MATEC-WI Newsletter | February 2021

New White House Administration Brings New Changes

With a new administration in the White House, new changes are underway and the Biden Administration has hit the ground running. One of Biden’s first actions as President was to sign a plethora of Executive Orders (EOs) to counteract previous EOs the new administration deemed “harmful” to efforts to confront the nation’s urgent challenges. This includes revoking Executive Order 13950, Combatting Race and Sex Stereotyping enacted by President Trump. In addition, President Biden has selected a handful of new candidates for a variety of federal roles. Among these new appointees are esteemed professionals such as Dr. Rochelle Walensky, Andrea Palm, and Dr. Rachel Levine.

Rochelle Walensky, MD, MPH, quickly assumed the role of the Centers for Disease Control and Prevention’s (CDC) director on January 20, 2021. Walensky, an expert on HIV and AIDS, is tasked with “rebuilding a critical health agency that has been sidelined … amid a pandemic.” Walensky has indicated one her top priorities will be to improve communications with the public to restore public trust, a task she has proven herself to be qualified at, as she emerged as a prominent voice on the pandemic. The CDC faces a variety of public health challenges this year, from the ongoing COVID-19 pandemic and the largest-ever vaccine campaign, to the opioid and HIV epidemics. Walensky is already determined to meet the U.S. goal of administering 100 and we look forward to seeing Dr. Walensky’s plans going forward.

Biden nominated Andrea Palm, MSW, as the deputy secretary of HHS. If confirmed, she will be responsible for the operations of the largest civilian department in the federal government and will be dedicated to supporting the health and well-being of the nation. Palm most recently served as Wisconsin Department of Health Services’ Secretary, leading the state’s COVID-19 response. Wisconsin Governor Tony Evers described Palm as “a consummate professional who has done an extraordinary job helping lead our state during an unprecedented health crisis.” Prior to that, she served as Senior Counselor to the Secretary of HHS under President Obama and as the senior advisor at the White House Domestic Policy Council during the implementation of the Affordable Care Act. Senator Tammy Baldwin of Madison (Wisconsin) has said she will support Palm’s latest nomination.

Biden also nominated Rachel Levine, MD, FAAP, as HHS Assistant Secretary for Health. “Dr. Rachel Levine will bring the steady leadership and essential expertise we need to get people though this pandemic… She is a historic and deeply qualified choice to help lead our administration’s health efforts,” Biden stated. Dr. Levine is a physician, as well as a pediatrics and psychiatry professor at Penn State College of Medicine. She has also been leading Pennsylvania’s COVID-19 pandemic response. Additionally, her work has focused on the opioid crisis, eating disorders, and adolescent and LGBTQ medicine. Upon confirmation, Levine would make history as the first openly transgender Senate-confirmed official.

Additional COVID Resources

• Wisconsin DHS has begun moving beyond phase 1b for those eligible for COVID-19 vaccines. Now police and fire personnel, correctional staff, and as of January 25, 2021, all
  

  

  those 65 and older are eligible to receive a vaccine. WI DHS anticipates that the next eligible groups will be able to get vaccinated starting around March 1. Learn more about the DHS’s COVID-19 Vaccine Rollout Plan.

• Wisconsin DHS identified the second case of variant strain B.1.1.7 of SARS-CoV-2 in Wisconsin on February 6, 2021. Read DHS’s press release.
• IDSA has released new guideline recommendations on the use of bamlanivimab among hospitalized patients, and casirivimab/imdevimab among ambulatory patients for treating and managing patients with COVID-19. Read the new guidelines.
• 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.
• CDC has new information available regarding new COVID-19 variants, the federal mandate requiring masks be worn while traveling on public transportation, and the Federal Retail Pharmacy Program for COVID-19 Vaccination. Learn more about some of these highlights.
• CDC designed a toolkit for organizations serving communities affected by COVID-19. The toolkit is to help education organization members about COVID-19 vaccines, raise awareness on the benefits of vaccination, and address common questions and concerns.

