Courses – International Association of Providers of AIDS Care

Culturally Competent Approaches to HIV Prevention

Background

Black/African American and Hispanic/Latino communities in the United States are disproportionately affected by HIV compared to other racial/ethnic groups. Subpopulations within these racial and ethnic minority groups are most affected with gay, bisexual, and other men who have sex with men (MSM) accounting for 66% of new infections each year, even though they make up only 2% of the population. Tailored interventions are needed to engage them in HIV prevention strategies. CDC’s Prevention Research Synthesis Project has identified culturally competent interventions tailored for African-American, Asian-American, Native Hawaiian and other Pacific Islander, and Hispanic/Latinx individuals.

Program

Implementing Culturally Competent Approaches to HIV Prevention Service Delivery is a web-based activity that provides clinicians in primary care settings with the resources, knowledge, and skills to deliver culturally competent, linguistically appropriate, and accessible HIV prevention services, notably PrEP. The activity is in alignment with CDC’s Prevention Research Synthesis Project recommendations and supports US National HIV/AIDS Strategy (NHAS) Goal 1.3 of expanding and improving implementation of effective HIV prevention interventions; 3.1 of reducing HIV-related stigma and discrimination; 3.5 of training and expanding a diverse HIV workforce; and 3.6 of advancing HIV-related communication to achieve improved messaging towards communities affected by HIV.

The activity’s educational focus includes:

The role that biomedical HIV prevention can play in reducing the acquisition of HIV
The importance of delivering culturally competent, linguistically appropriate HIV prevention services, including PrEP, to highly stigmatized patient populations
Strategies to integrate culturally competent and linguistically appropriate models of care into clinical practice within a primary care setting

Planning Committee

This educational activity was developed by a course director and an activity manager:

Course Director: Christopher Duncombe, MD, AM (University of Washington, Seattle, WA, USA)
Faculty: Anne Monroe, MD, MSPH (George Washington University, Washington, DC, USA)
Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Assistant: Cassandra Moore, MPH (International Association of Providers of AIDS Care, Washington, DC, USA)

Accreditation

Providership

This CME activity is provided by Albert Einstein College of Medicine-Montefiore Medical Center in joint providership with the International Association of Providers of AIDS Care (IAPAC).

Commercial Support Acknowledgement

This activity was supported by an independent medical education grant from ViiV Healthcare.

Target Audience

This activity has been designed to meet the educational needs of HIV care providers and other healthcare professionals providing HIV prevention, care, and treatment in specialized and primary care settings, including physicians, nurse practitioners, and physician assistants.

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Describe populations most at risk for HIV acquisition and need targeted prevention interventions
Explain how culturally competent HIV prevention approaches can be in integrated into daily practice
List evidence-based culturally competent HIV prevention approaches, interventions, and approaches

Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Albert Einstein College of Medicine-Montefiore Medical Center and the International Association of Providers of AIDS Care (IAPAC). Albert Einstein College of Medicine-Montefiore Medical Center is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Designation Statements

Physicians Albert Einstein College of Medicine-Montefiore Medical Center designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Financial Relationships

Planners, faculty members and peer reviewers have no relevant financial relationships with ACCME-defined ineligible companies during the past 24 months.

The “Policy on Identification, Mitigation and Disclosure of Relevant Financial Relationships” of Albert Einstein College of Medicine-Montefiore Medical Center requires that any individual in control of content, including faculty, participating in CME/CE activities disclose to the audience all relevant financial relationships with ineligible companies* in the last 24 months.

Any individual in control of content who refuses to disclose, or their disclosed relationships prove to create a conflict of interest will be recused. Individuals with the absence of relevant financial relationships with ineligible companies will be disclosed to the audience.

All financial relationships of individuals in a position to control the content of this CME/CE activity has been identified and mitigated prior to this educational activity.

*The ACCME defines an ineligible company as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Course Content

This activity’s three modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessment

This activity has a knowledge assessment. The assessment requires completing 30 multiple choice questions covering topics covered in the activity’s three modules and must be completed following the activity’s completion to claim 2.0 AMA PRA Category 1 Credits™.

