PrEP U™: HIV-Prevention Education for University Student Health Centers

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

FACULTY

Gregory S. Felzien, MD, AAHIVS

FACULTY

Diplomate: Internal Medicine and Infectious Disease Medical Advisor Division of Health Protection/IDI-HIV Georgia Department of Public Health Atlanta, Georgia

Damon Johnson, Jr.

Program Manager Georgia AIDS Education & Training Center Atlanta, Georgia

Stacy W. Smallwood, PhD, MPH

Assistant Professor, Department of Community Behavior and Education Jiann-Ping Hsu College of Public Health Affiliate Faculty Women’s, Gender, & Sexuality Studies Program College of Arts and Humanities Diversity & Inclusion Faculty Fellow, Centers for Teaching & Technology Georgia Southern University Statesboro, Georgia

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HIV-Prevention Education for University Student Health Centers REGIONAL, COMMUNITY-BUILDING LIVE MEETING

TARGET AUDIENCE

This activity is intended for Student healthcare providers (MDs, NPs, PAs, nurses), social workers, counselors, peer educators, and other community stakeholders engaged in the care of patients with or at risk for human immunodeficiency virus (HIV) in a college or university health center setting.

PREAMBLE

PROGRAM OVERVIEW

Welcome to PrEP U™ 2019: HIV-Prevention Education for University Health Centers! This is a comprehensive professional and lay-leadership training program to help you meet the health needs of your university community. Through a series of regional, community-building live meetings and a number of on-campus training sessions, the program seeks to help participants understand the changing landscape of human immunodeficiency virus (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 campus.

LEARNING OBJECTIVES

After completing this activity, the participant should be better able to: »» Demonstrate knowledge of key epidemiologic data on HIV incidence and burden in the Southern United States. »» Determine patients’ preexposure prophylaxis (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 strategies to reduce stigma related to PrEP use, sexual health and sexual behaviors »» Engage health-care providers, administrators, students, and/or other pertinent community or campus stakeholders in the implementation of campus-specific, comprehensive HIV-prevention strategies.

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9:00 am-9:05 am

Overview and Preactivity Polling

9:05 am-9:15 am

The Epidemiologic Imperative for HIV Prevention

9:15 am-9:45 am

HIV Prevention: From Sexual History-Taking to PrEP (Preexposure Prophylaxis) Initiation on Campus

9:45 am-10:00 am

The Impact of HIV on College Campuses Today

10:00 am-10:10 am

Behaviors and Stigma as Barriers

10:10 am-10:50 am

Panel Discussion: HIV Prevention Implementation and Resources

10:50 am-11:30 am

Breakout Sessions: A Call to Action for Colleges and Universities

11:30 am-11:55 pm

Final Thoughts • Sharing of Breakout Session Insights and Action Plans • Key Messages of the Day • Q&A

11:55 am-12:00 pm

Postactivity Polling and Concluding Comments

PREAMBLE

PROGRAM AGENDA

ACCREDITATION INFORMATION Joint Accreditation Statement

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 (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care 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.

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HIV-Prevention Education for University Student Health Centers REGIONAL, COMMUNITY-BUILDING LIVE MEETING

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 is 0.3 APNP credits.

PREAMBLE

Social Worker Education

As a Jointly Accredited Organization, Postgraduate Institute for Medicine is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program.

Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Postgraduate Institute for Medicine maintains responsibility for this course. Social workers completing this course receive 3.0 clinical continuing education credits.

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.

DISCLOSURE OF CONFLICTS OF INTEREST

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COIs are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of a commercial interest.

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: Gregory S. Felzien, MD, AAHIVS Damon Johnson, Jr. Stacy W. Smallwood, PhD, MPH 6

No financial relationships to disclose No financial relationships to disclose 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. PIM and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

PREAMBLE

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.

DISCLAIMER

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.

FEE INFORMATION

There is no fee for this educational activity.

