BLOCK HIV/HCV

BRINGING LOCAL COMMUNITIES TOGETHER TO ELIMINATE COINFECTION THROUGH KNOWLEDGE & PARTNERSHIPS In collaboration with:

Jointly provided by Postgraduate Institute for Medicine and Integritas Communications.

This activity is supported by independent educational grants from Gilead Sciences, Inc., and AbbVie Inc.

CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

COLLABORATORS

FACULTY

We’d like to thank our local collaborators for their contributions and support.

FACULTY David L. Wyles, MD Course Chair

Chief, Division of Infectious Diseases Denver Health Professor of Medicine University of Colorado School of Medicine Denver, Colorado

Dr. David Wyles earned his medical degree from Northwestern University in Chicago, Illinois, and completed an internal medicine residency and infectious diseases fellowship at the University of Colorado. He is a professor of medicine in the Division of Infectious Diseases at the University of Colorado and Chief of the Division of Infectious Diseases at Denver Health medical center.

Dr. Wyles’ research interests include hepatitis C virus (HCV) drug resistance and retreatment strategies and the treatment of HCV in vulnerable populations. An inaugural and current member of the American Association for the Study of Liver Diseases (AASLD)/ Infectious Diseases Society of America (IDSA) HCV guidelines panel, he also serves on the International Antiviral Society (IAS) – USA Hepatitis Advisory Board and the acquired immunodeficiency syndrome (AIDS) Clinical Trials Group (ACTG) Hepatitis Transformative Science Group. Clinically, Dr. Wyles is involved in the care of patients with HCV and HCV/human immunodeficiency virus (HIV) coinfection.

Stuart C. Gordon, MD, FACP, FACG, AGAF, FAASLD Regional Co-Chair

Professor of Medicine Wayne State University School of Medicine Director, Division of Hepatology Henry Ford Health System Detroit, Michigan Dr. Stuart Gordon is a professor of medicine at Wayne State University School of Medicine and Director, Division of Hepatology at Henry Ford Hospital, both in Detroit, Michigan. He received his training in clinical hepatology at the University of Miami, under Drs. Leon and Eugene Schiff. He has authored or coauthored over 200 papers, and is on the editorial board of Clinical Gastroenterology and Hepatology. Dr. Gordon was the recipient of the Distinguished Alumni Award from Wayne State University School of Medicine and is a Laureate of the Michigan Chapter of the American College of Physicians. He is currently an appointed member of the AASLDIDSA Hepatitis C Guidance Committee. In collaboration with the Centers for Disease Control and Prevention, Dr. Gordon served as the Principal Investigator of the multicenter CHeCS (Chronic Hepatitis Cohort Study), which examined the health burden, natural history, epidemiology, and treatment challenges associated with chronic viral hepatitis in the United States.

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BRINGING LOCAL COMMUNITIES TOGETHER TO ELIMINATE COINFECTION THROUGH KNOWLEDGE AND PARTNERSHIPS

Peter Gulick, DO, FACP, FACOI, FIDSA

FACULTY

Associate Professor of Medicine College of Osteopathic Medicine Internal Medicine Osteopathic Residency Program Director Michigan State University Lansing, Michigan

Dr. Peter Gulick is a professor at the Michigan State University College of Osteopathic Medicine who has developed courses on HIV and hepatitis, teaching medical residents as well as infectious diseases fellows at his clinical sites. He is the Director of HIV/ Hepatitis clinics at the Ingham County Health Department, Central Michigan Department of Community Health, and Great Lakes Community Health Clinics. These 3 Federally Qualified Health Center (FQHC)–sponsored clinics, funded by Ryan White for HIV Care, take care of more than 1000 HIV patients and over 500 hepatitis C and B patients. Dr. Gulick is also the Director of the HIV Registry at Michigan State University, which has data on over 600 HIV patients and is currently doing translational research sponsored by grants from the National Institutes of Health. He is board certified in Internal Medicine, Medical Oncology, and Infectious Diseases and has taken care of patients with HIV for over 30 years and with hepatitis C for 20 years.

