We’d like to thank our local collaborators for their contributions and support:
Jointly provided by Postgraduate Institute for Medicine and Integritas Communications This activity is supported by an independent educational grant from Gilead Sciences, Inc.
MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com
STEERING COMMITTEE
Debbie P. Hagins, MD, AAHIVS
FACULTY
Medical Director CARE Centers of Coastal Georgia Academy of Physicians in Clinical Research Fellow Coastal Health District Savannah, Georgia
Dr. Debbie Hagins is the medical director of the Coastal CARE Centers in southeast Georgia, serving the medical needs of some of the most vulnerable persons living with HIV/AIDS. As a fellow of the Academy of Physicians in Clinical Research, she serves as an investigator on a number of pivotal clinical trials. Dr. Hagins is an educator and mentor, training young clinicians and students in primary and HIV care. She is involved in her community as a presenter on a range of health topics to lay audiences. Dr. Hagins is a veteran in-the-trenches physician, having dedicated the entirety of her now 25 year career to the underserved and is the recipient of such awards as: Women Rock, Georgia Public Health Primary Care Leadership, and Unstoppable Woman. She has been featured in the local and national media.
3
Stacy Smallwood, PhD, MPH FACULTY
Assistant Professor Department of Community Health Behavior and Education Jiann-Ping Hsu College of Public Health Affiliate Faculty, Women’s, Gender and Sexual Studies Program College of Arts and Humanities Diversity and Inclusion Faculty Fellow, Centers for Teaching and Technology Georgia Southern University Statesboro, Georgia Dr. Stacy W. Smallwood is an Assistant Professor in the Department of Community Health Behavior and Education at the Jiann-Ping Hsu College of Public Health and affiliate faculty in the Women’s, Gender, & Sexuality Studies Program at Georgia Southern University. Prior to joining the faculty of Georgia Southern, he completed a postdoctoral fellowship in the I. DeQuincey Newman Institute for Peace and Social Justice in the College of Social Work at the University of South Carolina. His research interests include HIV prevention, sexual health, LGBT health, and community engagement and organizing within marginalized communities. He received his Bachelor of Science degree in Health and Exercise Science from Wake Forest University, and a Master of Public Health and PhD in Health Promotion, Education, and Behavior from the University of South Carolina’s Arnold School of Public Health.
4
FACULTY
Mesfin G. Fransua, MD
FACULTY
Professor of Clinical Medicine (Infectious Diseases) Morehouse School of Medicine Principal Investigator Georgia AIDS Education & Training Center Atlanta, Georgia
Dr. Mesfin Fransua received his medical degree from Jimma University, Ethiopia, in 1991. Subsequently, he completed his Internship and residency in Internal Medicine at Saint Barnabas Hospital in New York in 1998 and Infectious Diseases (ID) fellowship at the University of Rochester, New York, in 2002. After completing his ID fellowship, he joined the faculty at Morehouse School of Medicine (MSoM) in Atlanta, Georgia. Currently he is Professor of Medicine in the Department of Medicine at MSoM. He serves as Infectious Diseases consultant at Grady Memorial Hospital (GMH) in Atlanta, Georgia. He also manages HIV, hepatitis C virus, hepatitis B virus, as well as general ID patients at GMH and Morehouse Health Care (MHC) clinics. Since 2015, Dr. Fransua has served as a course director of Georgia AIDS Education & Training Center (GAETC). The GAETC is a local partner of the Southeast AIDS Education & Training Center (SEATC) based at Vanderbilt University in Nashville, Tennessee. This is a Health Resources and Services Administration (HRSA)-funded project tasked with capacity building and training manpower to combat the HIV/AIDS epidemic in the Southeast.
