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TitreDateDurée
An Exciting New Twice-yearly Option for HIV PrEP10 Sep 202400:13:35

“This podcast discusses the recent presentation of data for lenacapavir, a potent capsid inhibitor for HIV that was 100% effective in preventing HIV infection in cis-gender woman at risk for HIV. If approved, it will offer an exciting new option to prevent HIV which should dramatically improve our chances of reaching the goal of totally eliminating new HIV infections.  The trial compared twice yearly injections of lenacapavir to both F/TAF and F/TDF in cis-gender woman and found similar effectiveness for F/TAF compared to F/TDF but there were zero new HIV infections in participants on lenacapavir.”. Related Content: 

  • The New England Journal of Medicine. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. Authors: Linda-Gail Bekker, M.B., Ch.B, Ph.D. https://orcid.org/0000-0002-0755-4386, Moupali Das, M.D., M.P.H., Quarraisha Abdool Karim, Ph.D. https://orcid.org/0000-0002-0985-477X, Khatija Ahmed, M.B., B.Ch., Joanne Batting, M.B., Ch.B., D.F.S.R.H., D.R.C.O.G., Dip. HIV Man., William Brumskine, M.B., Ch.B., Dip. HIV Man., Katherine Gill, M.B., Ch.B., M.P.H., +33, for the PURPOSE 1 Study Team*Author Info & Affiliations. Published July 24, 2024. DOI: 10.1056/NEJMoa2407001
  • CEI toll free line for NYS providers: 866-637-2342
  • https://ceitraining.org/
When HIV Tests Perplex: Expert Insights on Ambiguous and Discordant Results08 Aug 202400:29:08

Providers calling into our CEI hotline often ask me what to do when their patient's HIV test results are unclear. These ambiguous or discordant test results can be a source of anxiety and confusion for both patients and healthcare providers alike.

To provide additional insight into this complex issue, 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 Dr. Lucia Torian, a distinguished epidemiologist who has dedicated over three decades of her career to the New York City Department of Health. As the Deputy Director of the HIV Epidemiology Program, she brings a wealth of expertise in HIV diagnostic testing and case surveillance.

In our conversation, we dive into real-world scenarios that illustrate the challenges of interpreting HIV test results. We explore real-world cases involving early exposure, false positives, and the added complications of testing migrant populations. The discussion includes practical advice on managing patient anxiety, effective communication strategies, and navigating ambiguous results. Listeners will gain insights into testing acute infections, how to handle PrEP ambiguity, and the role of advanced diagnostic techniques like Western blot tests. Additionally, Dr. Torian shares her thoughts on whether ambiguous results are becoming more prevalent in NYC and provides recommendations for follow-up procedures and timing. Tune in for a comprehensive look at improving HIV testing accuracy and patient care.  Related Content:

RSV Vaccination in HIV Positive Adults11 Jan 202400:11:53

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:

We can do it! Improving access to care for transgender and gender diverse patients14 Dec 202300:17:39

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:

What is Doxy-PEP? A Conversation about the Use of Doxycycline Post Exposure Prophylaxis to Prevent STIs09 Nov 202300:15:44

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:

Safe and Safer Supply for People Who Use Drugs12 Oct 202300:32:30

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:

REPRIEVE: Pitavastatin to Prevent Cardiovascular Disease in HIV14 Sep 202300:12:51

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:

Making a SPLASH! Long-acting Injectables for vulnerable populations with HIV10 Aug 202300:18:34

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:

Tackling Syphilis: A Conversation with the New York State Department of Health AIDS Institute Office of Sexual Health and Epidemiology13 Jul 202300:30:57

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:

Integrating Hepatitis C Treatment into Opioid Treatment Programs: The Greenwich House Story08 Jun 202300:31:40

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:

 

Talking to patients about Lenacapavir (Sunlenca); the new long-acting injectable medication for HIV11 May 202300:16:11

In this episode, Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester and Anthony Jordan Health Center explains the pros and cons behind the newly approved Lenacapavir (Sunlenca) injectable for HIV. Dr. Fine receives a lot of questions about the medication in his practice. Many patients have heard good things about the new treatment for HIV that is given as a subcutaneous injection once every 6 months. Dr. Fine discusses the current indication in combination with other agents for “treatment-experienced” HIV patients and possible future uses. You’ll hear about Lenacapavir, the data that led to approval, and how it may be used in the future - including possibly for Pre-Exposure Prophylaxis (PrEP).

