Conversations with CEI

HIV Prevention Research in the Kink-Involved Population

Cultural humility in healthcare, especially for those involved in kink, requires going beyond basic competence. Clinicians must provide respectful care, acknowledging patients' diverse backgrounds and beliefs about kink as part of their identity. This necessitates self-reflection, ongoing learning, and awareness of the doctor-patient power dynamic. Healthcare professionals still hold unfounded biases, highlighting the need for further education and combating the stigma surrounding healthy expressions of sexuality. Related Content:
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Doxy-PEP Part II: Where Are We Now?

In this episode, Dr. Marguerite Urban and Dr. Daniela DiMarco pick up from the November 2023 episode of Conversations with CEI, where they talked about Doxy-PEP for the prevention of sexually transmitted infections (STIs) covering updates on doxy-PEP since the last episode, and delving deeper into some unique aspects. Drs. Urban and DiMarco are infectious disease faculty members at the University of Rochester, specializing in sexual health care. They were part of the team who authored the recently released New York State (NYS) Department of Health (DOH) AIDS Institute’s guidelines regarding Doxy-PEP. This episode is a “part two” of Doxy-PEP. Drs. Urban and DiMarco review the results of a recently published trial from Kenya, and discuss common questions related to Doxy-PEP. Related Content: 
“Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women” - https://www.nejm.org/doi/full/10.1056/NEJMoa2304007?query=featured_home
https://www.hivguidelines.org/guideline/sti-doxy-pep/?mycollection=sexual-health
https://www.cdc.gov/nchhstp/newsroom/2022/Doxy-PEP-clinical-data-presented-at-2022-AIDS-Conference.html
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Tackling Stigma with Compassion: Harm Reduction in Clinical Practice

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. It is also a movement for social justice build on a belief in, and respect for, the rights of people who use drugs. With its introduction as a U.S. Federal Drug Policy Priority in 2022, harm reduction has been in the news a lot lately.This episode will build on the momentum by discussing action steps that clinicians can take to address stigma and promote compassionate, non-judgmental interactions with people who use drugs. Dr. Linda Wang will use a clinical vignette to describe the impact of stigma on access to and engagement in healthcare services. She will continue by outlining commonly-used stigmatizing language associated with drug use, and providing practical replacements that promote engagement and trust. Related Content: 
National Harm Reduction Coalition: https://harmreduction.org/
New York State Office for Addiction Services and Supports (OASAS) Harm Reduction: https://oasas.ny.gov/harm-reduction
Hawk, M., Coulter, R.W.S., Egan, J.E., et al. (2017). Harm reduction principles for healthcare settings. Harm Reduct J. 14(70). doi: https://doi.org/10.1186/s12954-017-0196-4
Zwick, J., Appleseth, H., and Arndt, S. (2020). Stigma: How it affects the substance use disorder patient. Subst Abuse Treat Prev Policy. 15(50). doi: https://doi.org/10.1186/s13011-020-00288-0
Logan, D.E., and Marlatt, G.A. (2014). Harm reduction therapy: A practice-friendly review of research. J Clin Psychol. 66(2): 201-214. doi: https://doi.org/10.1002%2Fjclp.20669
Milaney, K., Haines-Saah, R., Farkas, B., et al. (2022). A scoping review of opioid harm reduction interventions for equity-deserving populations. The Lancet. 12(100271). doi: https://doi.org/10.1016/j.lana.2022.100271
2022 National Survey on Drug Use and Health: https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-main-highlights.pdf
Kelly, F., and Westerhoff, C.M. (2010). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. Int J Drug Policy. 21(3): 202-207. doi: https://doi.org/10.1016/j.drugpo.2009.10.010
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

RSV Vaccination in HIV Positive Adults

RSV vaccine for adults has recently become available and can protect against severe disease or death from one of the main causes of upper respiratory infections. HIV patients are asking if they should receive the vaccine. This question is discussed by Dr. Steven Fine. Related Content:
Respiratory syncytial virus in adults with severe acute respiratory illness in a high HIV prevalence setting: DOI: https://doi.org/10.1016/j.jinf.2017.06.007
Immunizations for Adults with HIV: https://www.hivguidelines.org/guideline/hiv-immunizations/?mycollection=hiv-care.
CDC: Respiratory Syncytial Virus (RSV) Vaccine VIS: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rsv.html#:~:text=CDC%20recommends%20a%20single%20dose,most%20of%20the%20United%20States.
Respiratory Syncytial Virus Infection (RSV) in Older aAdults and Adults with Chronic Medical Conditions: https://www.cdc.gov/rsv/high-risk/older-adults.html
Adult Immunization Schedule by Age: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html
CEI Clinician toll free line for NYS providers: 866- 637-2342
https://ceitraining.org/

