centric approaches to ensure safe and effective use of key therapies (e.g., HCQ) and improve health outcomes in lupus.

My research has delivered several field‑shaping contributions: (1) a global meta‑analysis, one of the top 20 most discussed ACR journal articles in 2021, establishing HCQ levels as an objective measure of adherence; and (2) a landmark study, invited as a 2025 ACR Plenary presentation, defining a therapeutic reference range for HCQ blood levels (750-1150 ng/mL) in lupus, advancing personalized dosing of high-risk medicines such as HCQ. Equally central to my program is the use of qualitative and implementation science to make precision actionable at the bedside. Towards this, I developed the first interactive, pictogram‑based, end‑user-informed shared decision‑making tools (HCQ‑SAFE and Pred‑SAFE) that clearly communicate benefits and harms of HCQ and chronic prednisone use. HCQ‑SAFE has >1,500 views in 18 months, improved adherence by 47% across eight clinics, and is incorporated in the ACR Lupus Implementation Guide, demonstrating real‑world scalability. These tools operationalize personalized care by reducing decisional conflict, aligning therapy with patient values, and embedding adherence support into clinical workflows.

I serve on national ACR Clinical Practice Guideline and Collaborative Care Committees. My record includes a PhD in Clinical Investigation, 60 publications, three Plenary presentations, >8 competitive grants including an NIH K23, the Rheumatology Research Foundation Innovation Award, and multiple institutional and national honors. Collectively, my work has helped shift treatment paradigms in lupus by coupling pharmacologic precision with patient‑centered implementation.