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Teresa Juridico, MPH Viral Hepatitis Prevention Coordinator Division of Communicable Diseases Bureau of Infectious Disease Prevention Michigan Department of Public Health and Human Services Lansing, Michigan

Ms. Teresa Juridico is a Viral Hepatitis Prevention Coordinator with the Michigan Department of Health and Human Services’ Division of Communicable Disease. In her role, she coordinates activities to increase hepatitis C testing and linkage to care, and more recently, provides support to the We Treat Hep C Initiative, which aims to eliminate hepatitis C by increasing access to curative hepatitis C treatment. Ms. Juridico has been in her role since 2017 and earned a master of public health degree from Des Moines University in Iowa.

Dr. Stacey Trooskin is Chief Medical Officer and Director of Viral Hepatitis Programs at Philadelphia FIGHT Community Health Centers and a faculty member in the Infectious Diseases Division at the University of Pennsylvania. She received her master of public health from Yale University, New Haven, Connecticut, her doctorate in epidemiology from Rutgers School of Public Health, and her medical degree from the University of Medicine and Dentistry of New Jersey, at the Robert Wood Johnson School of Medicine. Dr. Trooskin specializes in infectious diseases, HIV medicine, HIV/HCV coinfection, and internal medicine. She has an interest in public health, particularly the epidemiology of hepatitis C and identifying and overcoming barriers to testing and treatment. She recently completed a 3-year term of service on the AASLD/IDSA HCV treatment guidance panel and currently serves as the Chief Medical Advisor to the National Viral Hepatitis Roundtable and as a member of the Technical Advisory Board of the Coalition for Global Hepatitis Elimination.

Upon completion of this program, the participant should be better able to: • Describe epidemiologic trends in HCV monoinfection and HIV/ HCV coinfection within at-risk populations, including men who have sex with men (MSM), people who inject drugs (PWID), and incarcerated individuals • Provide guideline-based treatment for HCV monoinfection and HIV/HCV coinfection • Identify patient, provider, and health care system barriers to effective management of HCV monoinfection and HIV/HCV coinfection • Implement strategies to overcome risk-cohort–specific challenges to the treatment of HCV monoinfection and HIV/ HCV coinfection

PROGRAM DESCRIPTION

Eliminating HCV by 2030 will require significant coordination across not only the HCV care cascade, but also across regions and communities.1,2 To advance this strategy, the BLOCK HIV/ HCV initiative presents timely evidence-based content backed by expert input to enhance the participant’s understanding of national and regional epidemiological trends, guideline-based treatment, barriers to effective HCV management, and tactics for overcoming challenges to elimination of HCV monoinfection and HCV in HIV/HCV coinfection.3,4 Interactive workshops will allow small, multidisciplinary groups to brainstorm 5 HCV-related imperatives at the regional level: enhanced education and awareness of HCV at the patient, provider, and community levels; expansion of access to HCV testing and linkage to care; extended outreach to marginalized populations; collaboration in optimizing local and regional resources; and advocacy to promote HCV-care access and equity.5

REFERENCES

1. Department of Health and Human Services (DHHS). National Viral Hepatitis Action Plan 2017–2020. 2017. https://www.hhs.gov/sites/ default/files/National%20Viral%20Hepatitis%20Action%20Plan%20 2017-2020.pdf. Accessed September 16, 2021.

TARGET AUDIENCE

This activity is intended for a multidisciplinary audience including community-based infectious disease specialists and other human immunodeficiency virus (HIV) treaters, gastroenterology/ hepatology clinicians, mental health specialists, substance abuse specialists, correctional health care professionals, public policy/ public health officials, hepatitis C virus (HCV) and HIV advocacy groups, payers, and clinical office staff who are engaged in the care of patients with HIV and/or HCV.

2. Department of Health and Human Services. Mapping HepatitisElimination in Action. Last updated August2021. https://www. hhs.gov/hepatitis/mapping-hepatitis-elimination-in-action/index.html.

Accessed September 16, 2021.

3. Centers for Disease Control and Prevention Hepatitis C. Last reviewed July 2020. https://www.cdc.gov/hepatitis/hcv/index.htm. Accessed September 16, 2021.

