NURSE LED PrEPMODEL IN A COMMUNITY HEALTH CENTER Progress Remains - PowerPoint PPT Presentation

NURSE –LED PrEPMODEL IN A COMMUNITY HEALTH CENTER

Progress Remains Uneven in Reducing New HIV Infections Estimated HIV Incidence Among MSM a , New HIV Infections by Age, United States, 2008–2014 in the United States, 2014 12,000 Heterosexuals Age range: 23% 8,600 infections 25–34 10,000 (36% decline since 2008) 37,600 8,000 13–24 People who inject drugs New HIV 1,700 infections 6,000 5% (56% decline since 2008) Infections 35–44 3% 4,000 in 2014 45–54 MSM who inject drugs 2,000 70% 1,100 infections ≥55 0 MSM 2008 2009 2010 2011 2012 2013 2014 26,200 infections (Stable since 2008) • Estimated annual HIV infections declined 18% in the US from 2008 to 2014 • MSM were the only group that did not experience an overall decline from 2008 to 2014 MSM, men who have sex with men. a. Adjusted for missing risk factor information. Singh S, et al. CROI 2017. Seattle, WA. #30. Adapted from CDC at https://www.cdc.gov/nchhstp/newsroom /docs/factsheets/hiv ‐ incidence ‐ fact ‐ sheet_508.pdf . Accessed April 2017.

HIV Prevalence in Certain Populations in the United States Is Higher Than in Some Nations With High Prevalence of HIV 1,2 3 United States 0.4 3 Washington, DC 2.5 3 Washington, DC (blacks) 3.9 4 Washington, DC (black men) 5.8 4 New Orleans, LA 1 5 New Orleans, LA (blacks) 1.5 5 New York City, NY 1.3 New York City, NY (blacks) 2.6 6 6 Brazil 0.6 6 Burundi 1.2 6 Thailand 1.2 6 Rwanda 3 6 Nigeria 3.2 6 Kenya 6 South Africa 18.9 0 5 10 15 20 Prevalence (%) 1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol. 26. http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2015. Accessed April 2017; 2. U.S. Census Bureau. Population estimates. http://www.census.gov/programs ‐ surveys/popest/data/data ‐ sets.2013.html. Accessed April 2017; 3. Annual Epidemiology and Surveillance Reports for the District of Columbia. HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) Annual Report 2014; 4. AIDSVu. https://aidsvu.org/state/louisiana/new ‐ orleans/. Accessed April 2017; 5. AIDSVu. https://aidsvu.org/state/new ‐ york/new ‐ york ‐ city/. Accessed April 2017; 6. Prevalence of HIV, World Bank Group. http://data.worldbank.org/indicator/SH.DYN.AIDS.ZS. Accessed April 2017.

Lifetime Risk of HIV Diagnosis Lifetime Risk of Lifetime Risk of HIV Diagnosis Among HIV Diagnosis by Race/Ethnicity MSM by Race/Ethnicity African- 1 in 20 American Men 1 in 6 Total MSM African-American 1 in 48 Women African- 1 in 2 Hispanic Men 1 in 48 American MSM Hispanic Women 1 in 227 1 in 4 Hispanic MSM White Men 1 in 132 White MSM 1 in 11 White Women 1 in 880 • The overall lifetime risk of HIV in the United States is 1 in 99 • African-American men have highest lifetime risk of HIV of all races and ethnicities (1 in 20) • African-American MSM (1 in 2) and Hispanic MSM (1 in 4) have even higher lifetime risk of HIV

What is PrEP? One Pill Once-A-Day • Pr E P

PrEP: Safe & Effective to Reduce Risk of HIV Acquisition in Adults

PrEP Guideline Highlights

The Risks • Men who have sex with men (MSM) • Injection drug users (IDU) -HIV positive injecting partner -Sharing injection equipment -Recent drug treatment (but currently injecting) • Heterosexual women & men

The Setting On site pharmacy, lab, x-ray, mammogram, primary care, ob/gyn, BH/SA, WIC, eye care, dental, MIHP, rheumatology, HCV services, & many more

The Departments Involved in PrEP

Nurse Leader: HIV Clinical Nurse Manager

Registered Nurses:

Patient Section

Nurse Practitioner: High Quality, Cost ‐ Effective Health Care

Provider Checklist for Initiating PrEP (US Public Health Service PrEP for the Prevention of HIV Infection in the US, 2014)

PrEP & PEP Billing Codes ICD-10= Z20.6, Z20.2, Z20.828, Z20.89, Z20.9 ICD-10= Z72.51, Z72.52, Z72.53 ICD-10= Z77.21, Z77.9 ICD-10= W46.0XXA, W46.0XXD, W46.1XXA, W46.1XXD ICD-10= Z79.899 99401 99402 99403 99404

PrEP Guidelines & Resources: UCSF Clinician Consultation Center (2016)