Related Content:

Providing Affirming Care to Transgender Youth13 Apr 202300:20:12

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:

It’s Complicated…but Necessary! Navigating Confidential Sexual Healthcare for Adolescents11 Jul 202400:22:05

“Nobody goes into adolescent medicine or into a field of medicine that serves adolescent patients because it’s simple and straightforward, right?”

In May 2024, the New York State Department of Health AIDS Institute Clinical Guidelines Program published an update to the guidelines, “Guidance: Adolescent Consent to HIV and STI Treatment and Prevention.” These guidelines serve to inform New York State clinicians who provide primary care to adolescents about existing regulations that allow minors to consent for and receive confidential HIV and STI screening, treatment, and prevention.

In this episode, Dr. Erica Bostick chats with Dr. Uri Belkind, Associate Medical Director for Adolescent Medicine and Clinical Director of the Health Outreach to Teens (HOTT) program at Callen-Lorde Community Health Center in New York City, and original lead author of these guidelines. Drs. Bostick and Belkind discuss the intricacies of providing confidential HIV and STI care to adolescents, perspectives on how to navigate sexual health conversations with patients and a trusted adult, resources on confidential adolescent healthcare for general providers, and more! Related Content: 

The Resurgence of Congenital Syphilis in NYS: A Look at the Past and Present to Change the Future09 Mar 202300:24:51

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:

What We Know About Xylazine09 Feb 202300:30:04

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:

START Trial Update12 Jan 202300:09:38

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

How Can We Destigmatize HIV and Pregnancy?08 Dec 202200:27:45

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:

Taking the Next Step: Providing Proactive Reproductive Health Care in Your Clinical Setting10 Nov 202200:38:41

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:

Universal Hepatitis C Screening among Pregnant Persons: The Time is Now11 Oct 202200:27:48

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-Infection15 Sep 202200:30:03

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:

Where are we with an HIV vaccine and cure?11 Aug 202200:45:55

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:

Check Yourself! Bringing STI Home Testing to Your Patients14 Jul 202200:35:14

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:

There is Love in the Overdose Prevention Center09 Jun 202201:06:01

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:

Special Conversations with CEI: Best Practices for Hepatitis C and Pregnancy Screening: Advice from a Fellow Clinician13 Jun 202400:34:45

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: 

Exciting Injectable PrEP for HIV; No More Pills!12 May 202200:29:28

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:

Where Are We Now With HIV and COVID-1914 Apr 202200:50:23

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 Guidelines10 Mar 202200:35:59

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:

One Step Closer: Introducing the New York State Hepatitis C Elimination Plan10 Feb 202200:25:29

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:

Simplified HCV Treatment for treatment naive patients: Anyone can do it!13 Jan 202200:24:38

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:

Addressing the Intersections of HIV and Health Inequities: Considerations for Providers09 Dec 202101:05:49

It has been 40 years since the first known case of HIV was documented and we have come a long way in the past 40 years. HIV is now a chronic disease, we have highly effective HIV prevention options like PEP and PrEP, and we are now able to offer long-acting injectables for HIV treatment and soon HIV prevention. While we can celebrate these achievements, HIV health disparities persist. We see that communities who experience multiple forms of oppression have not benefitted as much from medical advances in HIV treatment and prevention. In this episode, Dr. Antonio E. Urbina, Medical Director for CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with two experts to learn more about these disparities and what providers can do to address them: Kenyon Farrow, a public health and infectious disease activist, writer, and editor, and Dr. Sabrina Gard, a primary care provider specializing in HIV. Related Content:

The Intersection of Drug User Health and Infectious Diseases07 Dec 202100:46:56

Join us for the fifth and final episode of Any Positive Change, a Drug User Health Podcast. Dr. Margie Urban from the University of Rochester and the Clinical Education Initiative’s Sexual Health Center of Excellence joins as a guest host for this episode. She met with Dr. Sandy Springer from Yale University for a wide ranging conversation about her experiences as a joint Infectious Diseases and Addiction Medicine specialist from the early in the HIV epidemic to the present day. Listen as they discuss the progress in the field and some future directions of research at the intersection of drug user health and infectious diseases.