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CLINICAL PRACTICE GUIDELINES & RECOMMENDATIONS

»»Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations on the International Antiviral SocietyUSA Panel Saag MS, et al. JAMA. 2018;320(4):379-396. https://jamanetwork.com/journals/jama/article-abstract/2688574

»»Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

US Department of Health and Human Services, revised July 16, 2019. 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 July 10, 2019. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

»»Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement.

USPSTF. JAMA. 2019;321(22):2203-2213. https://jamanetwork.com/journals/jama/fullarticle/2735509

»»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/risk/prep/cdc-hiv-prep-guidelines-2017.pdf

RESOURCE CENTER

»»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/risk/prep/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.

Centers for Disease Control and Prevention, 2015. https://www.cdc.gov/std/prevention/screeningreccs.htm

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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, April 2019. https://www.cdc.gov/hiv/basics/statistics.html

»»Center of Excellence for Transgender Health.

University of California, San Francisco, School of Medicine, 2018. http://transhealth.ucsf.edu/trans?page=lib-00-00

»»Database of Antiretroviral Drug Interactions.

HIV InSite. University of California, San Francisco. http://arv.ucsf.edu/insite?page=ar-00-02

»»A Guide to Taking a Sexual History.

Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment/sexualhistory.pdf

»»HIV Among Youth.

Centers for Disease Control and Prevention, April 2019. www.cdc.gov/hiv/group/age/youth/index.html

»»HIV in the United States by Region.

Centers for Disease Control and Prevention, 2018. https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html

»»HIV Surveillance Report, Diagnoses of HIV Infection in the United States and Dependent Areas, 2017.

RESOURCE CENTER

Centers for Disease Control and Prevention, 2018. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report2017-vol-29.pdf

»»National College Health Assessment II.

American College Health Association, 2015. https://www.acha.org/documents/ncha/NCHA-II_WEB_SPRING_2015_REFERENCE_ GROUP_EXECUTIVE_SUMMARY.pdf

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HIV-Prevention Education for University Student Health Centers REGIONAL, COMMUNITY-BUILDING LIVE MEETING

»»PrEP Training Curriculum Modules

Developed by the South African HIV Clinicians Society, this training curriculum is for implementers rolling out PrEP. Modules are available on the PrEP Watch website. https://www.prepwatch.org/resources/#?topics=201&countries=176

»»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.

Centers for Disease Control and Prevention, 2019. https://www.cdc.gov/std/default.htm

»»Southeast AETC (AIDS Education & Training Center Program) https://aidsetc.org/aetc-program/southeast-aetc

PARTNER ORGANIZATION »»Above the Status Quo

https://www.asqyouth.org/

PATIENT RESOURCES

»»Centers for Disease Control and Prevention (CDC): HIV Basics.

RESOURCE CENTER

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/

»»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/

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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

»»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

»»Implementation of a rapid entry program decreases time to viral suppression among vulnerable persons living with HIV in the southern United States.

Colasanti J, et al. Open Forum Infect Dis. 2018;5(6):ofy104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022569/

»»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

»»HIV Preexposure prophylaxis, by race and ethnicity – United States, 2014-2016.

»»Efficacy, safety, and effect on sexual behaviour of on-demand preexposure prophylaxis for HIV in men who have sex with men: an observational cohort study.

Molina JM, et al. Lancet HIV. 2017;4(9):e402-e410. https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(17)30089-9/fulltext

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RESOURCE CENTER

Huang YA, et al. MMWR Morb Mortal Wkly rep. 2018;67(41):1147-1150. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193685/

HIV-Prevention Education for University Student Health Centers REGIONAL, COMMUNITY-BUILDING LIVE MEETING

»»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.

RESOURCE CENTER

Rolle CP, et al. Int J STD AIDS. 2017;28(9):849-857. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178514/

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Please visit the CLINICAL RESOURCE CENTER for additional information and resources

www.ExchangeCME.com/PrEPURESOURCES19

Š 2019 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.