MATEC-WI Newsletter | January 2021

Disproportionate Rates of COVID-19 Infection, Hospitalization, and Mortality Amongst Black and Hispanic Populations

Two recent community-level studies on COVID-19 infection, hospitalization, and mortality rates amongst Black and Hispanic populations have found that these populations are disproportionately affected by COVID-19. Both studies suggest “a constellation of community, system, and individual factors,” which are “pervasive in Black and Hispanic communities” likely lead to amplified health inequalities.

One recent study by Ogedegbe, Ravenell, Adhikari, et al. was published in December 2020 by the Journal of the American Medical Association (JAMA). This study assessed over 9700 patients within the New York University Langone Health System, in New York City, to determine whether outcomes among patients with COVID-19 differ by race/ethnicity. The authors found that “Black and Hispanic patients were more likely than White patients to test positive for COVID-19,” with 56% of Black, non-Hispanic patients and 60% of Hispanic patients testing positive. However, while Black patients were more likely to test positive for COVID-19, the authors found that “after hospitalization, [Black patients] had lower mortality.” The authors suggest that the higher likelihood of testing positive for COVID-19 may be due to “pervasive social inequalities … in Black and Hispanic communities” and that the higher mortality noted in Black populations “could largely be attributed to higher out-of-hospital deaths.”

Another study conducted by Podweils, Burket, Mettenbrink, et al., was published by the CDC in the Morbidity and Mortality Weekly Report (MMWR) in December 2020 as well. This study analyzed the racial and ethnic disparities of COVID-19 at a community level in Denver, Colorado. The authors found that during the first 7 months of the COVID-19 epidemic in Denver, “the majority of adult COVID-19 cases (55%), hospitalizations (62%), and deaths (51%) were among Hispanic adults.” In particular, the authors noted that this was “double the proportion of Hispanic adults in Denver (24.9%).” The authors also found that among adults with COVID-19, Hispanic persons reported “more known COVID-19 household exposure, working in essential industries, working while ill, and delays in testing after symptom onset.”

In both studies, the authors concluded that these data supported the assertion that “a constellation of community, system, and individuals factors, including systemic discrimination,” which are “pervasive in Black and Hispanic communities” likely lead to amplified health inequalities. These studies encourage public health and clinical health systems to address structural inequalities, in order to improve COVID-19 outcomes amongst Black and Hispanic populations.

Additional COVID Resources

• IDSA has released new recommendations on the use of baricitinib in hospitalized patients with COVID-19 and an updated literature review on hydroxychloroquine for the Treatment & Management of Patients with COVID-19. Recommendations include: 1.) Among hospitalized patients with severe COVID-19 who cannot receive corticosteroids because of a contraindication, the IDSA guideline panel suggests use of baricitinib with remdesivir rather than remdesivir alone. 2.) Among hospitalized patients with COVID-19, the IDSA guideline panel recommends treatment with baricitinib plus remdesivir plus corticosteroids only in the context of a clinical trial.
• Wisconsin’s Vaccine Rollout Plan: The first shipments of COVID-19 vaccines arrived in Wisconsin on Monday, December 14, 2020. The Deputy Secretary of the Wisconsin Department of Health Services (WI DHS) stated about phase 1a, “We’ll be giving vaccine [sic] to community providers to administer to healthcare workers and to people living in long-term care.” The Deputy Secretary also indicated that Wisconsin’s progression to vaccinations for group 1b will not happen until later this winter or early spring. For more information on WI’s vaccination rollout plan, visit the WI DHS’s “COVID-19 Vaccine: What You Need to Know” webpage.
• For more on the diagnosis of COVID-19, IDSA has released evidence-based guidelines on molecular diagnostic testing for SARS-CoV-2. These are guidelines to assist clinicians, laboratorians, patients and policymakers on the optimal use of SARS-CoV-2 nucleic acid amplification tests.
• For information and tips on what language and messaging effectively informs hesitant groups de Beaumont has conducted a nationwide poll, “The Language of Vaccine Acceptance,” and has provided highlights of the information revealed and created a communication cheat sheet.
• For HIV self-testing and tele-testing resources, check out Denver Protection Training Center’s Clinical Protocols. The Denver PTC provides HIV self-testing and tele-testing clinical protocol materials from across the nation to support clinicians and patients during these complicated times.
• The HHS Panel on Treatment of Pregnant Women with HIV Infection & Prevention of Perinatal Transmission has announced updated recommended guidelines on the use of antiretroviral (ART) drugs in pregnant women with HIV and interventions to reduce perinatal HIV transmission in the U.S.

Generic Truvada (TDF/FTC) Released in the U.S. Market, Increasing Access to PrEP 

Teva, Amneal, Aurobindo, and Zydus Pharmaceuticals introduced cheaper generic versions of Truvada (TDF/FTC) to the U.S. market in October 2020. Teva Pharmaceuticals released their generic version of Truvada (TDF/FTC) in the United States on October, 2 2020. By October 21, 2020, three other pharmaceutical companies, Amneal, Aurobindo, and Zydus Pharmaceuticals, released generic versions of Truvada (TDF/FTC) as well. By October 14, the wholesale acquisition cost of Teva’s generic TDF/FTC was $48.51 per pill, 21 percent cheaper than brand-name TDF/FTC. NASTAD anticipated that prices would again fall as the other generic TDF/FTC versions reached the market.

