Reproductive healthcare is a critical part of healthcare overall. Yet components of this care, including abortion, are becoming more and more inaccessible to certain parts of the population, worsened by the overturning of Roe vs. Wade. The implications of this decision on access to care, marginalization and inequity are already being seen and causing substantial concern within the medical community.

In this episode, Dr. Erica Bostick chats with Dr. Rachael Phelps, a nationally recognized family planning expert, about the impact of this decision on New York State clinicians and patients. Dr. Phelps offers her expertise and insights into what encompasses reproductive healthcare, and how clinicians can “take the next step” in offering comprehensive, preventative reproductive health services to patients of all ages.

Hepatitis C is the most commonly reported blood-borne infection in the US, responsible for more deaths than all 60 reportable infectious diseases combined. Once most prevalent among “Baby Boomers” or those born between 1945 and 1965, the current hepatitis C burden disproportionately affects young adults who inject drugs, including women of childbearing age. Because of this epidemiological shift, perinatal transmission – which happens when a pregnant person living with hepatitis C passes it to their baby either within the uterus or during labor – is also on the rise. Approximately 6% of infants born to people with hepatitis C will become infected.

Given the increased prevalence of hepatitis C among women of childbearing age, more people with hepatitis C will become pregnant and for many of them, obstetric care will be their primary encounter with the health system. Hepatitis C screening during pregnancy presents an opportunity for early identification as well as dialogue between pregnant people and their clinicians about transmission and risk. In a sense, pregnancy presents an ideal opportunity to diagnose hepatitis C among pregnant people, link them to care and refer them to treatment. Tackling hepatitis C among women, and during pregnancy in particular, is critical to achieving the New York State Hepatitis C Elimination Plan’s goal to eliminate hepatitis C as a public health problem in the state by 2030.

Resources

  • New York State Department of Health AIDS Institute guideline for treatment of chronic HCV with direct-acting antivirals, Pregnancy and HCV: https://www.hivguidelines.org/hepatitis-care/treatment-with-daa/#tab_4
  • New York State Department of Health AIDS Institute guideline for substance use disorder treatment in pregnant adults: https://www.hivguidelines.org/substance-use/sud-treatment-pregnancy/
  • The American College of Obstetricians and Gynecologists Routine Hepatitis C Virus Screening in Pregnant Individuals Practice Advisory: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/05/routine-hepatitis-c-virus-screening-in-pregnant-individuals
  • Godar, E.A., & Jhaveri, R. (2021). A survey of practices in the United States regarding hepatitis C screening in pregnant women. Clin Ther, 43(3):780-784. doi: 10.1016/j.clinthera.2021.01.016
  • Kushner, T., Chappell, C.A., & Kim, A.Y. (2019). Testing for hepatitis C in pregnancy: the time has come for routine rather than risk-based. Curr Hepatol Rep,18(2):206-215. doi: 10.1007/s11901-019-00468-y
  • Kushner, T. & Reau, N. (2021). Changing epidemiology, implications, and recommendations for hepatitis C in women of childbearing age and during pregnancy. Jour of Hepatol, 74(3):734-741. doi: 10.1016/j.jhep.2020.11.027
  • Ly, K.N., Jiles, R.B., Teshale, E.H., Foster, M.A., Pesano, R.L., & Holmberg, S.D. (2017). Virus infection among reproductive-aged women and children in the United States, 2006-2014. Ann Intern Med, 166(11):775-782. doi: 10.7326/M16-2350

HIV and Hepatitis B share similar routes of transmission. In United States, a large cohort study of patients with HIV showed that over 10 % of men who had sex with men, over 8% of those who injected drugs and over 5% of heterosexual individuals with risk factors tested positive for HBsAg or detectable HBV DNA. Because of the shared transmission routes, there is an increased risk of HIV and HBV co-infection. Despite the advancement of ART, that has a very efficient suppression rate of the HIV and HBV replication, morbidity and mortality rates are still higher in patients with HIV-HBV co-infection. In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center, speaks about the management of Hepatitis B in patients with HIV.

Despite the existence of medications that can control HIV and even reduce viral transmission, HIV is still a leading cause of death and a health threat to millions worldwide. The goal of this episode is to highlight where we are in the development of an HIV vaccine and cure which will improve the health and well-being of millions of people worldwide.

AIDS Vaccine Advocacy Coalition: https://www.avac.org/

Antibody therapy controls HIV for months in new clinical trial at The Rockefeller University: https://www.rockefeller.edu/news/32186-antibody-therapy-controls-hiv-for-months-in-new-clinical-trial/#:~:text=Now%2C%20findings%20from%20a%20clinical,conventional%20antiretroviral%20drugs%20cannot%20do.

Mitchell Warren LinkedIn 

AIDS Vaccine Advocacy Coalition (AVAC)

Dr. Marina Caskey LinkedIn

Weill Cornell Reach Program Grant

Rockefeller HIV Trial

The COVID-19 pandemic substantially impacted the capacity of sexual health clinics across the nation. It also provided insight into the availability and demand for at-home health testing.

