Conversations with CEI

HIV patients are known to have up to a two-fold increase in heart-related events, compared with the general population. Could treatment with statins reduce this risk? Dr. Steven Fine, an infectious disease specialist affiliated with the University of Rochester, reviews the recently published results of the REPRIEVE trial. The big picture is a 35% reduction in heart-related events. Dr. Fine digs into the details and statistics of the trial, and the encouraging results of statin treatment, even in those deemed to be at lower risk. Related Content: The Reprieve TrialThe Results in NE Journal of Medicinehttps://ceitraining.org/

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: https://www.acpjournals.org/doi/10.7326/M23-0788https://profiles.ucsf.edu/monica.gandhihttps://www.hivguidelines.org/antiretroviral-therapy/art-injectable/https://ceitraining.org/

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: https://www.health.ny.gov/diseases/aids/general/about/sexual_health_epi.htmhttps://www.health.ny.gov/statistics/diseases/communicable/std/docs/sti_surveillance_report_2021.pdfhttps://ceitraining.org/

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: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hepatitis_c_elimination_plan.pdfhttps://hcvdashboardny.org/https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/providers/index.htmhttps://www.hcvguidelines.org/https://doi.org/10.1002/cld.921https://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.pdfhttps://attcnetwork.org/sites/default/files/2020-07/Guide%20to%20Integrating%20HCV%20Services%20into%20Opioid%20Treatment%20-%20July%2024-1.pdfhttps://www.greenwichhouse.org/https://ceitraining.org/

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: The Capella Trial for Lenocapavir CROI 2023FDA Approves New HIV Drug for Adults with Limited Treatment OptionsVisit us at https://ceitraining.org/

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 CenterArticle about Dr. Wolf-Gould and the Gender Wellness CenterDr. Antonio Urbina LinkedInhttps://ceitraining.org/

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 InformaionClinical Education Initiative; Sexual Health Learning Pathways - Mastering syphilishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956094/https://ceitraining.org/

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 prescriptionSafer Consumption Spaces - End Overdose NY 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.United States Department of Justice, Drug Enforcement Administration. Xylazine. November 2022United States Food and Drug Administration. FDA alerts health care professionals of risks to patients exposed to xylazine in illicit drugs. November 2022.https://ceitraining.org/

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

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: https://www.thewellproject.org/https://virology.eventsair.com/international-workshop-on-hiv-women-2023/registration/Site/Registerhttps://www.idsog.org/https://www.hivguidelines.org/perinatal-hiv-care/https://ceitraining.org/

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: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.htmlhttps://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdfhttps://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.htmlhttps://www.cdc.gov/reproductivehealth/contraception/contraception-app.htmlbedsider.orghttps://societyfp.org/https://abortionpillcme.teachtraining.org/https://www.ansirh.org/research/ongoing/turnaway-studyhttps://www.heyjane.co/home-bhttps://www.plancpills.org/https://ceitraining.org/

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: https://www.hivguidelines.org/hepatitis-care/treatment-with-daa/#tab_4https://www.hivguidelines.org/substance-use/sud-treatment-pregnancy/https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/05/routine-hepatitis-c-virus-screening-in-pregnant-individualshttps://ceitraining.org/

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: https://ceitraining.org/courses/https://www.hivguidelines.org/hiv-care/hbv-hiv/#tab_0https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/hepatitis-b-virushiv-coinfectionhttps://www.cdc.gov/hepatitis/populations/hiv.htmhttps://ceitraining.org/

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: https://www.avac.org/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%20doAIDS Vaccine Advocacy Coalition (AVAC)Weill Cornell Reach Program GrantRockefeller HIV Trialhttps://ceitraining.org/

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-Yourselfcheckyourself@ncsddc.orghttps://ceitraining.org/

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: https://nyhre.org/https://www.facebook.com/WashingtonHeightsCORNERProject/https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief131.pdfhttps://health.ny.gov/statistics/opioid/data/pdf/nys_apr22.pdfhttps://ceitraining.org/

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.htmhttps://www.health.ny.gov/diseases/aids/ending_the_epidemic/index.htmhttps://ceitraining.org/courses/https://ceitraining.org/request/PrEP GuidelinesCEI TrainingEnding the EpidemicNYS Ending the Epidemichttps://ceitraining.org

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, https://www.publichealth.columbia.edu/people/our-faculty/ref5 Part 2: Keith Sigel, MD, PhD, MPH https://www.cdc.gov/hiv/covid-19/index.htmlhttps://ceitraining.org/

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: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdfhttps://www.cdc.gov/mmwr/volumes/68/rr/rr6805a1.htm?s_cid=rr6805a1_whttps://www.stdccn.org/render/Publichttps://ceitraining.org/

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 PlanNew York State Hepatitis C Guidelines and RecommendationsNew York State Hepatitis C DashboardWorld Health Organization Hepatitis InformationTreatment Action GroupHep ElimiNATION InitiativeVOCAL New Yorkhttps://ceitraining.org/