Implementing LAI-PrEP in Ryan White CARE Act Clinics

Background

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is a paradigm shift in HIV combination prevention with the potential to improve PrEP persistence and transform PrEP delivery. Long-acting cabotegravir (CAB-LA) was shown to be superior to oral PrEP and safe and effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in two landmark randomized controlled trials, HPTN 083 and HPTN 084. In HPTN 083, CAB-LA reduced the risk of sexually acquired HIV by 66% compared to daily oral PrEP. In HPTN 084, the risk of acquiring HIV was reduced by 89% for those receiving CAB-LA compared to daily oral PrEP. Long-acting injectable products have also been reported to be acceptable and preferred in studies examining PrEP preferences and may reach new and hard-to-reach individuals who would benefit from effective HIV prevention.

Despite being a key component of the federal National HIV/AIDS Strategy (NHAS) and the Ending the HIV Epidemic (EHE) initiative, PrEP uptake in the United States has been sub-optimal with the Centers for Disease Control and Prevention (CDC) estimating that only about 300,800 people were prescribed PrEP in 2020, representing only 25% of individuals with an indication for its use. Access to PrEP is also inequitable, with only 8% of African Americans and 14% of Hispanics/Latinox individuals eligible for PrEP being prescribed it in 2019, compared to 63% of white Americans. Similarly, uptake of PrEP among trans people is low. Communities of color have been reported to be underrepresented in PrEP uptake as are people residing in the Southern U.S., in part because of a lack of awareness about PrEP in these population groups. Simplification of PrEP dosing is one key to improving uptake, as is optimization of PrEP delivery in clinical settings, including Ryan White CARE Act clinics.

Program

Strengthening Capacity to Implement LAI-PrEP in Ryan White CARE Act Clinics is a web-based activity to build capacity among clinicians for accelerated implementation of long-acting injectable pre-exposure prophylaxis (LAI-PrEP). The activity’s educational focus includes:

An overview of the paradigm shift in biomedical HIV prevention with LAI-PrEP
Benefits and risks of switching from an oral to an LAI-PrEP regimen
Requirements to adapt services to initiate and maintain reliable delivery of LAI-PrEP
Communication strategies to increase patient acceptability of injectable LAI-PrEP
Management strategies to deliver LAI-PrEP with cultural competence
Implementation strategies to optimize LAI-PrEP persistence and adherence
Addressing stigma and other challenges in transitioning from an oral to LAI-PrEP regimen
Management strategies to respond to missed doses and discontinuation of LAI-PrEP (when indicated)

Planning Committee

This educational activity was developed by a course director and an activity manager:

Course Director: Christopher Duncombe, MD, AM (University of Washington, Seattle, WA, USA)
Faculty: Rupa Patel, MD, MPH (Washington University, St. Louis MO, USA)
Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Assistant: Cassandra Moore, MPH (International Association of Providers of AIDS Care, Washington, DC, USA)

Accreditation

Providership

This CME activity is provided by Albert Einstein College of Medicine-Montefiore Medical Center in joint providership with the International Association of Providers of AIDS Care (IAPAC).

Commercial Support Acknowledgement

This activity is made possible through an independent medical education grant from ViiV Healthcare.

Target Audience

This activity has been designed to meet the educational needs of HIV care providers and other healthcare professionals providing HIV care and treatment such as physicians, nurse practitioners, and physician assistants.

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Describe how LAI-PrEP is prescribed and monitored
List which patients would benefit from initiating LAI-PrEP orswitching from oral PrEP to LAI-PrEP
Describe who are the hardest-to-reach populations and strategies to engage them in care
Explain how hard-to-reach populations may benefit from LAI-PrEP
Describe how to minimize the risk of LAI-PrEP drug resistance

Accreditation Statement

Credit Designation Statements

Financial Relationships

Planners, faculty members and peer reviewers have no relevant financial relationships with ACCME-defined ineligible companies during the past 24 months.

All financial relationships of individuals in a position to control the content of this CME/CE activity has been identified and mitigated prior to this educational activity.

*The ACCME defines an ineligible company as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Course Content

This activity’s three modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessment

Promoting Integrated Care for People Living with HIV

Background

Global efforts are focused on health integration and the move towards people-centered, primary care encompassing the treatment and prevention of multiple diseases, under the umbrella of universal health coverage. Integration of HIV services and other health services can improve health and health systems outcomes. Patient perspectives and experiences on integrated care for HIV and comorbidities have been reported as mostly positive and integrated services can save resources and allow for a more holistic approach to healthcare. The integration of HIV services with sexual and reproductive health services has the potential to increase the efficiency and effectiveness of care providers and health systems to better meet the needs of patients seeking these services. Service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of ending the HIV epidemic (EHE) in the U.S. by 2030. CDC has called for community engagement and the integration of programs at the local level to address the syndemic of HIV, STIs, viral hepatitis, substance use and mental health disorders. It is essential to go beyond a biomedical approach and to fully integrate social determinants of health into the EHE response.

