Conversations with CEI

Special Conversations with CEI: Best Practices for Hepatitis C and Pregnancy Screening: Advice from a Fellow Clinician

Hepatitis C virus (HCV) is a pathogen spread by contact with blood from a person with HCV infection. Prevalence among the US obstetric population rose nearly 10-fold over the past 20 years and approximately 6% of infants born to people with HCV become infected during pregnancy or delivery. The New York State Hepatitis C Elimination Plan outlines over 30 recommendations to eliminate HCV in the state by 2030, including implementation of universal screening for all adults. And in 2023, state legislators approved expanding the existing hepatitis C virus (HCV) testing law to include screening during each pregnancy; changes will go into effect on May 3rd, 2024.
This special edition of “Conversations with CEI” describes best practices for screening and identifying hepatitis C and substance use in pregnant persons and linking people to care and treatment. The conversation identifies key steps clinicians can take to support pregnant persons in their care, including ways to operationalize critical health systems for universal hepatitis C screening among pregnant persons. Related Content: 
New York State Hepatitis C Screening during Pregnancy, Digital Provider Toolkit: https://ceitraining.org/documents/HCV%20Screening%20for%20Pregnant%20People%20-%20Provider%20Toolkit%20MARCH%202024%20for%20Posting.pdf
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.suguidelinesnys.org/guideline/substance-use-disorder-treatment-in-pregnant-adults/
National Harm Reduction Coalition “Pregnancy and Substance Use: A Harm Reduction Toolkit” https://harmreduction.org/issues/pregnancy-and-substance-use-a-harm-reduction-toolkit/
Ramsey KS, Cunningham CO, Stancliff S, et al.; Substance Use Guidelines Committee. Substance Use Disorder Treatment in Pregnant Adults [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572854/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Special Conversations with CEI: Best Practices for Working with People Who Use Substances

Hepatitis C virus (HCV) is a pathogen spread by contact with blood from a person with HCV infection.Prevalence among the US obstetric population rose nearly 10-fold over the past 20 years and approximately6% of infants born to people with HCV become infected during pregnancy or delivery. The New York StateHepatitis C Elimination Plan outlines over 30 recommendations to eliminate HCV in the state by 2030,including implementation of universal screening for all adults. And in 2023, state legislators approvedexpanding the existing hepatitis C virus (HCV) testing law to include screening during each pregnancy;changes will go into effect on May 3rd, 2024.
This special edition of “Conversations with CEI” describes common barriers people who use substances facewhen seeking health care services, particularly HCV screening during pregnancy. The conversation alsoidentifies best practices clinicians can implement in practice to provide responsive care for people who usedrugs, including pregnant persons. Related Content: 
New York State Hepatitis C Screening during Pregnancy, Digital Provider Toolkit: https://ceitraining.org/documents/HCV%20Screening%20for%20Pregnant%20People%20-%20Provider%20Toolkit%20MARCH%202024%20for%20Posting.pdf
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/
National Harm Reduction Coalition “Pregnancy and Substance Use: A Harm Reduction Toolkit” https://harmreduction.org/issues/pregnancy-and-substance-use-a-harm-reduction-toolkit/
Ramsey KS, Cunningham CO, Stancliff S, et al.; Substance Use Guidelines Committee. Substance Use Disorder Treatment in Pregnant Adults [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572854/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Special Conversations with CEI: The Impact of Hepatitis C Screening during Pregnancy: A Client’s Story

Hepatitis C virus (HCV) is a pathogen spread by contact with blood from a person with HCV infection. Prevalence among the US obstetric population rose nearly 10-fold over the past 20 years and approximately 6% of infants born to people with HCV become infected during pregnancy or delivery. The New York State Hepatitis C Elimination Plan outlines over 30 recommendations to eliminate HCV in the state by 2030, including implementation of universal screening for all adults. And in 2023, state legislators approved expanding the existing hepatitis C virus (HCV) testing law to include screening during each pregnancy; changes will go into effect on May 3rd, 2024.
This special edition of “Conversations with CEI” will provide important information about pregnancy, HCV and substance use from the perspective of a client with lived experience, with a focus on providing affirming services for all pregnant persons and their infants. Related Content: 
New York State Hepatitis C Screening during Pregnancy, Digital Provider Toolkit: https://ceitraining.org/documents/HCV%20Screening%20for%20Pregnant%20People%20-%20Provider%20Toolkit%20MARCH%202024%20for%20Posting.pdf
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/
American Association for The Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) Recommendations for Testing, Managing and Treating Hepatitis C: https://www.hcvguidelines.org/
The American College of Obstetricians and Gynecologists Clinical Practice Guidelines for Viral Hepatitis in Pregnancy: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/09/viral-hepatitis-in-pregnancy
US Centers for Disease Control and Prevention (CDC) Recommendations for Hepatitis C Testing among Perinatally Exposed Infants and Children (2023): https://www.cdc.gov/mmwr/volumes/72/rr/rr7204a1.htm?s_cid=rr7204a1_e&ACSTrackingID=USCDC_921-DM116215&ACSTrackingLabel=MMWR%20Recommendations%20and%20Reports%20%E2%80%93%20Vol.%2072%2C%20November%203%2C%202023&deliveryName=USCDC_921-DM116215
Ramsey KS, Cunningham CO, Stancliff S, et al.; Substance Use Guidelines Committee. Substance Use Disorder Treatment in Pregnant Adults [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572854/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Would you consider Injectable ART for those unable to suppress with oral HIV treatment?

In this episode, Dr. Steven Fine discusses some of the latest data that might be used to support startingpatients who are unable to take oral antiretroviral medications on long acting, injectable ARV. Patients whoconsider this off label use because their HIV viral load was not suppressed on oral treatment would have to becarefully selected and well supported. Related Content: 
Long-acting Injectable Cabotegravir/Rilpivirine Effective in a Small Patient Cohort With Virologic Failure on Oral Antiretroviral Therapy. James B. Brock, Peyton Herrington, Melissa Hickman, and Aubri Hickman. Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center. Jackson, Mississippi, USA. Clinical Infectious Diseases, Volume 78, Issue 1, 15 January 2024, Pages 122–124, https://doi.org/10.1093/cid/ciad511
CROI 2024: Abstract number 628 24 Week Viral Suppression in Patients Starting Long-Acting CAB/RPV Without HIV Viral Suppression. Matthew D Hickey, Janet Grochowski, Francis Mayorga-Munoz, Elizabeth Imbert, John D. Szumowski, Jon Oskarsson, Mary Shiels, Samantha Dilworth, Ayesha Appa, Diane V Havlir, Monica Gandhi, Katerina Christopoulos. Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States.
CROI 2024: ABSTRACT NUMBER 212. SESSION TITLE. Special Session. Clinical Late-Breaking Oral Abstracts. SESSION NUMBER Oral Session-14. Long-Acting Injectable CAB/RPV is Superior to Oral ART in PWH With Adherence Challenges: ACTG A5359. Aadia I. Rana, Yajing Bao, Lu Zheng, Sara Sieczkarski, Jordan E. Lake, Carl J. Fichtenbaum, Tia Morton, Lawrence Fox, Paul Wannamaker, Jose R. Castillo-Mancilla, Kati Vandermeulen, Chanelle Wimbish, Karen T. Tashima, Raphael J. Landovitz
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

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/