Conversations with CEI

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/

Where are we with an HIV vaccine and cure?

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. Related Content:
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.
AIDS Vaccine Advocacy Coalition (AVAC)
Weill Cornell Reach Program Grant
Rockefeller HIV Trial
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

Check Yourself! Bringing STI Home Testing to Your Patients

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. Related Content:
www.NCSDDC.org/Check-Yourself checkyourself@ncsddc.org
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/

There is Love in the Overdose Prevention Center

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

Exciting Injectable PrEP for HIV; No More Pills!

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

Where Are We Now With HIV and COVID-19

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

Behind the Scenes: A Look at the 2021 CDC STI Treatment Guidelines

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

One Step Closer: Introducing the New York State Hepatitis C Elimination Plan

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

Simplified HCV Treatment for treatment naive patients: Anyone can do it!

According to the updated HCV guidelines, initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether investigational, or US Food and Drug Administration (FDA) approved. However, the simplification of the treatment regimen for HCV may expand the number of healthcare professionals who prescribe antiviral therapy and increase the number of persons treated. In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center, speaks about simplified HCV treatment for treatment naïve patients. Related Content:
HCV Guidelines: hcvguidelines.org
https://www.hivguidelines.org/hepatitis-care/treatment-with-daa/recommended-regimens-adults/
https://www.hcvguidelines.org/Treatment-Naive
https://ceitraining.org/courses/
https://ceitraining.org/resources/hcv/
https://www.health.ny.gov/publications/1806.pdf
https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/providers/testing_law.htm
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/