Conversations with Clinical Education Initiative (CEI) features clinical experts in HIV Primary Care and Prevention, Sexual Health, Hepatitis C and Drug User Health. Our episodes feature CEI clinicians’ experience and insight on the current health issues, alongside the latest news and guidelines on our areas of expertise.
This podcast is produced by the CEI, a New York State Department of Health AIDS Institute program.
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PrEParing for Lenacapavir Implementation in Your Clinic: Early Lessons Learned (00:28:23)
On June 18, 2025, the FDA approved Yeztugo, the brand name for subcutaneous lenacapavir, a prescription medication used for the pre-exposure prophylaxis of HIV. Subcutaneous lenacapavir is administered twice a year (every six months) to reduce the risk of sexually acquired HIV-1 infection in adults and adolescents at risk. With patients only needing lenacapavir twice a year for HIV prevention, the field has been optimistic about the potential for lenacapavir to reduce barriers and improve access to PrEP. Since we are still early in the rollout subcutaneous lenacapavir, many providers have questions about how to offer it to their patients—from workflow to billing to managing potential side effects and drug-drug interactions.
On this episode, Antonio Urbina, MD, Medical Director for CEI’s HIV Primary Care and Prevention Center of Excellence, speaks with Alex Danforth, PharmD. Alex Danforth is a clinical pharmacist in Rochester, NY. She practices at Trillium Health, a federally qualified health center, where she works with patients and providers to help manage medications and optimize care. Alex currently provides clinical leadership for HIV treatment and prevention programs.
Drs. Urbina and Danforth talk about the latest New York State Clinical Guidelines for PrEP, which were updated on October 16th. The new guidelines provide important updates, including subcutaneous lenacapavir. They discuss important considerations for initiating patients on lenacapavir as well as some early lessons learned from implementing lenacapavir in their Rochester- and New York City-based clinics. Related Content:
PrEP to Prevent HIV and Promote Sexual Health
University of Liverpool HIV Drug Interactions Checker (website and app)
CEI Line: 1-866-637-2342
https://ceitraining.org/
Keeping an Eye on STIs – Have You Heard of TMVII? (00:18:04)
This month, host Dr. Marguerite Urban chats with Dr. Jason Zucker, an adult and pediatric infectious diseases physician at Columbia University and the assistant medical director of the New York City HIV/STI Prevention Training Center, about an emerging fungal infection, Trichophyton mentagrophytes Genotype VII, also known as TMVII. Curious about what clinicians should know about TMVII? Listen now to learn more! Related Content:
CEI Line: 1-866-637-2342
www.ceitraining.org
www.hivguidelines.org
“Notes from the Field: Trichophyton mentagrophytes Genotype VII – New York City, April – July 2024” - https://www.cdc.gov/mmwr/volumes/73/wr/mm7343a5.htm
Emerging Sexual Transmission of Trichophyton mentagrophytes Genotype VII Infections, United States - https://wwwnc.cdc.gov/eid/article/31/10/25-1056_article
Information for Healthcare Providers: Emerging Ringworm - https://www.cdc.gov/ringworm/hcp/clinician-brief-resistant-infections/index.html
Recap of the 2025 Annual New York State Hepatitis C and Drug User Health Conference (00:27:28)
On September 9th, CEI hosted its first in-person conference dedicated to hepatitis C and drug user health. A
group of New York State-based clinicians met in Catskill for a full day agenda focused on (1) integrating
wellness into clinical practice as a way to improve patient care and outcomes, and (2) innovative decision-
making frameworks to help clinicians navigate complex scenarios in the absence of strong formal evidence,
like clinical guidelines and peer reviewed studies.
