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:

• https://www.hptn.org/research/studies/hptn-084

• https://programme.aids2024.org/Programme/Session/349

• CEI toll free line for NYS providers: 866-637-2342

• https://ceitraining.org/

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:

• 2021-2022 Lesbian, Gay, And Bisexual Behavioral Health
• A Provider's Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, & Transgender (LGBT) Individuals
• CEI toll free line for NYS providers: 866-637-2342
• https://ceitraining.org/

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:

• CDC STI Prevention Conference 2024 website: https://stipreventionconference.org/
• CEI toll free line for NYS providers: 866-637-2342
• https://ceitraining.org/

Are current guidelines failing chronic pain patients with a history of substance-use disorders? Find out why Dr. Wang and Dr. Kelly are calling for urgent policy changes and how updated guidelines can support effective pain management.

Join us for a compelling discussion on the intersection of chronic pain and substance use disorders with insights from Dr. Linda Wang, Medical Director of CEI's Hepatitis C and Drug User Health Center, and Dr. Lauren Kelly, a geriatrician and palliative care provider at Mount Sinai. We explore the complex case of a 62-year-old woman who, after decades of sobriety, began experiencing severe, undiagnosed pain. Despite numerous consultations and non-opioid treatments, her pain remained unmanaged, leading her to self-medicate with heroin. We discuss the significant barriers she faced in seeking appropriate care, including the reluctance of prescribers to provide methadone due to her history of opioid use disorder.

Dr. Wang and Dr. Kelly discuss the importance of understanding patients' substance use patterns and the benefits of treatments like methadone and buprenorphine for stability and safety. We also cover non-opioid treatments such as physical therapy, acupuncture, and emerging modalities like scrambler therapy. The conversation emphasizes addressing the psychological aspects of pain and tackling the pervasive issue of stigma that impacts patients' access to necessary treatments. Finally, we delve into the critical issue of prescribing controlled substances to individuals with a history of addiction, shedding light on the gaps in current guidelines and the stigma within the healthcare system. Dr. Wang and Dr. Kelly stress the need for updated guidance to support chronic pain patients with substance use disorder, advocating for compassionate, individualized care. Related Content:

• Rules and Regulations on Controlled Substances in NYS

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

“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/

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:

• CDC HIV Nexus  --  https://www.cdc.gov/hivnexus/hcp/prep/index.html#:~:text=If%20results%20are%20discordant%20or,until%20HIV%20status%20is%20confirmed.
• AIDS Institute PrEP guidance including diagnostic testing -- https://www.hivguidelines.org/guideline/hiv-prep/
• NY State Wadsworth Center -- https://www.aphl.org/conferences/proceedings/Documents/2018/43_Gaynor_Parker.pdf
• APHL -- https://www.aphl.org/aboutAPHL/publications/Documents/ID-2019Jan-HIV-Lab-Test-Suggested-Reporting-Language.pdf
• CEI toll free line for NYS providers: 866-637-2342
• https://ceitraining.org/

“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:

• Guidance: Adolescent Consent to HIV and STI Treatment and Prevention: https://www.hivguidelines.org/guideline/adolescent-consent/?mycollection=hiv-treatment
• NYCLU – Teenagers, Health Care, and the Law: https://www.nyclu.org/uploads/2018/10/thl.pdf
• Guidance for Local Health Departments (LHD) and Health Care Providers on STI Billing and Minor's Consent to Prevention Services and. HIV-related Services: https://www.health.ny.gov/diseases/communicable/std/docs/faq_billing_consent.pdf
• “Effect of Mandatory Parental Notification on Adolescent Girls' Use of Sexual Health Care Services” - https://jamanetwork.com/journals/jama/fullarticle/195185
• CEI toll free line for NYS providers: 866-637-2342
• https://ceitraining.org/

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:

• New York State Hepatitis C Screening during Pregnancy, Digital Provider Toolkit: https://ceitraining.org/documents/HCV%20Screening%20for%20Pregnant%20People%20-%20Provider%20Toolkit%20MARCH%202024%20for%20Posting.pdf
• 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.suguidelinesnys.org/guideline/substance-use-disorder-treatment-in-pregnant-adults/
• National Harm Reduction Coalition “Pregnancy and Substance Use: A Harm Reduction Toolkit” https://harmreduction.org/issues/pregnancy-and-substance-use-a-harm-reduction-toolkit/
• Ramsey KS, Cunningham CO, Stancliff S, et al.; Substance Use Guidelines Committee. Substance Use Disorder Treatment in Pregnant Adults [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572854/
• CEI toll free line for NYS providers: 866-637-2342
• https://ceitraining.org/