Future podcasts can be found at ‘Conversations with CEI’ and will focus on drug user health, Hepatitis C, sexual health and HIV care and prevention. Come join us there. Related content: 

Pre-Exposure Prophylaxis (PrEP): What Clinicians Need to Know28 Jun 202100:56:35

[The following episode was initially recorded as part of "Any Positive Change", which has since merged with Conversations with CEI]

Pre-exposure prophylaxis, also known as PrEP, is a highly effective way to prevent HIV infection. While we are most familiar with the pill that is taken every day, there are new long acting injectables coming down the pipeline, with the potential to improve PrEP adherence. Roughly 1 in 5 people who use drugs are at very high risk of getting HIV. Despite this, very few of them are actually getting PrEP. To hear more about these new advancements in PrEP, and how we can close the treatment gap for people who use drugs, Dr. Linda Wang interviewed Dr. Tony Urbina, an infectious disease physician and Professor of Medicine at the Icahn School of Medicine. Dr. Urbina is also the Medical Director of the New York State Clinical Education Initiative HIV Primary Care and Prevention Center of Excellence.

Future podcasts can be found at ‘Conversations with CEI’ and will focus on drug user health, Hepatitis C, sexual health and HIV care and prevention. Come join us there. Related content: 

Updates in Sexually Transmitted Infections and Sexual Health04 Jun 202100:40:17

[The following episode was initially recorded as part of "Any Positive Change", which has since merged with Conversations with CEI]

In this episode, Dr. Linda Wang interviews Dr. Margie Urban, an infectious disease physician and Professor of Medicine at the University of Rochester and the Medical Director of the New York State Clinical Education Initiative Sexual Health Center of Excellence. Listen as we discuss the rising number of sexually transmitted infections affecting communities across the country and in New York State, and how clinicians and the New York State Department of Health have been responding to this crisis in the middle of a pandemic.

Future podcasts can be found at ‘Conversations with CEI’ and will focus on drug user health, Hepatitis C, sexual health and HIV care and prevention. Come join us there. Related content: 

“Where they feel honored as a human being.”22 Jan 202100:53:46

[The following episode was initially recorded as part of "Any Positive Change", which has since merged with Conversations with CEI]

The medical clinic at New York Harm Reduction Educators (NYHRE) provides access to healthcare right in the middle of the drop-in center. Participants who come for sterile injection equipment can also receive treatment for hepatitis C and be prescribed buprenorphine, a medication for opioid use disorder, on-site at NYHRE. Perhaps more importantly, they receive all of this at a clinic that is loving, nurturing, and provides non-stigmatizing care to people who use drugs. Hear about how the NYHRE clinic operates and why it is so important to provide this low-barrier model of care to people who use drugs, from Brianna Norton, DO, Medical Director of the NYHRE medical clinic, and Christine Fitzsimmons, RN. Brianna and Christine also talk about the challenges faced during the pandemic, and how they are staying connected to their patients to keep them safe and healthy.

Special Conversations with CEI: Best Practices for Working with People Who Use Substances06 Jun 202400:30:04

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 common barriers people who use substances face when seeking health care services, particularly HCV screening during pregnancy. The conversation also identifies best practices clinicians can implement in practice to provide responsive care for people who use drugs, including pregnant persons. Related Content: 

”It‘s already rough out here.”13 Jan 202100:46:15

[The following episode was initially recorded as part of "Any Positive Change", which has since merged with Conversations with CEI]

Syringe service programs play a critical role in the lives of people who use drugs, providing not only sterile injection equipment and naloxone kits for overdose reversal, but also a safe and welcoming place to take a shower and get a cup of coffee. Some programs, like New York Harm Reduction Educators (NYHRE) in East Harlem, also provide medical care, including hepatitis C treatment and buprenorphine, a medication for opioid use disorder. In early 2019, when the Covid pandemic hit New York City and led to widespread disruptions in routine healthcare delivery, syringe service programs like NYHRE rapidly adjusted their model of care in order to sustain their life-saving programming. Hear from Sheree, a participant at NYHRE as well as Pia Marcus, Director of Syringe Access and Outreach for NYHRE and Washington Heights Corner Program, about their experiences.