In addition, starting in January 2021, most private insurance plans must provide $0 cost-sharing for at least one PrEP product, as mandated by the Affordable Care Act. This means most patients should not need copay assistance programs. For those who do, Teva has announced a copay savings card/coupon for PrEP for up to $600 for 6 months, and the federal Ready, Set, PrEP program will continue to help make PrEP medication available at no cost to individuals who lack prescription drug coverage.

As a result of this ACA mandate becoming effective and the introduction of cheaper generic TDF/FTC medications with AB bioequivalence, insurance companies have begun to shift their coverage of PrEP from expensive brand names to these more generic versions. As such, insurers have been updating their customers of any changes to their coverage, which has resulted in some confusion and concern from those taking PrEP.

Moreover, these changes in coverage impact billing codes many health professionals use when billing for PrEP, HIV screenings, and linkage services. NASTAD has also developed a Billing Code Guide for HIV Prevention.

Interprofessional Course Prepares Students to Provide Team-Based HIV Care

As the COVID-19 outbreak morphed into a pandemic and fear and misinformation follow closely, it can be difficult to remember when the AIDS epidemic began 40 years ago, and those same forces traumatized a community already reeling from the tragic deaths of so many of its members. However, for students who took the University of Wisconsin-Madison’s Interprofessional Collaborative Practice (ICP) in HIV Care course last spring, “the current public health crisis offers a unique lens with which to approach their training.”

Now in its fifth year, the ICP course will meet virtually during the spring semester, with the first of six synchronous class meetings on February 1, 2021. Students will again have the opportunity learn team-based care through both asynchronous and synchronous learning, providing a unique perspective to the ongoing HIV epidemic with comparisons to the current COVID-19 health crisis.

Read more about MATEC-WI’s team-based ICP in HIV Care course.

Expanding the HIV Primary Care Workforce in Wisconsin through MATEC’s Clinician Scholars Program

MATEC-WI’s HIV Clinician Scholars Program is an intensive, year-long training program that seeks to strengthen the HIV workforce in the United States’ Midwest by focusing on HIV treatment, care and prevention. Current and graduating Clinician Scholars have a lasting impact on HIV care in Wisconsin, gaining the knowledge and skills necessary to provide quality, patient-centered HIV care. That is why we would like to congratulate the 2019-2020 Clinician Scholar, Jorge Ramallo, MD, MPH, on successfully completing the Clinician Scholars Program and give a warm welcome to Michael Potnek, DNP, who recently joined the 2020-2021 cohort!

Dr. Jorge Ramallo successfully completed this program with over 136 training and clinical preceptorship hours – and during a pandemic nonetheless. Dr. Ramallo is an internist and pediatrician, and the newly appointed HIV Medical Director at Sixteenth Street Community Health Centers in Milwaukee. He has quickly become an HIV physician champion at the clinic, leading practice transformation efforts to expand HIV testing, same-day start for PrEP, and rapid-start antiretroviral therapy. He credits being part of the Latinx community and speaking Spanish to over 90 percent of the patients he provides care for as a contributing factor to his success.

Dr. Ramallo said about MATEC-WI’s Clinician Scholars Program: “The [program] was a fitting opportunity for me during a time of personal and professional growth in my practice. As a primary care physician, HIV medicine can be intimidating. The MATEC program gently introduced me to this exciting field and provided me with all the resources necessary to start caring for this special patient population. I will be forever thankful for the wonderful program.”

We would also like to welcome Michael Potnek, DNP, as the newest addition to the 2020-2021 cohort! His goal for participating in the Clinician Scholars Program is to provide HIV care to patients who consider Outreach Community Health Centers in Milwaukee their medical home. He has stated, “I am excited to be able to offer my patients a body of specialized knowledge and service through HIV management, a historically scarce resource due to a limited number of providers in my community.”

To offer this specialized knowledge and service, Dr. Potnek will be focusing on increasing his knowledge and capacity to provide HIV care and treatment along the status-neutral continuum, and has said he is looking forward to “forging partnerships and utilizing resources in the HIV treatment community to enhance not only my own personal practice, but also the care available to my patients.”

For more information on how to apply for the Clinician Scholars Program in the future, please email Amanda Wilkins, MATEC-WI Program Director, at awilkins@medicine.wisc.edu.

Community Spotlight: Dr. Ajay Sethi

Ajay Sethi, PhD, MHS is Associate Professor in Population Health Sciences and Faculty Director of the Master of Public Health Program at the University of Wisconsin, School of Medicine and Public Health. Dr. Sethi is an infectious disease epidemiologist who studies the prevention and natural history of HIV, healthcare associated infections, and COVID-19. He incorporates the socio-behavioral sciences into his research.

Dr. Sethi has been recognized for his teaching. In his popular class, Conspiracies in Public Health, he teaches future clinicians and public health practitioners about the psychosocial basis of conspiracy thinking, and the needed skills to have conversations with patients and clients whose views are different from their own. Research has shown that more than half of Americans, including our family members and professional colleagues, adopt and embrace medical conspiracy theories. Since the beginning of the HIV pandemic, prominent scientists, leaders, and average citizens alike have questioned the origin of HIV and its established cause of AIDS. Similarly, people today question the origin, seriousness, and mortality associated with SARS-CoV-2.

In his class, Dr. Sethi teaches the importance of changing societal beliefs and norms “one conversation at a time.” To his community-based and health care colleagues, he offers this advice: “In a society with growing mistrust of others, fortunately most Americans continue to rely on healthcare professionals for medical information, but that trust is at risk of eroding. When talking to patients and clients who are misinformed, avoid the immediate temptation to inject facts into conversations. Correcting misinformation must be preceded by active listening, fortifying trust, and allaying any fears.”

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