HIV Resources

• The NIH released the newest NIH Strategic Plan for HIV and HIV-Related Research. The latest strategic plan for HIV research is a 5-year plan, a transition from the NIH’s long-standing practice of annual strategic plans. Read more about the NIH’s Strategic Plan for HIV and HIV-Related Research.
• HHS also just released the National Strategic Plan, A Roadmap to End the Epidemic for the United States, 2021-2025. The plan focuses on four goals: prevent new HIV infections, improve HIV-related health outcomes of those living with HIV, reduce HIV-related disparities and health inequities, and achieve integrated and coordinated efforts that address the HIV epidemic among all partners and stakeholders. Read more on the HIV National Strategic Plan.
• 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.

Community Spotlight: Elle Hill

A Black woman of trans experience, Elle Hill is the Inclusion Health Program Specialist at the Planned Parenthood of WI, and a subject matter expert in LGBTQIA health, and transgender health, safety, and social disparities. Elle had this to say her colleagues in the HIV care continuum: “Growing up queer and Black, I think we are conditioned to believe that the risk of HIV is inevitable. That notion is a part of the stigma in our community. It impacts our mental health and safety. But HIV is actually passed by people when they don’t know their status at all. We need to debunk stigma on every level and stop associating HIV with queerness. Test people, regularly, and talk to them about PrEP.”

When she began transitioning, Elle found herself in unsafe situations, situations where she felt like her power was being taken away. She was introduced to PrEP and felt safer knowing that even in a bad situation, she had the power to protect herself. “Taking my sexual health seriously and learning more about HIV/AIDS helped me get past my own fear of being tested, and helped me begin to unpack my own internalized stigma.”  Elle also encourages care providers and patients to learn more about the U=U campaign. “HIV/AIDS is not a death sentence anymore. People don’t need to be afraid, no matter what their status is.” Elle is in her 6^th year of transition and is still a PrEP user.

Elle is also the first trans woman to be the co-chair elect of the Wisconsin HIV & AIDS Statewide Action Planning Group (SAPG), and the youngest member, and first trans womxn, to sit on the Board of Directors at Diverse & Resilient. She has received a 2019 Rising Star Award from the Black Trans Advocacy Coalition for her tireless volunteerism, in addition to being awarded the 2019 Milwaukee Pridefest Individual of the Year Award, being a Bobbie Jean Baker Transfaith grantee, and a Gender Reveal Podcast grantee. Her mother is minister Evangelist Veronica Sears, and Elle says her community work honors her mother’s example of unconventional community leadership.

Elle has said she is always available for community members in need of resources, transgender healthcare, or whenever someone wants to discuss sexual health questions or situations with another trans person or trans womxn of color.

Elle Hill is proud to stand for sexual autonomy, sexual liberation, inclusion, and safety for National Women & Girls HIV/AIDS Awareness Day!

The Heightened Risks of Pregnancy during Both a Pandemic & an Epidemic

Pregnancy comes with risks, but in the midst of a global pandemic alongside the ongoing HIV epidemic, the risks are more than usual and confusion is rife. The WHO and CDC have conflicting messages on whether pregnant people should take a COVID vaccine. And while it’s very rare for pregnant people to pass on COVID to their fetus, people with HIV who become pregnant can transmit the virus to their baby during pregnancy or breastfeeding. The American College of Obstetricians and Gynecologists (ACOG) has provided their recommendations on whether pregnant people should take a COVID vaccine, and the HHS announced updated recommended guidelines on the use of antiretroviral (ART) drugs in pregnant people with HIV.

Some confusion has been generated by conflicting messages between the CDC and the WHO. The CDC urged pregnant women to consult with their doctor before making a decision, whereas the WHO advised pregnant women not receive the vaccine unless at high risk for COVID because of work exposure or chronic conditions. The ACOG seems to agree with the CDC, recommending “pregnant women should be free to make their own decision in conjunction with their clinical care team.” The differences of opinion stems from a lack of information, as pregnant people have been prohibited from participating in the vaccine clinical trials. The ACOG explained their reasoning: “the mRNA vaccines are not live virus vaccines … They do not enter the nucleus, and do not alter human DNA in vaccine recipients. As a result, mRNA vaccines do not cause any genetic changes.” Both the CDC and the ACOG seem to concur that the dangers of severe COVID or death outweigh the unknown risks of vaccination, but that the choice is ultimately between pregnant persons and their doctors.