This episode of “Conversations with CEI” features conference planner and facilitator Taylor Edelmann – an
educator and consultant working at the intersection of LGBTQIA+ health, drug user health and harm
reduction – sharing his experience and insights about the day. Taylor currently oversees the Lighthouse
Learning Collective at the National Harm Reduction Coalition, a program focused on supporting
LGBTQIA+ harm reductionists and people who use drugs and engage in sex work. As one of the first openly
transgender NCAA athletes, Taylor brings a deeply personal lens to his work advocating for gender-affirming
care. He regularly provides clinical education and technical assistance to providers across the country,
including Yale University and one of Connecticut’s largest federally qualified health centers, and recently
presented at the 2025 Harm Reduction International Conference in Bogotá, Colombia. Taylor is also the co-
creator of ChemSex Awareness Week, and the lead author of Gender Affirming Harm Reduction: A Toolkit
for Syringe Service Programs, the first resource of its kind developed specifically for social service providers
in harm reduction settings. Related Content:
2025 Annual NYS Hepatitis C and Drug User Health conference website: https://ceitraining.org/conference/conferences/3
Lighthouse Learning Collective at the National Harm Reduction Coalition: https://harmreduction.org/our-work/action/lighthouse-learning-collective/
Gender Affirming Harm Reduction: A Toolkit for Syringe Service Programs: https://lighthousetoolkit.my.canva.site/
Narrative Medicine: https://www.aamc.org/news/narrative-medicine-every-patient-has-story
Drug, Set, and Setting: The Basis for Controlled Intoxicant Use: https://southwestrecoveryalliance.org/wp-content/uploads/2020/02/Drug-Set-and-Setting-Zinberg-N-1.pdf
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.
ceitraining.org
Insights from the 13th International AIDS Society Conference on HIV Science (00:16:30)
In this episode of Conversations with CEI, Dr. Steven Fine unpacks some of the latest developments and research presented at the 2025 International AIDS Society (IAS) Conference on HIV Science, held in Kigali, Rwanda. From innovative treatment strategies to advancements in prevention and global health equity, Dr. Fine highlights the pivotal discussions and groundbreaking studies that are shaping the future of HIV care. Tune in to gain a deeper understanding of the strides being made in the fight against HIV and the collaborative efforts driving progress on a global scale. Related Content:
The International AIDS Society (IAS) https://www.iasociety.org/conferences/ias2025 Official site for the IAS 2025, 13th IAS Conference on HIV Science, held in Kigali, Rwanda, from July 14-17, 2025.
https://www.iasociety.org/blog/takeaways-ias-2025 Takaways from the IAS 2025 Conference
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.
www.ceitraining.org
Evolving Landscape of Geriatric HIV Care (00:27:19)
The demographics of HIV care are rapidly changing, and with them, the clinical needs of patients aging with HIV. In this episode, host Dr. Tony Urbina, Medical Director for CEI's HIV Primary Care and Prevention Center of Excellence, sits down with geriatrician Dr. Angela Condo to explore the unique intersection of geriatric medicine and HIV care.
Dr. Angela Condo is a board-certified internist and geriatrician at Mount Sinai's Icahn School of Medicine, where she established the Comprehensive Program of Integrated Care for Older Adults with HIV at the Peter Krueger Clinic. With initial support from the Keith Herring Foundation and additional HRSA funding through the Aging with HIV initiative, her interdisciplinary program has been serving patients for five years using an innovative embedded consultation model. Related Content:
NYS DOH AI Guidance on Addressing the Needs of Older Patients in HIV Care: https://www.hivguidelines.org/guideline/hiv-aging/
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.
ceitraining.org
Highlights and Perspectives from the 11th Annual NYS Sexual Health Conference (00:16:36)
Live from Canandaigua…it’s the 11th Annual NYS Sexual Health Conference!
The CEI Sexual Health Center of Excellence hosted the 11th Annual NYS Sexual Health Conference in-person on Friday May 2, 2025, in beautiful Canandaigua, NY. This was the Center’s second in-person conference since the COVID-19 pandemic and was the Center’s largest in-person event held to-date, bringing together over 225 clinicians and public health professionals from across NYS (and beyond!).