Special Conversations with CEI: The Impact of Hepatitis C Screening during Pregnancy: A Client’s Story30 May 202400:36:45

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: 

Would you consider Injectable ART for those unable to suppress with oral HIV treatment?07 May 202400:14:49

In this episode, Dr. Steven Fine discusses some of the latest data that might be used to support starting patients who are unable to take oral antiretroviral medications on long acting, injectable ARV. Patients who consider this off label use because their HIV viral load was not suppressed on oral treatment would have to be carefully 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 Population11 Apr 202400:23:43

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:

Doxy-PEP Part II: Where Are We Now?14 Mar 202400:17:25

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: 

Tackling Stigma with Compassion: Harm Reduction in Clinical Practice08 Feb 202400:28:35

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: 

Xylazine & Medetomidine & Nitazines, Oh My! An Update on New York State’s Drug Supply12 Jun 202500:29:38

New York drug overdose deaths and death rates are on the decline, but with significant disparities and the current, toxic drug supply is partially to blame. Harmful additives like fentanyl analogues, xylazine and medetomidine, among others, have been found in cocaine, heroin, MDMA and pressed into pills. Additives are undetectable by sight, taste and smell which increases the risk of overdose for people who use and may not be aware of what’s in their drug supply.

This episode features Drs. Sharon Stancliff and Jennifer Love discussing additives commonly found in the New York State supply, including BTMPS, fentanyl analogues, medetomidine, nitazenes and an updates on xylazine. Related Content: 

CEI…we got you! Evolving with the Science16 May 202500:38:16

In this episode of Conversations with CEI, we engage with CEI’s clinicians, researchers, and public health experts to explore current and emerging issues in HIV primary care, sexual health, Hepatitis C, and drug user health.

From the early days of the HIV epidemic to today’s complex syndemic approach, our experts share valuable insights and practical strategies for translating science into practice.

We emphasize the importance of a syndemic approach to care, recognizing the overlapping health needs of patients, particularly in the marginalized population. Through a wide range of training and resources, CEI supports New York State clinicians in delivering comprehensive and inclusive care. Related Content:

  • CEI Clinical Consultation Line 1-866-637-2342 A toll-free service for NYS clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health.
Navigating Measles Vaccine Recommendations for Patients with HIV08 May 202500:20:06

In light of the increase in measles cases within the United States, this episode features Dr. Steven Fine, an infectious disease expert, who offers a comprehensive exploration of the history and progress of measles eradication efforts. Dr. Fine delves into the factors contributing to the resurgence of measles, particularly the role of misinformation in undermining public trust and vaccination efforts. Additionally, Dr. Fine walks us through the latest vaccination recommendations for patients with HIV, addressing the unique considerations required to safeguard this vulnerable group. Tune in to gain valuable insights and practical guidance on current vaccination recommendations aimed at protecting patients with HIV from measles in today's healthcare environment. Related Content:

  • Measles for Health Care Providers: https://www.health.ny.gov/diseases/communicable/measles/providers/
  • Measles Cases and Outbreaks | Measles (Rubeola) | CDC https://www.cdc.gov/measles/data-research/index.html
  • CEI Clinical Consultation Line 1-866-637-2342 A toll-free service for NYS clinicians offering real-time clinical consultations with specialists on HIV, sexual health, hepatitis C, and drug user health.
The Invisible Latino HIV Crisis10 Apr 202500:21:40

In May 2024, the Centers for Disease Control and Prevention (CDC) released its annual HIV surveillance reports. The new data show a continuation of year-over-year reductions through 2022 in the estimated number of new HIV infections in the United States. But disconcerting trends among Latino people — the country’s second-largest racial or ethnic group after White, non-Latino people — reflect persistent failures in HIV prevention and treatment systems that this overall progress has overshadowed. Related Content: 

Updates in Syphilis: Looking Back to Look Forward13 Mar 202500:34:19

Let’s dive in!

