Conversations with CEI

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/

Integrating Hepatitis C Treatment into Opioid Treatment Programs: The Greenwich House Story

Hepatitis C virus (HCV) infection is a major public health problem responsible for substantial morbidity, including cirrhosis and liver cancer, and mortality. In 2021, over 6,500 new cases were reported in New York State, many of which occurred in younger people as a result of injection drug use. Although we have highly  effective treatments available for HCV, many people face numerous barriers to accessing them. With the ongoing opioid epidemic fueling new cases, innovative ways of reaching people who inject drugs to ensure they have access to treatment are more essential than ever. Furthermore, people who use drugs and substance use disorder treatment programs were identified in the New York State HCV Elimination Plan as priority populations and settings to focus HCV elimination efforts.Opioid Treatment Programs, or OTPs for short, are uniquely poised to engage people who inject drugs and integrate HCV treatment into their services and help expand access to those most in need. This episode, featuring Dr. Sara Lorenz Taki from New York City’s Greenwich House, will discuss evidence for and best practices to integrate hepatitis C treatment into an OTP setting. Related Content:
New York State Hepatitis C Elimination Plan: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hepatitis_c_elimination_plan.pdf
New York State Hepatitis C Dashboard: https://hcvdashboardny.org/
New York State Hepatitis C Guidelines and Recommendations: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/providers/index.htm
American Association for the Study of Liver Diseases Hepatitis C Guidelines: https://www.hcvguidelines.org/
Taylor, LE. (2020), Colocalization in Hepatitis C Virus Infection Care: The Role of Opioid Agonist Therapy Clinics. Clinical Liver Disease, 16:12-15. https://doi.org/10.1002/cld.921
Empire Liver Foundation (2020), Building Capacity for Hepatitis C Treatment at Opioid Treatment Programs On-site and via Telemedicine, New York City: https://empireliverfoundation.org/wp-content/uploads/2020/10/Building-Capacity-for-Hepatitis-C-Treatment-at-Opiod-Treatment-Programs-On-site-and-via-Telemedicine-in-New-York_slides.pdf
Addiction Technology Transfer Center Guide to Integrating HCV Services into Opioid Treatment Programs: https://attcnetwork.org/sites/default/files/2020-07/Guide%20to%20Integrating%20HCV%20Services%20into%20Opioid%20Treatment%20-%20July%2024-1.pdf
Greenwich House: https://www.greenwichhouse.org/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/
 

Talking to patients about Lenacapavir (Sunlenca); the new long-acting injectable medication for HIV

In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University ofRochester and Anthony Jordan Health Center explains the pros and cons behind the newlyapproved Lenacapavir (Sunlenca) injectable for HIV.Dr. Fine receives a lot of questions about the medication in his practice. Many patients haveheard good things about the new treatment for HIV that is given as a subcutaneous injectiononce every 6 months. Dr. Fine discusses the current indication in combination with other agentsfor “treatment-experienced” HIV patients and possible future uses. You’ll hear aboutLenacapavir, the data that led to approval, and how it may be used in the future - includingpossibly for Pre-Exposure Prophylaxis (PrEP).
Related Content:
The Capella Trial for Lenocapavir
CROI 2023
FDA Approves New HIV Drug for Adults with Limited Treatment Options
CEI toll free line for NYS providers: 866-637-2342
Visit us at https://ceitraining.org/

Providing Affirming Care to Transgender Youth

One recent study shows that only 4% of trans youth with supportive parents attempted suicide, while 57% with unsupportive parents committed suicide…
In the current political landscape, transgender healthcare and rights have been used to stoke political divisiveness, creating confusion and perpetuating misinformation. As healthcare providers, it is important to focus on the facts and how to provide inclusive care and support the health and well-being of the transgender community, especially during these tumultuous times.
In this episode, Dr. Tony Urbina, Professor of Medicine from Mt. Sinai Health System and Medical Director of the New York State CEI HIV Primary Care and Prevention Center of Excellence, speaks with Carolyn Wolf-Gould, MD, founder of the Gender Wellness Center in Susquehanna, New York.
Dr. Wolf-Gould began practicing transgender medicine in 2007, when her first trans patient begged her to get educated on transgender care so she could provide treatment. She is a member of the World Professional Association for Transgender Health (WPATH), and trains healthcare professionals on how to include transgender health services within a primary care setting. Dr. Wolf-Gould and The Gender Wellness Center clinicians provide a broad range of patient care services- from medical and mental health care to research and legal advocacy. They provide care for all who consider themselves “under the transgender umbrella,” including individuals who identify as transgender, gender-expansive, or non-binary. Related Content:
The Gender Wellness Center
Article about Dr. Wolf-Gould and the Gender Wellness Center
Dr. Antonio Urbina LinkedIn 
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/