While it’s rare for pregnant people to transmit COVID-19 to the fetus during pregnancy, infants can become infected shortly after birth. Most newborns have none or mild symptoms, but those under 2 years old or born prematurely may be at higher risk for a serious case. Additionally, those breastfeeding who have COVID-19 are not likely to transmit it through their breastmilk, but they should wear a mask while breastfeeding and wash their hands before to prevent transmission from close contact.

Meanwhile, it’s unfortunately not rare for HIV-positive women to transmit the virus to their child. It can often be prevented though. 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 people with HIV, and interventions to reduce perinatal HIV transmission in the U.S. Some highlights from these updates are:

• Adding a section on PrEP to reduce the risk of acquiring HIV during periconception, antepartum, and postpartum.
• Recommending repeat HIV testing for pregnant people with a STI or signs of acute HIV.
• Recommending evidence-based counseling on infant feeding options to those who want to breastfeed.
• Relabeling dolutegravir as a “Preferred” drug for those trying to conceive & throughout pregnancy.
• Adding a section on Fostemsavir, a recently FDA-approved ARV for adult HIV. However, Fostemsavir is labelled as “Insufficient Data” for use in pregnancy.
• Lopinavir/ritonavir is now classified as “Not Recommended Except in Special Circumstances” rather than as an “Alternative” ARV, based on dosing frequency requirements and side effects.

The panel is also updating language to address the care of transgender and non-binary people who are pregnant or trying to conceive.

Understanding & Ameliorating Medical Mistrust among Black Americans

The medical establishment has a long history of mistreating Black Americans. Unfortunately, the mistrust created can prevent people from getting necessary care. Martha Hostetter and Sarah Klein released a recent piece, “Understanding and Ameliorating Medical Mistrust Among Black Americans,” in The Commonwealth Fund’s January newsletter. The article focuses on drawing lessons on ways to build trust with Black patients through improved communication, increased transparency, attending to access barriers, and by creating welcoming environments.

Events like the Tuskegee syphilis study and the forced sterilization of Black women have understandably played a role in Black Americans’ mistrust of the medical system. However, medical mistreatment of Black individuals is not a thing of the past. More recent studies have found Black Americans are consistently undertreated for pain, their symptoms and complaints are ignored, and even that “half of medical students and residents held at least one false belief about supposed biological differences between Black and White patients.” Dr. Kimlin Ashing said “Even the term mistrust is victim blaming. It puts it on the community when in fact the community has been let down by the medical system and by providers who continue to discriminate.”

Last month, MATEC-WI’s newsletter touched on how COVID-19 disproportionately affects Black populations, and yet, young, Black Americans were polled as less likely to take a COVID-19 vaccine. Similarly, Black Americans are more likely to say they don’t trust their physician, and people who say they mistrust the medical system are much more likely to report being in poor health. The medical establishment has a lot of work to do to begin to overcome its historical and present mistreatment of Black Americans. Read more on the lessons discussed in Hostetter and Klein’s article that could help Black Americans to feel more welcomed, supported, and most importantly, heard.

FDA Approves First Once-Monthly, Long-Acting Injectable to Treat Adult HIV

On January 21, 2021, the FDA approved Cabenuva (cabotegravir and rilpivirine, injectable formulation), the first once-monthly, long-acting injectable to treat adult HIV-1. The treatment is for adults who have their HIV well controlled by conventional HIV drugs and who have not shown signs of viral resistance. The FDA also approved Vocabira, a tablet version of cabotegravir, which should be taken with oral rilpivarine (Edurant) for 30 days before switching to the Cabenuva injections.

The director of the Office of Infectious Diseases within the FDA, John Farley stated, “This approval will allow some patients the option of receiving once-monthly injections in lieu of a daily oral treatment regimen.” According to the FDA, the most common adverse reactions to Cabenuva were injection site reactions, fever, fatigue, headache, musculoskeletal pain, nausea, sleep disorders, dizziness, and rash.

Cabenuva is still exceptionally expensive, costing $5,490 for an initial higher dose, and $3,960 per month afterward. Though costly, the long-acting shot “gives hope of reaching groups that have a hard time sticking to treatment” according to Dr. Steven Deeks, an HIV specialist at the University of California, San Francisco. Read the FDA’s press announcement on the approval of Cabenuva.

Additionally, ViiV Healthcare has indicated they will be seeking to get long-acting, injectable cabotegravir separately approved for HIV PrEP; the FDA has granted it Breakthrough Therapy Designation.

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