In this episode, host Juhua Wu, Director of the University of Rochester Center for Community Practice and team member of the CEI Sexual Health Center of Excellence, checks in live from the conference with four presenters about their experience at the conference, perspectives on what they learned from other sessions, and “need to know” highlights from their own presentations. Join Juhua, along with Rachel Hart-Malloy, PhD, MPH, Brenda Tesini, MD, Michael Brennan, DNP, FNP, and Jeremy Kidd, MD, MPH, for a real-time review of the conference! Related Content:
STI Dashboard New York: https://www.stidashboardny.org/
Chemsex: Questions and Answers: https://www.suguidelinesnys.org/guideline/chemsex/
New York State Department of Health, Healthy Sex campaign: https://campaigns.health.ny.gov/SexualHealth
University of Rochester Center for Community Practice: www.urccp.org
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.
ceitraining.org
Xylazine & Medetomidine & Nitazines, Oh My! An Update on New York State’s Drug Supply (00:29:38)
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:
New York State Department of Health AIDS Institute Clinical Guidelines Program for Substance Use Care: https://www.suguidelinesnys.org/
New York State Department of Health Drug Checking Program: https://www.health.ny.gov/diseases/aids/consumers/prevention/oduh/drug_checking.htm
New York City Department of Health Drug Checking Program: https://www.nyc.gov/site/doh/health/health-topics/alcohol-and-drug-use-services.page
New York City Department of Health. Setting Up a Drug-checking Program: A Comprehensive Guide to Implementation. https://www.nyc.gov/assets/doh/downloads/pdf/basas/drug-checking-program-implementation-guide.pdf
https://legislativeanalysis.org/wp-content/uploads/2025/03/BTMPS-Fact-Sheet-FINAL.pdf
Friedman, JR, et al. (2025) The detection of xylazine in Tijuana, Mexico: Triangulating drug checking and clinical urine testing data. J Addict Med. doi: 10.1097/ADM.0000000000001474
Krotulski, AJ, et al. (2024) Medetomidine Rapidly Proliferating Across USA — Implicated In Recreational Opioid Drug Supply & Causing Overdose Outbreaks, Center for Forensic Science Research and Education, United States. Available from https://www.cfsre.org/images/content/reports/public_alerts/Public_Alert_Medetomidine_052024.pdf
New York Medication for Addiction Treatment and Electronic Referrals (MATTERS) Program. Request test strips (for xylazine and fentanyl). Available from: https://mattersnetwork.org/request-test-strips/
New York State Office of Addiction Services and Supports (OASAS). Harm Reduction Delivered (online order for xylazine and fentanyl test strips). Available from: https://oasas.ny.gov/harm-reduction-delivered
NEXT Distro. Ordering Supplies (for safer drug use). Available from: https://nextdistro.org/nydistro
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.
ceitraining.org
CEI…we got you! Evolving with the Science (00:38:16)
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.
ceitraining.org
Navigating Measles Vaccine Recommendations for Patients with HIV (00:20:06)
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.
