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
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, MPA, LLM, 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™.
