PrEParing: PrEP for Providers and Patients

Pre-Exposure Prophylaxis (PrEP) using the antiretroviral medication emtricitibine/tenofovir approved in countries around the world is a highly effective means of reducing transmission of HIV through sexual encounters and needle sharing. This Johns Hopkins University course PrEPares you with essential information, concepts and practical advice regarding PrEP from leaders in the field. A first of its kind learning opportunity, both providers and patients learn from the same experts through content that meets the needs of both audiences, while facilitating the opportunity for a shared community space. Lessons for healthcare workers provide background on foundational and cutting-edge research and PrEP guidelines, how to initiate a PrEP program, clinical management and providing culturally sensitive sexual health and primary care to diverse communities. Lessons for PrEP enthusiasts, PrEP users or the PrEP curious provide information regarding who can benefit from PrEP, how to access services, what to expect and how to stick with your PrEP program long-term. OBJECTIVES: At the conclusion of the session, the participant will be able to: 1. Describe the differences between foundational PrEP studies and demonstration projects 2. Describe the basic pharmacodynamics of tenofovir/emtricitibine including mechanism of infection prevention and time to protective concentration in mucosal tissues 3. List recommendations from PrEP for Prevention of HIV Infection in the United States clinical practice guidelines, USPHS and CDC, including initial and ongoing screening and testing 4. Describe the need for PrEP as an HIV prevention tool for priority in often stigmatized populations 5. Indicate the components for integrating PrEP services into clinical practice 6. Outline guidelines for screening and treatment of sexually transmitted infections 7. Describe how to take a thorough sexual history and to engage with clients around sex in an affirming and non- judgmental manner 8. List the baseline and follow-up laboratory monitoring required 9. Explain key aspects of patient education for HIV prevention and sexual health 10. Describe protocols for ongoing PrEP services and when to discontinue FACULTY/ CREDENTIALS: Jason E. Farley, PhD, MPH, ANP-BC, FAAN, Associate Professor Johns Hopkins University School of Nursing Chris Beyrer, MD, MPH, Professor Johns Hopkins University Bloomberg School of Public Health Yusuf Ariyibi, BA, Disease Intervention Specialist Baltimore City Health Department Joyce Jones, MD, MS, Clinical Associate Johns Hopkins University School of Medicine Neha Sheth Pandit, PharmD, AAHIVP, BCPS, Associate Professor University of Maryland School of Pharmacy Pierre-Cedric Crouch, PhD, ANP-BC, ACRN, Director of Nursing San Francisco AIDS Foundation Renata Arrington Sanders, MD, Assistant Professor Johns Hopkins University School of Medicine Jenell Coleman, MD, MPH, Associate Professor Johns Hopkins University School of Medicine Michele Decker, ScD, MPH, Associate Professor Johns Hopkins University Bloomberg School of Public Health Deborah Dunn, PA-C, MBA, Physician Assistant Chase Brexton Health Care Jordan White, MS, Desmond Tutu Fellow of Public Health and Human Rights Johns Hopkins University Bloomberg School of Public Health Gregory Lucas, MD, PhD, Professor Johns Hopkins University School of Medicine Demetre Daskalakis, MD, MPH, Acting Deputy Commissioner, Division of Disease Control, NYC Dept. of Health and Mental Hygiene David Dowdy, MD, PhD, Associate Professor Johns Hopkins University Bloomberg School of Public Health Jessica LaRicci, PrEP Coordinator Johns Hopkins University School of Nursing Susan Tuddenham, MD, MPH, Assistant Professor Johns Hopkins University School of Medicine Joseph Cofrancesco, MD, MPH, FACP, Associate Professor of Medicine Johns Hopkins University School of Medicine Jill Crank, CRNP, MSN/MPH, Nurse Practitioner Evergreen Healthcare Paul Sacamano, MPH, ANP-BC, ACRN, PrEP Project Lead Johns Hopkins University School of Nursing Shima Ge, BS, PrEP Peer Navigator Johns Hopkins University School of Nursing ORIGINATION DATE October 02, 2017 RENEWAL DATE: November 30, 2019 EXPIRATION DATE: November 30, 2021 URL: https://www.coursera.org/learn/prep/ HARDWARE/SOFTWARE: Computer Hardware; Internet connection; Browser MATERIALS: None TARGET AUDIENCE: physicians, physician assistants, nurse practitioners, registered nurses, pharmacists, health education specialists, public health workers, social workers, case managers PREREQUISITES: None FORMAT: These seminars are enduring video presentations with online discussion forum and resources. CONTACT INFORMATION: Office of The REACH Initiative, Johns Hopkins University School of Nursing (888) 788-7737 ACCREDITATION STATEMENTS: CME activities with Joint Providers: 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 providership of the Centers for Disease Control and Prevention and Johns Hopkins University School of Nursing. The Centers for Disease Control and Prevention is accredited by the (ACCME®) to provide medical education for physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The Centers for Disease Control and Prevention designates this enduring material for a maximum of 10.75 AMA PRA Category 1 Credits™. CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 1.1 CEU's for this program. CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to receive up to 10.5 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 0. CDC provider number 98614. CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 1.05 CEUs in pharmacy education. The Universal Activity Number is 0387-9999-19-191-H01-P. Category: This activity has been designated as Knowledge-Based. Once credit is claimed, an unofficial statement of credit is immediately available on TCEOnline. Official credit will be uploaded within 60 days on the NABP/CPE Monitor. For Certified Public Health Professionals (CPH) The Centers for Disease Control and Prevention is a pre-approved provider of Certified in Public Health (CPH) recertification credits and is authorized to offer 11 CPH recertification credits for this program. DISCLOSURE: In compliance with continuing education requirements, all presenters must disclose any financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use. CDC, our planners, our content experts and their spouses/partners wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters with the exception of Dr. Jason Farley and he wishes to disclose that he received grant from Gilead. Planning committee discussed conflict of interest with Dr. Farley to ensure there is no bias. Content will not include any discussion of the unlabeled use of a product or a product under investigational use with the exception of Dr. Arrington Sander’s discussion of PrEP for adolescents, PrEP is not approved for adolescents < 18 years old; and Dr. Tuddenham’s discussion of STI screening, she will be discussing extra genital screening with NAAT currently recommended by CDC. CDC did not accept commercial support for this continuing education activity. Instructions for Obtaining Continuing Education (CE) In order to receive continuing education (CE) for WD2928- PrEParing: PrEP for Providers and Patients please visit TCEO and follow these 9 Simple Steps before 11/30/2021 Complete the activity Complete the Evaluation at https://tceols.cdc.gov/ Pass the posttest at 80% at https://tceols.cdc.gov/ Email [email protected] once the above is cpmpleted for CE FEES: No fees are charged for CDC’s CE activities.

• Module 1
• In this module, we describe PrEP and the evidence from the formative international studies that led to guidelines in the US and abroad recommending its implementation for HIV prevention. For patients, we discuss the importance of assessing your individual need and readiness to begin PrEP. For providers, we present case studies of implementation projects around the world. Please be sure to follow the link on the right below each video to complete a short speaker evaluation. Thanks!
• Module 2
• In this module, we distinguish PrEP from post-exposure prophylaxis (PEP) and when each is most appropriate. We also review what's in the pipeline for other forms of PrEP medication and modes of delivery. For Providers, we explain the activity of tenofovir/emtricitibine against HIV infection, its general pharmacodynamics and the application of clinical practice guidelines in a community clinic.
• Module 3
• In this module, we review issues related to accessing and navigating the healthcare system that are relevant to priority populations for PrEP, including men who have sex with men (MSM), women, sero-different couples, adolescents, transgender persons, sex workers and persons who inject drugs or experience coercive sex. For patients, content covers self-advocacy and population-focused concerns and resources for PrEP services. For providers, we discuss the need and approach for tailoring PrEP for priority and often under-served communities with cultural humility.
• Module 4
• In this module, we review issues related to accessing PrEP. For providers, we consider how to identify priority populations for PrEP in your service area, discuss the relative costs and outcomes for PrEP as a public health program, key elements of a PrEP business plan and the role of community outreach. For patients, barriers to accessing services are addressed.
• Module 5
• In this module, steps of the first clinic visit are reviewed, including payment for PrEP medication and services, lab work and sexual health assessment. The competencies for performing a thorough and non-judging sexual history, STI screening, and patient education and practical advice to offer clients regarding adherence are discussed.
• Module 6
• In this module, we review considerations for continuing PrEP beyond the first clinic visit, how to think about the quality of PrEP services, and when discontinuation may be appropriate. For patients, topics include medication adherence and risk reduction. For providers, recommendations for management of STIs, screening for and addressing barriers to medication adherence, models of care and case management and clinic retention are reviewed.