We can do it! Improving access to care for transgender and gender diverse patients

Compared with the general population, transgender and gender diverse people are more likely to experience poor health outcomes, such as chronic health conditions, HIV, substance use, and mental illness. We know these disparities are due structural factors, such as political and economic policies, and interpersonal factors, such as discrimination, stigma, and violence. Transgender people are also more likely to encounter barriers to accessing health insurance and health care. When transgender people do access health care, nearly half report being mistreated by medical providers.
In this episode, Dr. Antonio E. Urbina, Medical Director of CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Dr. Joshua D. Safer, Executive Director of Mount Sinai’s Center for Transgender Medicine (CTMS) and Professor at the Icahn School of Medicine. While gender wellness clinics like CTMS are so important, there is a need to expand the health care workforce of providers treating transgender patients. For example, transgender patients report barriers to accessing inclusive primary care providers and specialists who can treat them outside of their gender-affirming interventions.  Drs. Urbina and Safer unpack common misconceptions and discuss how providers can improve access to inclusive care for transgender and gender diverse patients.  Related Content:
Center for Transgender Medicine and Surgery at Mount Sinai: https://www.mountsinai.org/locations/center-transgender-medicine-surgery
WPATH: https://www.wpath.org/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

What is Doxy-PEP? A Conversation about the Use of Doxycycline Post Exposure Prophylaxis to Prevent STIs

In this episode, Dr. Marguerite Urban and Dr. Daniela DiMarco discuss Doxy-PEP, a new tool for the prevention of bacterial STIs.  Drs. Urban and DiMarco are infectious disease faculty members at the University of Rochester, specializing in sexual health care. They were part of the team who authored the recently released New York State (NYS) Department of Health (DOH)  AIDS Institute’s guidelines regarding Doxy-PEP.
This episode is an introduction to the use of doxycycline as post exposure prophylaxis for bacterial STIs. The hosts will briefly review results from recent clinical trials as well as discuss concerns about risks and side effects. They will also present how guidelines for implementation (who, when and how) of Doxy-PEP have varied thus far and review the current recommendations of the NYS DOH guidelines. Related Content:
Quick Survey: https://93dsff4pt87.typeform.com/to/ECrf0DTY 
https://www.hivguidelines.org/guideline/sti-doxy-pep/?mycollection=sexual-health
https://www.nejm.org/doi/full/10.1056/NEJMoa2211934
https://www.cdc.gov/nchhstp/newsroom/2022/Doxy-PEP-clinical-data-presented-at-2022-AIDS-Conference.html
NYSDOH STI Surveillance Report, 2021: https://www.health.ny.gov/statistics/diseases/communicable/std/docs/sti_surveillance_report_2021.pdf
CDC STI Surveillance Report, 2021: https://www.cdc.gov/std/statistics/2021/default.htm
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Safe and Safer Supply for People Who Use Drugs