5
David Malebranche, MD, MPH FACULTY
Associate Professor Morehouse School of Medicine Atlanta, Georgia
Dr. David J. Malebranche is a board-certified internal medicine physician and expert in men’s health, racial inequities in medicine, and LGBT health, as well as the prevention and treatment of HIV and sexually transmitted infections. He is currently an associate professor of medicine and the medical director of Student and Employee Health at Morehouse School of Medicine in Atlanta, Georgia. Dr. Malebranche is an experienced qualitative HIV behavioral prevention researcher who has completed several studies on sexual health among black men of diverse sexualities. Dr. Malebranche has published over 40 articles in medical and public health journals such as The Annals of Internal Medicine, The American Journal of Public Health, JAMA, and The Lancet. He is known as a dynamic speaker worldwide and has appeared in documentaries on CNN, ABC News Primetime, TV One, and Black Entertainment Television (BET) for his expertise on HIV in the black community. Dr. Malebranche served as a member of the President’s Advisory Council on HIV/ AIDS (PACHA) from 2006-2008 and was the HIV clinical expert on WebMD from 2010-2012. He also appears in the video series #AsktheHIVDoc, which promotes HIV education for same-gender-loving men, and Revolutionary Health, a weekly Facebook Live health web series that is part of The Counter Narrative Project, an advocacy organization for black same-gender-loving men. In 2015, Dr. Malebranche published his first book, a memoir about his father titled, Standing on His Shoulders. He currently resides in Atlanta, Georgia.
6
Gillian Greer, MD, AAHIVS
FACULTY
Physician, Chatham CARE Center Coastal Health District of Georgia Department of Public Health Savannah, Georgia
Dr. Gillian Greer attended medical school at the University of Alabama School of Medicine in Birmingham, Alabama, and completed her family medicine residency training at the John Peter Smith Hospital in Fort Worth, Texas. She is board certified in family medicine and is certified as an HIV specialist by the American Academy of HIV Medicine. She is employed by the Coastal Health District of the Georgia Department of Public Health and works as a primary care physician at the Chatham CARE Center, a Ryan White Funded Clinic, in Savannah, Georgia.
7
Damon Johnson, Jr. FACULTY
Program Manager Georgia AIDS Education and Training Center Atlanta, Georgia
Mr. Damon Johnson is a transformational public health leader dedicated to identifying needed change, creating a vision to guide the change through inspiration, and executing the change in tandem with committed members of the public health community. He has developed a number of highly effective behavioral and structural interventions, programs, and initiatives that serve as a counterforce to the complexities surrounding HIV and other health disparities. He takes a multidisciplinary approach to lead teams and people in developing comprehensive solutions to address disparities and inequities in marginalized communities. He currently serves as the program manager for Georgia AIDS Education and Training Center, which seeks to improve the HIV care continuum, increase patient retention in care, produce positive patient outcomes, and promote networking and capacity through the provision of trainings and technical assistance activities. The Center provides custom trainings and technical assistance activities to support, motivate, and educate public health providers, equipping them with the necessary knowledge, skills, and resources to provide quality care.
8
Sinead Younge, PhD
FACULTY
Associate Professor and Danforth Endowed Chair Department of Psychology Morehouse College Atlanta, Georgia
Dr. Sinead Younge is an associate professor and Danforth Endowed Chair of the Department of Psychology at Morehouse College, an all-male, historically black college. Dr. Younge is a trained ecological-community psychologist who conducts research on the reproductive health behaviors of college students, using a systems level approach.
9
TARGET AUDIENCE
This activity is intended for student healthcare providers (MDs, DOs, NPs, PAs, nurses), social workers, counselors, peer educators, and other community stakeholders engaged in the care of patients with or at risk for HIV or other sexually transmitted infections in a college or university health center setting.
PREAMBLE
PROGRAM OVERVIEW
PrEP U™: HIV-Prevention Education for University Student Health Centers is a comprehensive professional and lay-leadership training program to help you meet the health needs of your university community. Through this regional meeting for professionals from university health centers, the project seeks to help participants understand the changing landscape of HIV in the southeast, particularly among the university community, and implement comprehensive HIV-prevention strategies. Topics to be covered include: HIV epidemiology and risk, overcoming stigma and social barriers, screening and preexposure prophylaxis (PrEP), and strategies and resources for implementing an educational and awareness campaign to prevent HIV infection and increase the use of PrEP on your university campus.