4. American Association for the Study of Liver Diseases/Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Last updated March 2021. https://www.hcvguidelines.org/. Accessed September 16, 2021.

5. National Viral Hepatitis Roundtable. Hepatitis C: The State of Medicaid Access. https://stateofhepc.org/. Accessed September 16, 2021.

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FACULTY

Chief Medical Officer Director of Viral Hepatitis Programs Philadelphia FIGHT Philadelphia, Pennsylvania

EDUCATIONAL OBJECTIVES

PREAMBLE

Stacey B. Trooskin, MD, PhD, MPH

BRINGING LOCAL COMMUNITIES TOGETHER TO ELIMINATE COINFECTION THROUGH KNOWLEDGE AND PARTNERSHIPS

PREAMBLE

AGENDA 8:00 am – 8:30 am

REGISTRATION AND BREAKFAST

8:30 am – 8:45 am

Overview and Preactivity Polling David L. Wyles, MD

8:45 am – 9:25 am

The Epidemiologic Imperative for HCV Elimination: Local and Regional Challenges Teresa Juridico, MPH

9:25 am – 10:05 am

Populations in Greatest Need – People Who Inject Drugs (PWID) Stacey Trooskin, MD, PhD, MPH

10:05 am – 10:30 am

Populations in Greatest Need – HIV/HCV Coinfection in MSM David L. Wyles, MD

10:30 am – 10:45 am

BREAK & NETWORKING

10:45 am – 11:15 am

Other Real-World Circumstances – Reaching Rural Patients Peter Gulick, DO, FACP, FACOI, FIDSA

11:15 am – 11:55 am

HCV Therapy Today: What You Need to Know (A Case Study) Stuart C. Gordon, MD, FACP, FACG, AGAF, FAASLD

11:55 am – 12:20 pm

Success Stories – Philadelphia FIGHT Stacey Trooskin, MD, PhD, MPH

12:20 pm – 1:00 pm

LUNCH & NETWORKING

1:00 pm – 1:05 pm

Introduction to Small-Group Workshops: Bringing Together Stakeholders and Creating a Collaborative Plan David L. Wyles, MD

1:05 pm – 1:15 pm

TRANSITION TO WORKSHOPS

1:15 pm – 2:30 pm

Multidisciplinary Small-Group Breakouts: Putting a Plan Into Action

2:30 pm – 2:40 pm

TRANSITION TO GENERAL SESSION

2:40 pm – 2:55 pm

Postactivity Polling David L. Wyles, MD

2:55 pm – 3:45 pm

Panel Discussion and Q&A: The Call to Action and Beyond Moderator: David L. Wyles, MD

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Integritas Communications. Postgraduate Institute for Medicine 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 health care team.

Physician Continuing Medical Education

The Postgraduate Institute for Medicine designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Continuing Pharmacy Education

Postgraduate Institute for Medicine designates this continuing education activity for 6.5 contact hours (0.65 CEUs) of the Accreditation Council for Pharmacy Education. (Universal Activity Number—JA4008162-9999-21-2650-L05-P) Type of Activity: Application Pharmacists have up to 30 days to complete the evaluation and claim credit for participation so that information can be submitted to CPE Monitor as required. Upon registering and completing the activity evaluation, your transcript information will be sent to the National Association of Boards of Pharmacy CPE Monitor service.

The maximum number of hours awarded for this Continuing Nursing Education activity is 6.5 contact hours. Pharmacotherapy contact hours for Advanced Practice Registered Nurses will be designated on your certificate.

Social Worker Education

As a Jointly Accredited Organization, Postgraduate Institute for Medicine is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit.

Postgraduate Institute for Medicine maintains responsibility for this course. Social workers completing this course receive 6.5 clinical continuing education credits.

Case Manager Education

This program has been pre-approved by the Commission for Case Manager Certification to provide continuing education credit to Certified Case Managers (CCMs).