The National Coalition of STD Directors (NCSD) and LetsGetChecked, a virtual care company and commercial lab, have partnered on the Check Yourself initiative –the first ever STI home testing solution that was developed by, for, and in partnership with public health departments. Check Yourself was designed to expand capacity for self-collected STI testing within state and local health departments.

In this episode, Dr. Daniela DiMarco chats with Jennifer Mahn, Director of Clinical and Sexual Health at NCSD, and RJ Asplund, Vice President of Business Development at LGC Labs, about the Check Yourself partnership and how NYS clinicians can participate.

www.NCSDDC.org/Check-Yourself 
checkyourself@ncsddc.org
Jennifer Mahn Profile at NCSDDC.org
Ryan (RJ) Asplund LinkedIn
Dr. Daniela DiMarco Profile
CEI Training
CEI on LinkedIn
CEI on Twitter
CEI on Instagram
CEI on Facebook
CEI on YouTube

The number of drug overdose deaths in the US more than quadrupled between 2000 and 2019, and opioid overdose was declared a national public health emergency in 2017. Nationally, overdose deaths were the highest on record in 2020 with over 91,000 drug-involved overdose deaths and over 68,000 opioid-involved overdose deaths reported. New York State is no exception to the trend –drug-involved overdose deaths increased by 37% between 2019 and 2020, and overdose deaths involving any opioid increased by 44% during the same period for an average of nearly 12 deaths every day.

In response to the growing crisis, New York State convened a Heroin and Opioid Task Force in May 2016and on November 30th, 2021 New York became the first US city to open officially authorized Overdose Prevention Centers. Overdose Prevention Centers are an evidence-based approach to preventing overdose deaths adopted by countries around the world, however they remain unsanctioned in the US. They offer supervised, hygienic spaces for people who use drugs to do so safely, and provide a connection to health promoting services, such as harm reduction, medical care, mental health therapy, drug treatment and social supports. In addition, Overdose Prevention Centers improve individual and community health, increase public safety and reduce the social consequences of drug use.

Opponents view the Centers as magnets for drug use, however the New York State Department of Health announced that in their first three months of operation, the Centers were used more than 9,500times and staff on-site averted more than 150overdoses to prevent injury and death.

New York Harm Reduction Educators: https://nyhre.org/ 
Washington Heights CORNER Project: https://www.facebook.com/WashingtonHeightsCORNERProject/ 
February 2022 NYSDOH Epi Data Brief: Basic Needs among People who Use Opioids in NewYork City during the COVID-19 Pandemic https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief131.pdf 
NYSDOH New York State County Opioid Quarterly Report (April 2022): https://health.ny.gov/statistics/opioid/data/pdf/nys_apr22.pdf 
Levengood, T.W., Yoon, G.H., Davoust, M.J., Ogden, S.N., Marshall, B.D.L., Cahill, S.R., & Bazzi, A.R. (2021). Supervised injection facilities as harm reduction: a systematic review. Am J Prev Med,61(5):738-749. doi: 10.1016/j.amere.2021.04.17 
Kral, A.H., Lambdin, B.H., Wenger, L.D., & Davidson, P.J.(2020). Evaluation of an unsanctioned safe consumption site in the United States. N Engl J Med,383:589-590. doi: 10.1056/NEJMc2015435 

Access to PrEP is a pillar of the NYSDOH End the Epidemic initiative, that emphasizes the safety and effectiveness of PrEP as a method to prevent HIV infection. However, structural and individual barriers may result in PrEP being underutilized, particularly by the populations at the highest risk of acquiring HIV. In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center, speaks about the injectable option for PrEP, as a suitable choice for those who would prefer an alternative to preventative daily oral therapy.

https://www.hivguidelines.org/antiretroviral-therapy/art-injectable/
https://www.hivguidelines.org/prep-for-prevention/
https://www.health.ny.gov/diseases/aids/general/prep/prep_index.htm
https://www.health.ny.gov/diseases/aids/ending_the_epidemic/index.htm
https://ceitraining.org/courses/
https://ceitraining.org/request/
PrEP Guidelines
CEI Training
Ending the Epidemic
NYS Ending the Epidemic
Dr. Steven Mark Fine

As we enter year three of the COVID-19 pandemic, we would like to review the latest updates about HIV and COVID-19.

In the first segment we will speak with Dr. Robert Fullilove, EdD, about the social and historical factors which have led to racial health disparities for HIV and COVID-19. In the second segment we will speak with Dr. Keith Sigel, MD, PhD, MPH, who will unpack the latest research and data about COVID-19 outcomes for Persons Living with HIV (PLWH). The goal of this episode will be to provide information for providers about how to understand and meet their patients’ needs in relation to HIV and COVID-19.