LEARNING OBJECTIVES
Upon completion of this activity, participants will be better able to: »» Demonstrate knowledge of key epidemiologic data on HIV incidence and burden in the Southern United States »» Determine patients’ PrEP eligibility through HIV testing, sexual-history taking, and appropriate laboratory testing »» Describe evidence-based HIV PrEP principles and guideline-driven practices with regard to initiating treatment and on-treatment monitoring »» Implement Centers for Disease Control and Prevention recommendations for comprehensive HIV prevention for at-risk candidates »» Engage healthcare providers, administrators, students, and/or other pertinent community or campus stakeholders in the implementation of campus-specific, comprehensive HIV-prevention strategies
10
9:00 am-9:05 am
Overview and Preactivity Survey
9:05 am-9:20 am
The Epidemiologic Imperative for HIV Prevention
9:20 am-9:35 am
The Impact of HIV on Campus Today
9:35 am-9:55 am
Sexual History-Taking and Identifying Candidates for PrEP as an HIV Prevention Option
9:55 am-10:15 am
Comprehensive HIV Prevention: From Initial Patient Education to PrEP Initiation and Monitoring
10:15 am-11:10 am
Interprofessional Panel Discussion: Identifying Barriers to PrEP Implementation
PREAMBLE
AGENDA
»» Patient-readiness considerations »» Provider attitudes »» Systems-based priorities and challenges; cost/insurance, HIPAA »» Real-world implementation strategies: first steps for campus-wide education and mobilization 11:10 am-11:45 am
Breakout Sessions: A Call to Action for HBCUs/ Southeastern Universities »» Next steps: developing campus-specific action plans »» Community collaboration: resources and stakeholders
11:45 am-11:55 am
Sharing of Breakout-Discussion Insights and Action Plans/Final Q&A
11:55 am-12:00 pm
Postactivity Survey/Concluding Comments
HBCU, historically black colleges and universities; HIPAA, Health Insurance Portability and Accountability Act.
11
ACCREDITATION INFORMATION Joint Accreditation Statement
PREAMBLE
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Integritas Communications. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education, the Accreditation Council for Pharmacy Education, and the American Nurses Credentialing Center, to provide continuing education for the healthcare team.
Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this live activity for a maximum of 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 3.0 contact hours. Pharmacotherapy contact hours for Advanced Practice Registered Nurses to be determined.
Council on Social Worker Education
Social worker credit will be applied for but is not guaranteed at this time.
INSTRUCTIONS TO RECEIVE CREDIT A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you within 3 weeks. You will receive your certificate from CEcertificate@pimed.com. If you have questions regarding the receipt of your emailed certificate, please contact PIM via email at inquiries@pimed.com.
12
DISCLOSURE OF CONFLICTS OF INTEREST
The Postgraduate Institute for Medicine requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflicts of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by the Postgraduate Institute for Medicine for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
Debbie P. Hagins, MD, AAHIVS
Consulting Fees: Gilead Sciences, Inc.
Stacy Smallwood, PhD, MPH
No financial relationships to disclose
Mesfin Fransua, MD
No financial relationships to disclose
PREAMBLE
The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:
David Malebranche, MD, MPH Fees for non-CME services received directly from a commercial interest (eg, speakers’ bureaus): Gilead Sciences, Inc. Gillian Greer, MD, AAHIVS
No financial relationships to disclose
Damon Johnson, Jr.
No financial relationships to disclose
Sinead Younge, PhD
No financial relationships to disclose
The PIM planners and managers have nothing to disclose. The Integritas Communications planners and managers have nothing to disclose.
DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. The Postgraduate Institute for Medicine and Integritas Communications do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
13
DISCLAIMER
PREAMBLE
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
14
SLIDES
15
SLIDES
16
SLIDES
17
SLIDES
18
SLIDES
19
SLIDES
20
SLIDES
21
SLIDES
22
SLIDES
23
SLIDES
24
SLIDES
25
SLIDES
26
SLIDES
27
SLIDES
28
SLIDES
29
SLIDES
30
SLIDES
31
SLIDES
32
SLIDES
33
SLIDES
34
SLIDES
35
SLIDES
36
SLIDES
37
SLIDES
38
SLIDES
39
SLIDES
40
SLIDES
41
SLIDES
42
SLIDES
43
SLIDES
44
SLIDES
45
SLIDES
46
SLIDES
47
SLIDES
48
SLIDES
49
SLIDES
50
SLIDES
51
SLIDES
52
SLIDES
53
SLIDES
54
SLIDES
55
SLIDES
56
SLIDES
57
SLIDES
58
CLINICAL PRACTICE GUIDELINES
»»Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. US Department of Health and Human Services, revised 2018. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
»»Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV.
US Department of Health and Human Services, last updated May 30, 2018. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0/
»»Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2017 Update. Clinical Practice Guideline. Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/hiv/pdf/guidelines/cdc-hiv-prep-guidelines-2017.pdf
»»Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2017 Update. Clinical Provider’s Supplement.
Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/hiv/pdf/guidelines/cdc-hiv-prep-provider-supplement-2017.pdf
»»Quick Reference Guide: Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens. Centers for Disease Control and Prevention, 2018. https://stacks.cdc.gov/view/cdc/50872
»»STD and HIV Screening Recommendations.
CLINICAL RESOURCES
»»American Academy of HIV Medicine | Supporting the HIV Care Provider and the Profession. https://aahivm.org/
»»Basic Statistics.
Centers for Disease Control and Prevention, July 2018. https://www.cdc.gov/hiv/basics/statistics.html
59
RESOURCE CENTER
Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/std/prevention/screeningreccs.htm
»»Brief Sexual History Tool.
Centers for Disease Control and Prevention. https://www.cdc.gov/actagainstaids/pdf/campaigns/hssc/hssc_sexualhistorytool_v4.pdf
»»Database of Antiretroviral Drug Interactions. HIV InSite. University of California, San Francisco. http://arv.ucsf.edu/insite?page=ar-00-02
»»Effectiveness of Prevention Strategies to Reduce the Risk of Acquiring or Transmitting HIV. Centers for Disease Control and Prevention, 2017. www.cdc.gov/hiv/risk/estimates/preventionstrategies.html
»»HIV Among Youth.
Centers for Disease Control and Prevention, 2018. www.cdc.gov/hiv/group/age/youth/index.html
»»HIV Drug Interactions.
University of Liverpool (Web site), 2017. http://www.hiv-druginteractions.org/checker
»»HIV in the United States by Geography.
Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
»»HIV Surveillance Supplemental Report.
Centers for Disease Control and Prevention, 2018. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancesupplemental-report-vol-23-1.pdf
RESOURCE CENTER
»»HIV Surveillance Fact Sheet, Georgia, 2015.
Georgia Department of Public Health, April 2017. https://dph.georgia.gov/sites/dph.georgia.gov/files/HIV_EPI_Fact%20Sheet_ Georgia%202015_04.14.17.pdf
»»National College Health Assessment II.
American College Health Association, 2013. https://www.tru.ca/__shared/assets/NCHA_II_Spring_201329926.pdf
»»PrEP Kit.
AIDS United, 2015. https://www.aidsunited.org/data/files/Site_18/PrEP_Kit_Dec15_final.pdf
60
»»Provider Information Sheet: PrEP During Conception, Pregnancy, and Breastfeeding. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/pdf/prep_gl_clinician_factsheet_pregnancy_english.pdf
»»Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention, 2015. https://www.cdc.gov/std/tg2015/default.htm
»»State HIV Laws.
Centers for Disease Control and Prevention, 2018. https://www.cdc.gov/hiv/policies/law/states/
»»Taking a Sexual History.
NYC Health, 2015. https://www1.nyc.gov/assets/doh/downloads/pdf/csi/csi-prep-pep-sex-history.pdf
»»Transgender Health Learning Center.