Program

Promoting Integrated Care for People Living with HIV positions integrated care as a key component of delivering quality HIV care and improving patient outcomes, notably because people living with HIV are at increased risk for mental and psychosocial conditions and require care for HIV and associated medical conditions. The activity is in alignment with NHAS goal 2.3 of providing integrative HIV services for HIV-associated comorbidities, coinfections, and complications; 2.4 of increasing the capacity of the health care workforce to diagnose and provide holistic care and treatment for people living with HIV; 3.5 of training and expanding a diverse HIV workforce; and 3.6 of advancing HIV-related communication to achieve improved messaging towards communities affected by HIV. The information is delivered across two modules:

The first module addresses how inflammation contributes to earlier onset and increased frequency of cardiovascular disease, cancers, venous thromboembolism, type 2 diabetes, chronic obstructive airway disease, renal disease, bacterial pneumonia, cognitive dysfunction, depression, and frailty.
The second module addresses strategies for delivering whole-person care to people living with HIV within integrative health services.

Accreditation

Planning Committee

This educational activity was developed by a course director, activity manager, and activity assistant:

Course Director: Christopher Duncombe, MD, AM (University of Washington, Seattle, WA, USA)
Faculty: Christopher Duncombe, MD, AM (University of Washington, Seattle, WA, USA)
Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Assistant: Cassandra Moore, MPH (International Association of Providers of AIDS Care, Washington, DC, USA)

Providership

This CME activity is provided by Albert Einstein College of Medicine-Montefiore Medical Center in joint providership with the International Association of Providers of AIDS Care (IAPAC).

Commercial Support Acknowledgement

Educational grant from Merck & Co.

Target Audience

Learning Objectives

Explain the relationship between HIV, inflammation, and comorbidities.
Describe how integration of HIV and other services can improve individual and health systems outcomes.
Explain the importance of integrating the social determinants of health into their practices.
List evidence-based best practices on health systems integration.

Accreditation Statement

Credit Designation Statements

Physicians Albert Einstein College of Medicine-Montefiore Medical Center designates this live activity for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Financial Relationships

Planners, faculty members and peer reviewers have no relevant financial relationships with ACCME-defined ineligible companies during the past 24 months.

All financial relationships of individuals in a position to control the content of this CME/CE activity has been identified and mitigated prior to this educational activity.

*The ACCME defines an ineligible company as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Course Content

This activity’s two modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. This course will be accessible for credit from December 13, 2023 through December 31, 2024. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessment

This activity has a knowledge assessment. The assessment requires completing 20 multiple choice questions covering topics covered in the activity’s two modules and must be completed following the activity’s completion to claim 2.5 AMA PRA Category 1 Credits™.

Strengthening Capacity to Implement LA-ART in Hard-to-Reach Populations

Background

Socially disadvantaged groups, such as people who inject drugs, sex workers, and homeless individuals, are disproportionately affected by HIV. Hard-to-reach status is associated with sub-optimal retention in care and viral load suppression. Strategies to engage the hard-to reach include addressing mental health and social needs, promoting self-determination and self-care, contact tracing through electronic databases and community and phone call outreach. Long-acting injectable antiretroviral therapy (LA-ART) has been shown to be non-inferior to daily oral ART, with good patient satisfaction and a preference in some patients over oral ART. LA-ART has the potential capacity to reduce stigma in those who are/feel stigmatized by the need to take daily oral medication, including the most marginalized and hard-to reach in society. For some people with HIV, lifestyle, structural, behavioral, and cognitive factors may contribute to sub-optimal adherence. LA ART may be a useful strategy to overcome some of these adherence barriers but will require a change in eligibility for LA-ART, currently restricted to those who have attained viral load suppression. Barriers to implementation of LA-ART include identifying those who are most suitable to receive it, including the most vulnerable and hard to reach, the frequency of injecting visits required, and adherence and missed visits. Multiple enablers at the provider, patient, clinic, and health system levels are needed to optimize patient-provider communication, decision-making and retention in care. Cost-related factors need to be addressed, particularly as the hardest-to-reach may be uninsured.

