Conversations with CEI

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/

The Resurgence of Congenital Syphilis in NYS: A Look at the Past and Present to Change the Future

In this episode host Melinda Godfrey, a Nurse Practitioner at the University of Rochester, and Program Manager of the Congenital Syphilis Prevention Project, (part of the NYS CEI Sexual Health Center of Excellence) speaks with special guest Dr. Geoffrey Weinberg, Professor of Pediatrics at the University of Rochester School of Medicine and Dentistry. Dr. Weinberg is the Clinical Director of the Pediatric Infectious Diseases and Pediatric HIV Program. He is the co-attending at the Pediatric Primary Immune Deficiency Disorders Clinic at the University of Rochester Golisano Children’s Hospital, and consults with the NYSDOH AIDS Institute.
Dr. Weinberg gives us a brief history of syphilis (“The Great Pox”) all the way back to the 1400s. Through the years, medicine began to understand how the disease was transmitted, and in the 1940s, with the advent of penicillin, syphilis was all but eliminated. The disease resurfaced in the 1980s with other STDs and chronic drug use. Again, it was all but eliminated by the year 2000. Alarmingly, in 2021 there were 2700 known cases in newborns, and this has led to today’s discussion about what clinicians can do to help reduce the number of babies born with syphilis today, and preventing transmission in the future. Related Content:
CDC - syphilis Informaion
Clinical Education Initiative; Sexual Health Learning Pathways - Mastering syphilis
Tampa M, Sarbu I, Matei C, Benea V, Georgescu SR. Brief history of syphilis. J Med Life. 2014 Mar 15;7(1):4-10. Epub 2014 Mar 25. PMID: 24653750; PMCID: PMC3956094. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

What We Know About Xylazine

In this episode host Lauren Walker, Program Director for the Hep C and Drug User Health Center of Excellence at CEI, speaks with special guests Dr. Sharon Stancliff and NYSDOH’s Lisa Skill about the increasing health threat posed by Xylazine.
Dr. Stancliff is Associate Medical Director of Harm Reduction in Healthcare and Medical Director of Harm Reduction in Healthcare, AIDS Institute, NYSDOH. She has been working with people who use drugs since 1990, and currently focuses on opioid overdose prevention. Lisa Skill is a Health Program Coordinator at the NYSDOH AIDS Institute Office of Drug User Health.
Xylazine, often called “tranq” or “tranq dope” on the street, is being used to amplify and extend the effects of other drugs such as stimulants, opioids, and other sedatives. The drug was designed for veterinary use in animals as a sedative and muscle relaxant and is not approved for human consumption. Human use of Xylazine was first noted in Puerto Rico in the early 2000s, and has since spread across the U.S. into local drug supplies. In November 2022, the FDA issued a national warning to healthcare professionals to be cautious of the potential for xylazine inclusion in fentanyl, heroin and other illicit drug overdoses.
This episode will describe xylazine trends and use over time, and provide clinicians with an understanding of the physiologic effects of xylazine intoxication. Dr. Sharon Stancliff and Lisa Skill will also share their clinical and harm reduction recommendations for xylazine intoxication, overdose and withdrawal. Related Content:
NYSDOH Naloxone Availability without a prescription
Safer Consumption Spaces - End Overdose NY
Fiorentin TR, Logan BK. Analytical findings in used syringes from a syringe exchange program. Int J Drug Policy. 2022, 81:102770. doi: 10.1016/j.drugpo.2020.102770
Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, Shover C. Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022, 233:109380. doi: 10.1016/j.drugalcdep.2022.109380
Johnson J, Pizzicato L, Johnson C, Viner K. Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010-2019. Injury Prevention. 2021, 24:395-398. doi: 10.1136/injuryprev-2020-043968
Kariisa M, Patel P, Smith H, Bitting J. Notes from the field: Xylazine detection and involvement in drug overdose deaths – United States, 2019. MMWR Morb Mortal Wkly Rep. 2021, 70(37):1300-1302. doi: 10.15585/mmwr.mm7037a4 National Institute of Drug Abuse. Xylazine.
Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int. 2014, 240:1-8. doi: 10.1016/j.forsciint.2014.03.015
United States Department of Justice, Drug Enforcement Administration. Xylazine. November 2022.
United States Food and Drug Administration. FDA alerts health care professionals of risks to patients exposed to xylazine in illicit drugs. November 2022.
CEI toll free line for NYS providers: 866-637-2342https://ceitraining.org/

START Trial Update

This podcast is about a long term follow up to the START trial which originally showed that startingantiretroviral therapy even at high CD4 counts (above 500) was better than waiting until CD4 counts drop to

How Can We Destigmatize HIV and Pregnancy?

Preventing perinatal HIV transmission is an important strategy for eliminating HIV. Historically, rates of perinatal HIV transmission were 25-40% without interventions, but advances in HIV research, prevention, and treatment have made it possible to reduce that risk to less than 1%. Despite this progress, many myths and misconceptions about HIV and pregnancy remain. In this episode, Dr. Antonio E. Urbina, Medical Director of CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Dr. Andrés Ramírez Zamudio, Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Medicine, Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai. Drs. Urbina and Ramírez Zamudio discuss strategies for preventing perinatal HIV transmission more broadly. As well, they unpack some of the common myths and misconceptions to help destigmatize HIV in pregnancy. Related Content:
CEI line for NYS providers: 866-637-2342 (press 2 for questions about perinatal HIV transmission)
National hotline: (888) 448-8765
The Well Project: https://www.thewellproject.org/
International Workshop on HIV and Women: https://virology.eventsair.com/international-workshop-on-hiv-women-2023/registration/Site/Register
Infectious Diseases Society for Obstetrics and Gynecology (IDSOG): https://www.idsog.org/
NYS Perinatal HIV Care Guidelines: https://www.hivguidelines.org/perinatal-hiv-care/
https://ceitraining.org/

Taking the Next Step: Providing Proactive Reproductive Health Care in Your Clinical Setting

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. Related Content:
CDC Medical Eligibility Criteria website: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html
CDC Medical Eligibility Criteria, PDF Chart: https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf
CDC Selected Practice Recommendations website: https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.html
CDC MEC & SPR App: https://www.cdc.gov/reproductivehealth/contraception/contraception-app.html
bedsider.org
Society of Family Planning: https://societyfp.org/
https://abortionpillcme.teachtraining.org/
The Turnaway Study: https://www.ansirh.org/research/ongoing/turnaway-study
Hey Jane Medical Abortion in NY https://www.heyjane.co/home-b
Plan C Abortion Resource https://www.plancpills.org/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Universal Hepatitis C Screening among Pregnant Persons: The Time is Now

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. Related Content:
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
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Some Basics About HIV-Hepatitis B Co-Infection

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. Related Content:
CEI Trainings: https://ceitraining.org/courses/ 
Prevention and Management of Hepatitis B Virus Infection in Adults With HIV: https://www.hivguidelines.org/hiv-care/hbv-hiv/#tab_0
Hepatitis B Virus/HIV Coinfection: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virushiv-coinfection
People Coinfected with HIV and Viral Hepatitis: https://www.cdc.gov/hepatitis/populations/hiv.htm
 CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/