Part 1: Robert Fullilove, EdD,

  • Robert Fullilove Columbia University Mailman School of Public Health https://www.publichealth.columbia.edu/people/our-faculty/ref5
  • Burns, D Learning for Our Common Health Association of American Colleges and Universities Washington, DC 109-119 1999
  • Golembeski C, Fullilove R Criminal (in)justice in the City and Its Associated Health Consequences. American Journal of Public Health 95 1701-6 2005
  • Green LL, Fullilove MT, Fullilove, RE. Remembering the Lizard: Reconstructing Sexuality in the Rooms of Narcotics Anonymous. Journal of Sex Research 42 28-34 2005
  • Fullilove RE HIV Prevention in the African American Community: Why Isn't Anybody Talking about the Elephant in the Room? AIDScience 1 1-7 2001
  • Fullilove MT and Fullilove RE What's housing got to do with it? American Journal of Public Health 90 183-4 2000
  • Fullilove RE, Green LL, Fullilove MT The Family to Family Program: A Structural Intervention with Implications for the Prevention of HIV/AIDS and Other Community Epidemics. AIDS. Vol 14 (1S) 2000.63-67 14(1S) 63-67 2000
  • Levine RS, Foster JE, Fullilove RE et al. Black-White Inequalities in Mortality and Life Expectancy, 1993-1999 :Implications for Healthy People 2010. Public Health Reports 116 474-83 2001
  • Malebranch DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and Sexual Identity: Perceptions about Medical Culture and Healthcare among Black Men Who Have Sex with Men. Journal of the National Medical Association 96 97-107 2004
  • Part 2: Keith Sigel, MD, PhD, MPH

    • Braunstein, S. L., Lazar, R., Wahnich, A., Daskalakis, D. C., & Blackstock, O. J. (2021). Coronavirus disease 2019 (COVID-19) infection among people with human immunodeficiency virus in new york city: a population-level analysis of linked surveillance data. Clinical Infectious Diseases, 72(12), e1021-e1029.
    • Centers of Disease Control and Prevention. (2021) COVID-19 and HIV. https://www.cdc.gov/hiv/covid-19/index.html
    • Cooper, T. J., Woodward, B. L., Alom, S., & Harky, A. (2020). Coronavirus disease 2019 (COVID‐19) outcomes in HIV/AIDS patients: a systematic review. HIV medicine, 21(9), 567-577.
    • Garret, N., Tapley, A., Andriesen, J., Seocharan, I., Fisher, L. H., Bunts, L., ... & Corey, L. (2021). High rate of asymptomatic carriage associated with variant strain Omicron. MedRxiv.
    • Sigel, K., Swartz, T., Golden, E., Paranjpe, I., Somani, S., Richter, F., ... & Glicksberg, B. S. (2020). Covid-19 and people with HIV infection: outcomes for hospitalized patients in New York City. Clinical Infectious Diseases.
    • Verity, R., Okell, L. C., Dorigatti, I., Winskill, P., Whittaker, C., Imai, N., ... & Ferguson, N. M. (2020). Estimates of the severity of coronavirus disease 2019: a model-based analysis. The Lancet infectious diseases, 20(6), 669-677.

In July 2021, the Centers for Disease Control and Prevention released new evidence-based guidelines for the prevention, diagnosis, and treatment of sexually transmitted infections. This is the first new issue since 2015. Listen to this episode for a discussion about how the guidelines are developed and some of the most important changes in the field.

2021 CDC STI Treatment Guidelines: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020: https://www.cdc.gov/mmwr/volumes/68/rr/rr6805a1.htm?s_cid=rr6805a1_w
National Network of STD Clinical Prevention Training Centers: https://www.stdccn.org/render/Public
Visit www.ceitraining.org for the toll-free number for NYS clinicians to discuss HIV, PEP, PrEP, HCV, Drug User Health, and STI management with a specialist.

Hepatitis C is a major public health issue responsible for more deaths in the US than all 60 reportable infectious diseases combined, including HIV and tuberculosis. It infects about 25,000 people each year, most of whom don’tknow they are infected and are at risk for developing chronic infection. In New York State alone, over 6,000cases of hepatitis C were reported in 2019.

On November 17, 2021 the New York State Department of Health released the New York State Hepatitis C Elimination Plan which outlines five key principles, including: (1) Prevention; (2) Access to Care and Treatment; (3) Testing and Linkage to Care; (4) Surveillance, Data and Metrics; and (5) Social Determinants of Health. The Plan further defines priority populations and settings to ensure those most at risk are placed at the front and center of elimination efforts to help achieve World Health Organization targets of reducing new chronic infections by 90% and mortality by 65% by 2030.

New York State Hepatitis C Elimination Plan
New York State Hepatitis C Guidelines and Recommendations
New York State Hepatitis C Dashboard
World Health Organization Hepatitis Information
Treatment Action Group
Hep ElimiNATION Initiative
VOCAL New York
Annette Gaudino LinkedIn
Christine Kerr, MD LinkedIn
Lauren Walker LinkedIn
CEI on LinkedIn
CEI on Twitter
CEI on Instagram
CEI on Facebook
CEI on YouTube

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