Program

Strengthening Capacity to Implement LA-ART in Hard-to-Reach Populations is a web-based activity to build capacity among clinicians for accelerated implementation of long-acting injectable antiretroviral therapy (LA-ART). The activity’s educational focus includes:

An overview of the paradigm shift in HIV care with LA-ART to achieve U=U
Benefits and risks of switching from an oral to an LA-ART regimen
Requirements to adapt services to initiate and maintain reliable delivery of injectable LA-ART
Communication strategies to increase patient acceptability of injectable LA-ART
Management strategies to deliver injectable LA-ART with cultural competence
Implementation strategies to optimize LA-ART adherence to achieve U=U
Addressing stigma and other challenges in transitioning from an oral to injectable LA-ART regimen
Management strategies to respond to missed doses and discontinuation of injectable LA-ART (when indicated).

Planning Committee

This educational activity was developed by a course director and an activity manager:

Course Director: Christopher Duncombe, MD, AM (University of Washington, Seattle, WA, USA)
Faculty: Monica Gandhi, MD, MPH (University of California-San Francisco, San Francisco, CA, USA)
Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Assistant: Cassandra Moore, MPH (International Association of Providers of AIDS Care, Washington, DC, USA)

Accreditation

Providership

This CME activity is provided by Albert Einstein College of Medicine-Montefiore Medical Center in joint providership with the International Association of Providers of AIDS Care (IAPAC).

Commercial Support Acknowledgement

Educational grant from ViiV Healthcare.

Target Audience

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Describe how LA-ART is prescribed and monitored
List available LA-ART options for their patients
Describe strategies to re-engage hard-to-reach populations in HIV care
Explain how hard-to-reach populations may benefit from LA-ART

Accreditation Statement

Credit Designation Statements

Financial Relationships

Planners, faculty members and peer reviewers have no relevant financial relationships with ACCME-defined ineligible companies during the past 24 months.

All financial relationships of individuals in a position to control the content of this CME/CE activity has been identified and mitigated prior to this educational activity.

*The ACCME defines an ineligible company as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Course Content

This activity’s three modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessment

This activity has a knowledge assessment. The assessment requires completing 20 multiple choice questions covering topics covered in the activity’s three modules and must be completed following the activity’s completion to claim 2.0 AMA PRA Category 1 Credits™.

Addressing Syndemic Conditions Affecting HIV Outcomes

Background

A syndemic is a set of linked health problems involving two or more conditions, interacting synergistically, and contributing to excess burden of disease in a population. People living with HIV are not only impacted by HIV. Common among people living with HIV are mental health issues such as depression and substance use and other physical health issues. The latter can be related to HIV, such as increased risk of cardiovascular disease, or unrelated, such as diabetes. Practitioners need the knowledge and clinical skills to provide a holistic approach to treating their patients with multiple syndemic conditions. Examining physical and social contexts will help clinicians understand how syndemics adversely affect HIV risk in vulnerable populations and how interventions can best be deployed to mitigate these risks. By broadening their understanding of HIV from a single epidemic to a component of wider syndemics, this program will help clinicians reach those historically left behind.

Program

Addressing Syndemic Conditions Affecting HIV Outcomes will examine physical and social contexts to help clinicians understand how syndemics adversely affect HIV risk in vulnerable populations and how interventions can best be deployed to mitigate these risks. The information will be provided to clinicians through case study-based webinars delivered across three modules.

The first module addresses the interface of substance use disorders, HIV, psychiatric comorbidity, minority stress, and incarceration, as well as strategies for addressing the interface, including community-based interventions, harm reduction, self-help groups, cognitive behavioral therapy, and motivational interviewing.
The second module addresses mental health, sexual risk behavior, and adherence to HIV care, as well as the integration of mental health screening and treatment (cognitive therapy and therapeutic) into HIV primary care.
The third module addresses enabling policies, on-site treatment, and partner services (i.e., contact tracing) for curbing HIV rates via clinical interventions in HIV-specialized and primary care settings.

Accreditation

Planning Committee

This educational activity was developed by a course director and an activity manager:

Learning Objectives

Upon successful completion of this activity, learners should be able to:

To define the interface of substance use disorders, HIV, psychiatric comorbidity, minority stress, and incarceration, as well as strategies for addressing the interface
To explain the impact of mental health and sexual risk behavior on adherence to HIV care, as well as the integration of mental health screening and treatment into HIV primary care
To describe enabling policies, treatments and clinical interventions in HIV-specialized and primary care settings

Accreditation Statements

Physicians

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The George Washington University School of Medicine and Health Sciences and International Association of Providers of AIDS Care. The George Washington University School of Medicine and Health Sciences is accredited by the ACCME to provide continuing medical education for physicians.