This month, we welcome new hosts Patrick Passarelli, MD, an infectious diseases fellow at the University of Rochester, and Nicholas Gerbino, a public health professional at the Monroe County Sexual Health Clinic, who take a deep dive into all things syphilis. Dr. Passarelli and Nick discuss history, epidemiological trends, updates and diagnostics, screening strategies, and new studies exploring additional treatment and preventative options for syphilis. Related Content:

The Role of Opioid Treatment Programs in Hepatitis C Care: A Path to Elimination13 Feb 202500:20:58

Between 2010 and 2022 (the latest year for which data are available), 194,375 New Yorkers were diagnosed with hepatitis C (HCV) and of those, 53% (103,213 individuals) are known to have cleared their infection either through treatment or spontaneously. This statistic is worth celebrating, but also highlights the ongoing need for action – the goal outlined in New York State’s Hepatitis C Elimination Plan is to reach 80% by 2030. Furthermore, people who inject drugs are disproportionally affected by HCV – in 2022, 48% of newly reported cases of acute HCV in New York indicated injection drug use as a risk factor. And, when analyzing cases with known risk factors, that figure rose to 81% of newly reported acute cases indicating injection drug use. Providing HCV treatment in opioid treatment program (OTP)s is an innovative and necessary strategy to curb the ongoing epidemic and achieve statewide goals for elimination.

This episode features Abigail Hunter, MPH, MSN, FNP-BC, sharing her experience providing HCV treatment at an OTP and recommendations for listeners interested in integrating treatment into clinical services.  Related Content:

Use of Injectable Cabotegravir for HIV PrEP in Pregnancy09 Jan 202500:09:28

This podcast outlines some of the data presented at the 25th International AIDS Conference from HPTN 084 as it pertains to using injectable cabotegravir for HIV PrEP during pregnancy. Related Content: 

Compassionate Care for LGBTQ+ Individuals Struggling with Substance Use Disorder12 Dec 202400:28:22

Research suggests that LGBTQ adults have higher rates of substance use and mental health issues, compared to their heterosexual cisgender peers.  These health disparities are often related to minority stress—the chronic psychological and emotional strain that people experience due to being part of a marginalized social group. For example, some LGBTQ folks may use alcohol and drugs to cope with internalized homophobia or to self-medicate for anxiety and depression. On the other hand, some people use drugs in the context of social settings and connecting with others in their community. Since not all substance use is unhealthy, how do providers know how to identify when substance use is problematic?  And what can physicians do to best support their patients who may be at greater risk for harm or even overdose? 

On this episode, Antonio Urbina, MD, Medical Director for CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Eric Kutscher, MD, MSc. Dr. Eric Kutscher is an Assistant Professor of Medicine at the Icahn School of Medicine, where he practices as a primary care and addiction medicine physician at Mount Sinai's Internal Medicine Associates and REACH Program. He currently serves as the Medical Director of the Mount Sinai Hospital Opioid Overdose Prevention Program and Primary Care Lead for the Mount Sinai Center for Transgender Medicine and Surgery. His clinical work and research focus on harm reduction techniques for patients with substance use disorders, particularly within the LGBTQ+ community. Drs. Urbina and Kutscher talk about how providers can identify when substance use is a problem and how to help patients manage substance use disorder, including treatment options and harm reduction strategies.  Related Content: 

Reflections from the 2024 CDC STI Prevention Conference07 Nov 202400:22:11

For the first time since 2018 and since the COVID-19 pandemic, the Centers for Disease Control and Prevention hosted their biennial STI Prevention Conference in-person in Atlanta, GA from September 16 – 19, 2024. This event brought together international leading researchers with government experts, clinical sexual healthcare providers, and state and local public health administrators for four days of scientific updates and sessions on science, programs, and policies related to STI care. Dr. Marguerite Urban and Dr. Daniela DiMarco from the CEI Sexual Health Center of Excellence attended the conference and are back to bring you insights about their experience at the event. They chat about the different sessions they attended and share personal thoughts and summaries of the cutting-edge research presented at the conference, focusing on syphilis, Doxy-PEP, gonococcal resistance, and the syndemic of substance use and STIs. Were you unable to attend the conference yourself? Were you there and want to hear our CEI experts’ perspectives about some of the sessions? Listen now and let us know what you think by leaving a comment!  Related Content: 

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