ceitraining.org
The Invisible Latino HIV Crisis (00:21:40)
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:
CEI Line: 1-866-637-2342
ceitraining.org
Updates in Syphilis: Looking Back to Look Forward (00:34:19)
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:
CDC’s Sexually Transmitted Infections Surveillance, 2023: https://www.cdc.gov/sti-statistics/annual/index.html
The Resurgence of Congenital Syphilis in NYS: A Look at the Past and Present to Change the Future: https://cei.podbean.com/e/the-resurgence-of-congenital-syphilis-in-nys-a-look-at-the-past-and-present-to-change-the-future/
Reflections from the 2024 CDC STI Prevention Conference: https://cei.podbean.com/e/reflections-from-the-2024-cdc-sti-prevention-conference/
CEI Line: 1-866-637-2342
ceitraining.org
The Role of Opioid Treatment Programs in Hepatitis C Care: A Path to Elimination (00:20:58)
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:
CEI Training “Hepatitis C and Injection Drug Use” - https://ceitraining.org/courses/1148
VOCAL-NY: https://www.vocal-ny.org/
Respectful, Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai: https://www.mountsinai.org/care/primary-care/upper-east-side/ima/reach
New York State Department of Health AIDS Institute guideline for the treatment of chronic hepatitis C virus infection in Adults: https://www.hivguidelines.org/hepatitis-care/hcv-treatment/
Taylor, LE. (2020), Colocalization in Hepatitis C Virus Infection Care: The Role of Opioid Agonist Therapy Clinics. Clinical Liver Disease, 16:12-15. https://doi.org/10.1002/cld.921
Addiction Technology Transfer Center Guide to Integrating HCV Services into Opioid Treatment Programs: https://attcnetwork.org/sites/default/files/2020-07/Guide%20to%20Integrating%20HCV%20Services%20into%20Opioid%20Treatment%20-%20July%2024-1.pdf
New York State Hepatitis C Elimination Plan: https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hepatitis_c_elimination_plan.pdf
New York State Hepatitis C Dashboard: https://hcvdashboardny.org/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/
Use of Injectable Cabotegravir for HIV PrEP in Pregnancy (00:09:28)
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:
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/
Compassionate Care for LGBTQ+ Individuals Struggling with Substance Use Disorder (00:28:22)
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:
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/
Reflections from the 2024 CDC STI Prevention Conference (00:22:11)
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:
CDC STI Prevention Conference 2024 website: https://stipreventionconference.org/
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/
The Case for Chronic Pain Management among People Who Use Opioids (00:46:50)
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/
An Exciting New Twice-yearly Option for HIV PrEP (00:13:35)
“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 Results (00:29:08)
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:
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/
It’s Complicated…but Necessary! Navigating Confidential Sexual Healthcare for Adolescents (00:22:05)
“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:
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/
Special Conversations with CEI: Best Practices for Hepatitis C and Pregnancy Screening: Advice from a Fellow Clinician (00:34:45)
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:
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/
Special Conversations with CEI: Best Practices for Working with People Who Use Substances (00:30:04)
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:
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.hivguidelines.org/substance-use/sud-treatment-pregnancy/
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/
Special Conversations with CEI: The Impact of Hepatitis C Screening during Pregnancy: A Client’s Story (00:36:45)
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:
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.hivguidelines.org/substance-use/sud-treatment-pregnancy/
American Association for The Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) Recommendations for Testing, Managing and Treating Hepatitis C: https://www.hcvguidelines.org/
The American College of Obstetricians and Gynecologists Clinical Practice Guidelines for Viral Hepatitis in Pregnancy: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/09/viral-hepatitis-in-pregnancy
US Centers for Disease Control and Prevention (CDC) Recommendations for Hepatitis C Testing among Perinatally Exposed Infants and Children (2023): https://www.cdc.gov/mmwr/volumes/72/rr/rr7204a1.htm?s_cid=rr7204a1_e&ACSTrackingID=USCDC_921-DM116215&ACSTrackingLabel=MMWR%20Recommendations%20and%20Reports%20%E2%80%93%20Vol.%2072%2C%20November%203%2C%202023&deliveryName=USCDC_921-DM116215
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/
Would you consider Injectable ART for those unable to suppress with oral HIV treatment? (00:14:49)
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 Population (00:23:43)
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:
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/
Doxy-PEP Part II: Where Are We Now? (00:17:25)
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:
“Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women” - https://www.nejm.org/doi/full/10.1056/NEJMoa2304007?query=featured_home
https://www.hivguidelines.org/guideline/sti-doxy-pep/?mycollection=sexual-health
https://www.cdc.gov/nchhstp/newsroom/2022/Doxy-PEP-clinical-data-presented-at-2022-AIDS-Conference.html
CEI toll free line for NYS providers: 866-637-2342
https://ceitraining.org/