The George Washington University School of Medicine and Health Sciences designates this enduring activity for a maximum of 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses

Education Review Systems is an approved approver of continuing nursing education by the Alabama State Nursing Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (Provider # 5-115).

This program is approved for a maximum of 3.00 hours of continuing nursing education. Educational Review Systems is also approved for nursing continuing education by the State of California, the State of Florida, and the District of Columbia.

Disclosure

This activity is supported through an educational grant from Gilead Sciences. The content for this activity was developed by and reflects the views of the activity’s planners, not those of the commercial entities providing educational grants.

Course Content

This activity’s three modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessment

This activity has a knowledge assessment. The assessment requires completing 15 multiple choice questions covering topics covered in the activity’s three modules and must be completed following the activity’s completion to claim 3.0 AMA PRA Category 1 Credits™.

Prioritizing Mental Health in Trauma Settings

Background

Significant gaps remain along the HIV care continuum. Mental illness influences every step of HIV prevention and care continuum. In fact, people living with HIV (PLHIV) have significantly higher rates of mental health symptoms and disorders. The estimated incidence of HIV in people with serious mental illness in the United States is 6% compared to the overall incidence of 0.6%. If we do not address behavioral health, it is unlikely to achieve the Joint United Nations Programme on HIV/AIDS 95-95-95 and other targets aimed at ending the HIV epidemic by 2030.

Program

Prioritizing Mental Health in Trauma Settings is focused on current evidence-based strategies to mitigate the effects of mental health conditions during trauma situations. Initially launched in 2021 with a target audience of clinicians affiliated to health departments, the curriculum was updated in 2023 and the activity re-designed to meet the educational needs of clinicians and other healthcare professionals providing HIV care and treatment, including physicians, nurse practitioners, and physician assistants.

Planning Committee

This educational activity was developed by a course director, an activity manager, and an activity coordinator:

Course Director: Robert Remien, PhD (Columbia University, New York, NY, USA)
Activity Manager: Jonathon Hess, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)

Activity Coordinator: John Charles (International Association of Providers of AIDS Care, Tampa, FL, USA)

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Understand mental health conditions exacerbated by trauma situations among PLHIV
Select interventions to mitigate the effects of mental health conditions during trauma situations
Communicate with PLHIV using language that recognizes the emotional impact of trauma situations

Disclosure

This activity was originally supported through an educational grant from Gilead Sciences. The content for this activity was developed by and reflects the views of the activity’s planners, not those of the commercial entity that provided the educational grant.

Course Content

This activity’s three modules are covered in the video link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, IAPAC Senior Director of Education, at jhess@iapac.org.

Culturally Responsive Care to Optimize HIV Outcomes

Background

A significant percentage of people living with HIV report fear of or experiencing discrimination and bias, including in health care settings. In relation to HIV, the fear of and actual experience of discriminatory or biased care can create a barrier to accessing and utilizing HIV services. For example, people living with HIV who are marginalized because of their age, ethnicity or race, or gender identity, may delay medically necessary care thus jeopardizing their health and well-being including and beyond HIV outcomes. Health care professionals can minimize negative experiences for their patients living with HIV by learning about and integrating culturally responsive care into clinical environments to create culturally affirming environments for all people living with HIV.

Program

Culturally Responsive Care to Optimize HIV Outcomes will provide an overview of current evidence-based strategies to address the implicit role that culturally specific barriers play in limiting universal access to and utilization of HIV services by key populations. The information will be provided to clinicians through a webinar delivered across three modules:

The first module defines culturally specific barriers in relation to accessing and utilizing HIV services, including culturally related patient preferences and values, patient literacy, language, and affordability.
The second module identifies approaches to integrate culturally responsive standards into clinical practice to eliminate age, gender identity, and racial as well as ethnic biases.
The third module defines strategies to operationalize continuous quality improvement plans to address gaps in culturally responsive care delivery in clinical practice.