The United States is in the midst of an overdose crisis that’s been exacerbated by the COVID-19 pandemic and increased toxicity of the drug supply, largely a result of adulterants like fentanyl and other synthetic opioids. In 2021, the number of deaths in New York State alone surged to more than 5,800 individuals – an average of nearly 16 people every day.
Scaling up harm reduction interventions has helped avert thousands of overdose-related deaths, but the persistent predominance of fentanyl continues to fuel mortality. To complement existing interventions, colleagues in Canada and elsewhere around the globe have pointed to providing “safer supply,” or an alternative to the unregulated, toxic drug supply as a potential solution to prevent overdose-related deaths and address the needs of people for whom current treatment models do not work or are not a good fit. Although not intended as a standalone treatment for substance use disorder, this novel approach is showing promise in addressing the growing morbidity and mortality surrounding the current drug supply.
This episode will introduce safer supply as a harm reduction approach to support and engage people who use drugs.
Disclaimer: Safer supply is not legal or authorized in the United States under current FDA and DEA regulations.  Related Content:
New York State Office of Addiction Services and Supports Harm Reduction: https://oasas.ny.gov/harm-reduction
Government of Canada Safer Supply: https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html
British Columbia Centre on Substance Use, Provincial Clinical Guidelines for Opioid Use Disorder:https://www.bccsu.ca/opioid-use-disorder/
The National Harm Reduction Coalition: https://harmreduction.org/
Haines M, O'Byrne P. Safer opioid supply: qualitative program evaluation. Harm Reduct J. 2023 Apr 20;20(1):53. doi: 10.1186/s12954-023-00776-z. PMID: 37081500; PMCID: PMC10117245
Tyndall M. A safer drug supply: a pragmatic and ethical response to the overdose crisis. CMAJ. 2020 Aug 24;192(34):E986–7. doi: 10.1503/cmaj.201618. PMCID: PMC7840515
McNeil R, Fleming T, Mayer S, Barker A, Mansoor M, Betsos A, Austin T, Parusel S, Ivsins A, & Boyd J. Implementation of safe supply alternatives during intersecting COVID-19 and overdose health emergencies in British Columbia, Canada 2021. Am J Public Health. 2022;112(S151_S158). doi: 10.2105/AJPH.2021.306692
Dr. Eric Kutscher Mount Sinai profile: https://profiles.mountsinai.org/eric-kutscher
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

REPRIEVE: Pitavastatin to Prevent Cardiovascular Disease in HIV

HIV patients are known to have up to a two-fold increase in heart-related events, compared with the general population. Could treatment with statins reduce this risk?
Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester, reviews the recently published results of the REPRIEVE trial. The big picture is a 35% reduction in heart-related events. Dr. Fine digs into the details and statistics of the trial, and the encouraging results of statin treatment, even in those deemed to be at lower risk. Related Content:
The Reprieve Trial 
The Results in NE Journal of Medicine
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Making a SPLASH! Long-acting Injectables for vulnerable populations with HIV

The clinical innovation of antiretroviral treatment for HIV is a major public health victory that has transformed the shape of the epidemic. Healthcare professionals must remain committed to reaching every person with HIV, which means not only developing new clinical technologies, but also the strategies to implement them equitably. Long-acting injectable antiretroviral treatment (LAI-ART) is the newest clinical tool for ending the epidemic. How can we make sure that it reaches the people living with HIV who are not virally suppressed? In today’s episode, I speak with Dr. Monica Gandhi about her research increasing access to LAI-ART among vulnerable populations. Related Content:
Dr. Gandhi’s newest publication, “Demonstration Project of Long-Acting Antiretroviral Therapy in a DiversePopulation of People With HIV” https://www.acpjournals.org/doi/10.7326/M23-0788
Dr. Gandhi’s faculty profile at UCSF: https://profiles.ucsf.edu/monica.gandhi
NYS Injectable ART Guidelines: https://www.hivguidelines.org/antiretroviral-therapy/art-injectable/ 
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Tackling Syphilis: A Conversation with the New York State Department of Health AIDS Institute Office of Sexual Health and Epidemiology

In this episode, Dr. Marguerite Urban chats with Drs. Rachel Hart-Malloy and Wilson Miranda from the New York State Department of Health AIDS Institute Office of Sexual Health and Epidemiology (OSHE) to discuss how clinicians and the Department of Health can collaborate to tackle the significant increases in cases of syphilis and congenital syphilis reported in New York State. What is the Office of Sexual Health and Epidemiology? Are we bending the curve in reducing syphilis? What are the trends in syphilis rates? What is the Department of Health and the Clinical Education Initiative doing to help reduce and prevent syphilis and congenital syphilis? Listen to this new episode to find out and learn more about what you can do to help!  Related Content:
NYSDOH OSHE: https://www.health.ny.gov/diseases/aids/general/about/sexual_health_epi.htm
NYSDOH STI Surveillance Report, 2021: https://www.health.ny.gov/statistics/diseases/communicable/std/docs/sti_surveillance_report_2021.pdf
CDC STI Surveillance Report, 2021
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/