INSTRUCTIONS TO RECEIVE CREDIT

A statement of credit will be issued only upon receipt of a completed activity evaluation form and will be emailed to you within 3 weeks. You will receive your certificate from CEcertificate@pimed.com. If you have questions regarding the receipt of your emailed certificate, please contact PIM via email at inquiries@pimed.com.

For Pharmacists: Upon receipt of the completed activity evaluation form, credits will be directly uploaded to CPE Monitor within 30 days.

DISCLOSURE OF CONFLICTS OF INTEREST

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of an ineligible company.

The faculty reported the following relevant financial relationships with ineligible entities related to the educational content of this CE activity: David L. Wyles, MD Grants/Research Support: Gilead Sciences, Inc. Stuart C. Gordon, MD, FACP, FACG, AGAF, FAASLD Contracted Research: AbbVie Inc., Gilead Sciences, Inc. Peter Gulick, DO, FACP, FACOI, FIDSA Consulting Fees: Gilead Sciences, Inc. ViiV Healthcare Honoraria: AbbVie Inc., Gilead Sciences, Inc., ViiV Healthcare Teresa Juridico, MPH Nothing to disclose Stacey B. Trooskin, MD, PhD, MPH Grants/Research Support: Gilead Sciences, Inc. Advisory Board Member: Gilead Sciences, Inc. The PIM planners and managers have nothing to disclose. The Integritas Communications planners and managers have nothing to disclose.

DISCLOSURE OF UNLABELED USE

This educational activity may contain discussion of published and/ or investigational uses of agents that are not indicated by the US Food and Drug Administration. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.

Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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Continuing Nursing Education

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» Considerations for Antiretroviral Use in Patients With Coinfections: Hepatitis C Virus/ HIV Coinfection.

US Department of Health and Human Services (DHHS).

Last updated December 2019. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescentarv/26/hcv-hiv

» HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. American Association for the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA), Last updated March 2021. https://www.hcvguidelines.org/

» Final Recommendation Statement. Hepatitis C Virus Infection in Adolescents and Adults: Screening.

US Preventive Services Task Force. March 2020. https://www.uspreventiveservicestaskforce.org/uspstf/ recommendation/hepatitis-c-screening

CLINICAL RESOURCES

» A Guide to Comprehensive Hepatitis C Counseling and Testing.

Centers for Disease Control and Prevention (CDC). https://www.aafp.org/dam/AAFP/documents/patient_care/nrn/ hepc-counselingandtesting-publichealth.pdf

» Harm Reduction Michigan. https://harmreductionmi.org/

» Henry Ford Health System Hepatitis C Clinical Consult Program. https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_ 2976_94001_105637_106443---,00.html

» Hepatitis C Online Tools and Calculators: APRI. Hepatitis C Online: University of Washington. https://www.hepatitisc.uw.edu/page/clinical-calculators/apri

» Hepatitis C Online Tools and Calculators: FIB-4.

Hepatitis C Online: University of Washington. https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4

» HEP Drug Interactions.

University of Liverpool. https://www.hep-druginteractions.org/

» Maternal Infant Health Program.

Michigan Department of Health and Human Services (MDHHS). https://www.michigan.gov/mihp/

» National Harm Reduction Coalition. http://harmreduction.org/

» PREP-C: Psychosocial Readiness Evaluation and Preparation for Hepatitis C Treatment.

Mount Sinai School of Medicine. https://prepc.org/

» Rural Health Information Hub. https://www.ruralhealthinfo.org/

LOCAL PROVIDERS AND RESOURCES » Great Lakes Bay Health Centers (GLBHC).

With 32 locations throughout the Great Lakes Bay region and beyond, GLBHC provide comprehensive health care to individuals and communities, especially those who are underserved, uninsured, or underinsured. https://greatlakesbayhealthcenters.org/

» Lansing Area AIDS Network (LAAN).

LAAN is dedicated to the delivery of services and programs designed to meet the needs of those living with HIV/AIDS and to help prevent the further spread of the virus. http://www.laanonline.org/

ACTION AND ADVOCACY: NATIONAL RESOURCES

» Center for Health Law and Policy Innovation (CHLPI).