Planning Committee

This educational activity was developed by a course director, an activity manager, and an activity coordinator:

Course Director: Sheldon D. Fields, PhD, RN, CRNP, FNP-BC, AACRN, FAANP, FNAP, FAAN (PennState Ross and Carol Nese College of Nursing, University Park, PA, USA)

Content Developer: LaTunja Sockwell, MA (University of Arkansas for Medical Sciences, Little Rock, AR, USA)

Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)

Activity Coordinator: John Charles (International Association of Providers of AIDS Care, Tampa, FL, USA)

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Understand the implicit role that culturally specific barriers play in limiting universal access to and utilization of HIV services by key populations
Identify approaches to integrate culturally responsive standards into clinical practice to eliminate age, gender identity, and racial/ethnic biases
Define strategies to operationalize continuous quality improvement plans to address gaps in culturally responsive care delivery in clinical practice

Disclosure

This activity is supported through educational grants from Janssen Therapeutics and Merck & Co. The content for this activity was developed by and reflects the views of the activity’s planners, not those of the commercial entities providing educational grants.

Course Content

Utilizing a Quality Improvement Approach to Eliminate HIV Stigma in Healthcare Settings

Background

HIV and intersectional stigma in healthcare settings undermine efforts to control the HIV epidemic by compromising access to and utilization of HIV prevention and treatment services. Quality improvement (QI) employs plan-do-study-act (PDSA) cycles in a structured approach to identifying, testing, and adopting interventions to reduce stigma and discrimination. Applying a QI approach to the reduction of HIV and intersectional stigma ensures that HIV service providers implement stigma elimination interventions that are adapted to local contexts.

Program

Utilizing a Quality Improvement Approach to Eliminate HIV Stigma in Healthcare Settings will provide an overview of evidence-based interventions to optimize the HIV care environment for people living with HIV. The information will be provided to clinicians through a webinar delivered across two modules.

The first module addresses the impact of HIV and intersectional stigma within health systems and in health care settings on access to and utilization of HIV services, as well as HIV and other health outcomes.
The second module addresses utilization of a QI approach to eliminate HIV stigma in health care settings, leveraging routine measurement of stigma and discrimination, team-based learning, root cause analyses, and tests of change.

Accreditation

Planning Committee

This educational activity was developed by a course director and an activity manager:

Course Director: Chris Duncombe, MD, AM, PhD (University of Washington, Seattle, WA, USA)

Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)

Activity Coordinator: John Charles (International Association of Providers of AIDS Care, Tampa, FL, USA)

Faculty Member: Chris Duncombe, MD, AM, PhD (University of Washington, Seattle, WA, USA)

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Recognize the impact of HIV and intersectional stigma within health systems and in health care settings on access to and utilization of HIV services, as well as HIV and other health outcomes
Describe how to utilize a QI approach to eliminate HIV stigma in health care settings, leverage routine measurement of stigma and discrimination, team-based learning, root cause analyses, and tests of change

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Miami Leonard M. Miller School of Medicine and International Association of Providers of AIDS Care. The University of Miami Leonard M. Miller School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

The University of Miami Leonard M. Miller School of Medicine designates this activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Disclosure and Conflict of Interest Mitigation

All conflicts of interest of any individual(s) in a position to control the content of this CME activity will be identified and resolved prior to this educational activity being provided. Disclosure about provider and faculty relationships, or the lack thereof, will be provided to learners.

Disclosure of Commercial Support

Resource Materials

Following are useful resources to contextualize this activity’s content:

Measuring HIV Stigma and Discrimination among Health Facility Staff. Health Policy Project, Futures Group International, Washington, DC, USA.

QI and Stigma Reduction. HEALTHQUAL. University of California San Francisco, CA, USA.

Target HIV: Ryan White HIV/AIDS Program. HIV Quality Measures (HIVQM) Module Instruction Manual 2021-2022. Health Resources and Services Administration, Rockville, MD, USA.

Continuous Quality Improvement. Minnesota Department of Health, Saint Paul, MN, USA.

Building a Coalition to Overcome Intersecting Stigmas and Improve HIV Prevention, Care Access, and Health Outcomes in New York City. New York City Department of Health and Mental Hygiene, New York, NY, USA.

Facilitator’s Training Guide for a Stigma-Free Health Facility: Training Menus, Facilitation Tips, and Participatory Training Modules. Futures Group International, Washington, DC, USA.

Plan-Do-Study-Act (PDSA). Louisiana Department of Health, Baton Rouge, LA, USA.

U=U in Clinical Practice. International Association of Providers of AIDS Care, Washington, DC, USA.

Course Content

This activity’s two modules are covered in the video link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessments

This activity has two knowledge assessments. The first assessment requires completing 8 multiple choice questions covering topics covered in the activity’s two modules and must be completed following the activity’s completion to claim 1 AMA PRA Category 1 Credit™. A second case study-based assessment will be emailed to activity participants two months post-activity along with guidance regarding how to claim an additional 0.5 AMA PRA Category 1 Credit™.

