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
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 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
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 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™.