CHLPI advocates for legal, regulatory, and policy reforms to improve the health of underserved populations. It has played a pivotal role in removing Medicaid restrictions on HCV treatment. https://www.chlpi.org/

» Hepatitis Education Project (HEP).

HEP provides support, education, advocacy, and direct services for people affected by hepatitis, and works to raise hepatitis awareness among patients, medical providers, and the general public. http://hepeducation.org/

» National Hepatitis Corrections Network (NHCN).

NHCN, managed by HEP, supports a public health approach to hepatitis education, prevention, testing, and treatment in prisons and jails. http://www.hcvinprison.org/ 55

RESOURCE CENTER

CLINICAL PRACTICE GUIDELINES

BRINGING LOCAL COMMUNITIES TOGETHER TO ELIMINATE COINFECTION THROUGH KNOWLEDGE AND PARTNERSHIPS

» National Viral Hepatitis Roundtable.

National Viral Hepatitis Roundtable (NVHR) is a coalition working together to eliminate hepatitis B and C in the U.S. It offers practical online resources for practice management. https://nvhr.org/

» Substance Abuse and Mental Health Services Administration (SAMHSA): Locator Map. SAMHSA provides an interactive national map that facilitates identification of local resources and services for substance use and mental health disorders. https://findtreatment.samhsa.gov/

PATIENT RESOURCES

» BodyPro — Project Inform.

Project Inform promotes the development of effective HIV and HCV therapies; supports patients’ informed choices about their health; advocates for quality, affordable health care; and addresses medical strategies that prevent new infections. https://www.thebodypro.com/author/project-inform

» Harm Reduction Michigan. https://harmreductionmi.org/

» Hepatitis C Information Center.

The American Liver Foundation’s Hepatitis C Information Center website is a dedicated online information and resource center created in support of individuals impacted

by HCV infection. https://liverfoundation.org/for-patients/about-the-liver/ diseases-of-the-liver/hepatitis-c/

» HepatitisC.net.

HepatitisC.net is a website for people living with HCV that offers education, tools, and resources. Articles are written by people living with or cured of HCV, patient advocates, and medical providers. https://hepatitisc.net/

» Hepatitis C Questions and Answers for the Public.

Centers for Disease Control and Prevention (CDC). Last reviewed July 2020. The CDC is a division within the US Department of Health and Human Services (DHHS), the principal agency for protecting the health of all Americans.

This patient-directed website addresses basics across the HCV clinical continuum. https://www.cdc.gov/hepatitis/hcv/cfaq.htm

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SUGGESTED READING

» Rural risk environments for hepatitis C among young adults in Appalachian Kentucky.

Cloud DH, et al. Int J Drug Policy. 2019;72:47-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335461/

» Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/ velpatasvir for the treatment of hepatitis C. Havens JR, et al. BMJ Open. 2021;11:e041490. https://bmjopen.bmj.com/content/bmjopen/11/7/e041490.full.pdf.

» Changing epidemiology, implications, and recommendations for hepatitis C in women of childbearing age and during pregnancy.

Kushner T, Reau N. J Hepatol. 2021;74(3):734-741. https://www.journal-of-hepatology.eu/action/ showPdf?pii=S0168-8278%2820%2933814-9

» Hepatitis C testing among perinatally exposed infants.

Lopata SM, et al. Pediatrics. 2020;145(3):e20192482. https://pediatrics.aappublications.org/content/pediatrics/145/3/ e20192482.full.pdf

» Barriers and facilitators to engaging in hepatitis C management and DAA therapy among general practitioners and drug and alcohol specialists— the practitioner experience.

Marshall AD, et al. Drug Alcohol Depend. 2020;206:107705. https://pubmed.ncbi.nlm.nih.gov/31718924/

» Incidence of HCV reinfection among HIVpositive MSM and its association with sexual risk behavior: a longitudinal analysis.

Newsum AM, et al. Clin Infect Dis. 2020.

Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32459339/

» Injection drug use, HIV/HCV, and related services in nonurban areas of the United States: a systematic review Paquette CE, Pollini RA. Drug Alcohol Depend.

2018;188:239-250. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999584/

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