Optimizing HIV Clinical Management

Background

HIV care is complex and rapidly evolving. To meet the needs of people living with HIV, antiretroviral therapy (ART) must be effective, safe, well-tolerated, and affordable. Treatment must also be easy-to-use for people with coinfections and comorbidities and the elderly. The systematic use of more potent and lower-cost drugs that meet these conditions enables clinicians to extend lifesaving treatment to a greater number of people living with HIV. Furthermore, advances in ART and a better understanding of drug resistance have made it possible to consider switching a person living with HIV from one regimen to another for various reasons. When considering such a switch, clinicians must keep several key principles in mind to maintain viral suppression while addressing the concerns with the current antiretroviral (ARV) regimen.

Program

Optimizing HIV Clinical Management will provide an overview of current evidence-based treatment strategies and interventions to optimize the HIV care continuum for people living with HIV. The educational content is provided to clinicians through a webinar delivered across four modules.

The first module addresses strategies for integrating non-oral ARV formulations into clinical practice, including topics such as clinician/patient hesitancy and promoting ART adherence.
The second module addresses pros and cons of switching ARV regimens in virally suppressed patients with a focus on two-drug regimens and effective clinician/patient dialogue about potent ART to achieve undetectable equals untransmittable, or U=U.
The third module addresses ARV drug regimen selection criteria for patients with comorbidities and integrated management of concomitant cardiovascular disease, diabetes, and hypertension.
The fourth module addresses the impact of HIV on chronic inflammation and the management of age-related comorbidities and frailty.

Accreditation

Planning Committee

This educational activity was developed by a course director and an activity manager:

Course Director: Christopher Duncombe, MD, AM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Manager: Jonathon Hess, MPA, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Coordinator: John Charles (International Association of Providers of AIDS Care, Tampa, FL, USA)

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Understand strategies for integrating non-oral ARV formulations into clinical practice
Identify pros and cons of switching ARV regimens in virally suppressed patients
Describe ARV drug regimen selection criteria and integrated management for patients with comorbidities
Recognize the impact of HIV on chronic inflammation and the management of age-related comorbidities and frailty

Accreditation Statements

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the George Washington University School of Medicine and Health Sciences and the International Association of Providers of AIDS Care.

The George Washington University School of Medicine and Health Sciences is accredited by the ACCME to provide continuing medical education for physicians.

The George Washington University School of Medicine and Health Sciences designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses

This program is approved for a maximum of 1.50 hours of continuing nursing education. Educational Review Systems is also approved for nursing continuing education by the State of California, the State of Florida, and the District of Columbia.

Disclosure

This activity is supported through educational grants from Gilead Sciences and Merck & Co. The content for this activity was developed by and reflects the views of the activity’s planners, not those of the commercial entities providing educational grants.

Resource Materials

Following are useful resources to contextualize this activity’s content:

What to Start: Initial Combination Antiretroviral Regimens for People with HIV. HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

Optimizing Antiretroviral Therapy in the Setting of Viral Suppression. HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

Switching or Simplifying Antiretroviral Therapy. National HIV Curriculum, University of Washington.

Laboratory Testing for Initial Assessment and Monitoring of People with HIV Receiving Antiretroviral Therapy. HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

Drug-Resistance Testing. HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention). HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

Drug-Drug Interactions. HHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV.

U=U in Clinical Practice. International Association of Providers of AIDS Care.

Course Content

This activity’s four modules are covered in the course content link below, which should be fully reviewed prior to completing the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, MPA, LLM, IAPAC Senior Director of Education, at jhess@iapac.org.

Knowledge Assessments

This activity has two knowledge assessments. The first assessment requires completing 10 multiple choice questions covering topics covered in the activity’s four modules and must be completed following the activity’s completion to claim 1 AMA PRA Category 1 Credit™. A second case study-based assessment will be emailed to activity participants two months post-activity along with guidance regarding how to claim an additional 0.5 AMA PRA Category 1 Credit™.

Integrating U=U into Clinical Practice in US Fast-Track Cities

Activity Description

Integrating U=U into Clinical Practice in US Fast-Track Cities is an educational activity designed to assist HIV-treating clinicians to integrate the Undetectable=Untransmittable (U=U) message into their clinical practices.