University of California, San Francisco, 2018. http://transhealth.ucsf.edu/trans?page=lib-00-00
PARTNER ORGANIZATIONS »»Above the Status Quo
https://www.asqyouth.org/
»»Georgia AIDS Education and Training Center
https://www.seaetc.com/state-partner-information/georgia-aetc/
PATIENT RESOURCES
RESOURCE CENTER
»»Centers for Disease Control and Prevention (CDC): HIV Basics.
The CDC is a division within the US Department of Health and Human Services (DHHS), the principal agency for protecting the health of all Americans. This comprehensive site provides extensive links to topics across the HIV-care continuum, including preexposure prophylaxis (PrEP). https://www.cdc.gov/hiv/basics/index.html
»»HIV Risk Reduction Tool.
Centers for Disease Control and Prevention. https://wwwn.cdc.gov/hivrisk/
61
PILL-REMINDER SMARTPHONE APPS (FREE) »»Mango Health – Medicine Reminder and Manager for iPhone. https://itunes.apple.com/us/app/mango-health-medication-manager/ id560657279?mt=8
»»Mango Health for Android.
https://play.google.com/store/apps/details?id=com.mangohealth.mango&hl=en
»»Medisafe Medicine Reminders & Tracker for iPhone. https://itunes.apple.com/il/app/id573916946?mt=8
»»Medisafe Pill Reminder & Medication Tracker for Android.
https://play.google.com/store/apps/details?id=com.medisafe.android.client
»»Positively Aware.
Positively Aware, created by TPAN (Test Positive Aware Network), is a source of HIV-treatment news for consumers, as well as an educational tool for HIV caregivers. The site features PrEP resources, including videos for men who have sex with men and transgender people. https://www.positivelyaware.com/
»»PrEP for U.S. Women: A Collection of Resources.
HIVE provides preconception and prenatal care and resources for women and couples affected by HIV. https://www.hiveonline.org/prep4women/
RESOURCE CENTER
SUGGESTED READING
»»Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. Baeten JM, et al. N Engl J Med. 2012;367(5):399-410. http://www.nejm.org/doi/full/10.1056/NEJMoa1108524#t=article
»»Benefit of continuous/immediate ART on disease risk: SMART & START combined analysis.
Borges AH, et al. 24th Conference on Retroviruses and Opportunistic Infections; February 13−16, 2017; Seattle, WA. Abstract 474. http://www.croiconference.org/sites/default/files/posters-2017/474_Borges.pdf
62
»»Frequency of HIV testing and time from infection to diagnosis improve. Centers for Disease Control and Prevention, 2017. https://www.cdc.gov/media/releases/2017/p1128-frequency-hiv-testing.html
»»Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.
Choopanya K, et al. Lancet. 2013;381(9883):2083-2090. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61127-7/abstract
»»Being PrEPared – preexposure prophylaxis and HIV disparities. Goldstein RH, et al. N Engl J Med. 2018;379(14):1293-1295. https://www.nejm.org/doi/full/10.1056/NEJMp1804306
»»Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. Grant RM, et al. N Engl J Med. 2010;363(27):2587-2599. http://www.nejm.org/doi/full/10.1056/NEJMoa1011205#t=article
»»Challenges in translating PrEP interest into uptake in an observational study of young black MSM. Rolle CP, et al. J Acquir Immun Defic Syndr. 2017;76(3):250-258. https://www.ncbi.nlm.nih.gov/pubmed/28708811
»»Willingness to use pre-exposure prophylaxis among black and white men who have sex with men in Atlanta, Georgia. Rolle CP, et al. Int J STD AIDS. 2017;28(9):849-857. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178514/
»»Initiation of antiretroviral therapy in early asymptomatic HIV infection.
RESOURCE CENTER
The INSIGHT START Study Group. N Engl J Med. 2015;373(9):795-807. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1506816
63
NOTES 64
NOTES 65
NOTES 66
Please visit the CLINICAL RESOURCE CENTER for additional information and resources
www.ExchangeCME.com/PrEPURESOURCES
Š 2018 Postgraduate Institute for Medicine and Integritas Communications. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.