The activity provides educational material through three video-enabled modules that focus on: 1) the scientific evidence underpinning U=U; 2) testimonials from people living with HIV regarding U=U; and 3) simulated dialogue between an HIV-treating clinician and a person living with HIV about U=U. The modules serve as a learning tool, and the subsequent knowledge assessment serves to assess the learners’ knowledge of the module for continuing medical education or nursing education credits.

The purpose of this activity is to promote the integration of U=U into clinical practice to generate increased demand for HIV testing, care, and treatment services. Additionally, the activity seeks to destigmatize HIV by promoting the scientific evidence that people living with HIV who are on antiretroviral therapy antiretroviral therapy and achieve an undetectable viral load pose zero risk of transmitting HIV to their sexual partners.

Accreditation

Planning Committee

This educational activity was developed by a course director, a multidisciplinary planning committee, and an activity manager:

Course Director: Amanda Castel, MD, MPH (George Washington University, Washington, DC, USA)
Planning Committee: Jason Farley, PhD, MPH, ANP-BC, AACRN (Johns Hopkins University, Baltimore, MD, USA); H. Jonathon Rendina, PhD, MPH (Hunter College, New York, NY, USA); Bruce Richman, JD, EdM (Prevention Access Campaign, New York, NY, USA); José M. Zuniga, PhD, MPH (International Association of Providers of AIDS Care, Washington, DC, USA)
Activity Manager: Jonathon Hess, LLM (International Association of Providers of AIDS Care, Washington, DC, USA)

Learning Objectives

Upon successful completion of this activity, learners should be able to:

Explain the scientific basis for the U=U message
Define strategies to communicate the U=U message to people living with HIV
Employ communication strategies to convey the U=U message to people living with HIV

Accreditation Statements

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the George Washington University School of Medicine and Health Sciences and the International Association of Providers of AIDS Care.

The George Washington University School of Medicine and Health Sciences is accredited by the ACCME to provide continuing medical education for physicians.

The George Washington University School of Medicine and Health Sciences designates this enduring activity for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses

Disclosure

This activity is supported through educational grants from Janssen Therapeutics, Merck & Co., and ViiV Healthcare. The content for this activity was developed by and reflects the views of the activity’s planners, not those of the commercial entities providing educational grants.

Each of the three modules below must be fully reviewed and marked as complete in order to access the knowledge assessment. If you encounter any issues, please contact Jonathon Hess, IAPAC Director of Education, at jhess@iapac.org.

Optimizing the Care Continuum to Facilitate HCV Elimination

Introduction

In 2013, the public health community recognized viral hepatitis as a leading cause of death worldwide. In that year, hepatitis C virus (HCV) infection resulted in more deaths than HIV, tuberculosis, or malaria. This alarming trend continues. Given that preventive strategies reduce the risk of infection, the World Health Organization (WHO) examined the feasibility of eliminating HCV. A WHO analysis outlined targets to eliminate HCV as a public health threat (i.e., 90% reduction in new chronic infections and 65% reduction in mortality). These targets now serve as defined metrics to monitor efforts to achieve HCV elimination worldwide.

Direct-acting antiviral (DAA) agents revolutionized HCV treatment and made the setting of HCV elimination targets more than aspirational. These all-oral medication options improved treatment efficacy so that nearly every individual chronically infected with HCV can expect cure rates higher than 95%. Viral eradication reduces the risk of liver-related mortality as well as all-cause mortality. Finite therapy leads to the elimination of the virus. Thus, successful HCV treatment is instrumental to elimination strategies, particularly for those at highest risk of transmitting the virus.

The safety profile of these DAA agents also allows for their use in many patient subsets that would not have been considered appropriate for interferon (IFN)-based therapy, such as individuals with immune diseases, psychiatric conditions, post-transplant, or advanced liver disease. In addition to expanding our potential pool of patients, this therapeutic advancement has also allowed therapy to occur outside of traditional constructs. A transition in the location of care is imperative as we work towards achieving HCV elimination.

This educational activity includes a didactic component followed by a series of clinical case studies. At the conclusion of this activity, learners should be able to:

Define the HCV care continuum from screening and diagnosis to treatment and cure
Implement evidence-based clinical management practices for acute and chronic HCV infection
Integrate into clinical practice medication adherence strategies to optimize HCV treatment
Deploy risk reduction efforts in patients with HCV and concomitant depression or substance use

Reference:

http://www.who.int/hepatitis/publications/hep-elimination-by-2030-brief/en/

Disclosure: This activity is made possible through an independent educational grant from Merck & Co.