MATEC-WI Newsletter | January/February 2022

National HIV/AIDS Strategy (2022-2025) Focuses on Addressing Health Disparities and Inequities

The 2022-2025 National HIV/AIDS Strategy (NHAS) was released on World AIDS Day. The updated NHAS focuses around equity as a means of ending the HIV epidemic, such as recognizing racism as a public health threat, calling to address misinformation and mistrust, and seeking to reduce stigma and discrimination. But do misinformation, stigma, and racism play a role in health outcomes?

The NHAS recognizes racism as a public health threat, but is it one? Data continue to show that there are gaps in access, quality and affordability of medical care, as well as continued disparate outcomes for populations of color. Systemic racism creates barriers in accessing quality and affordable care, which leads to worsened health outcomes. Making systemic racism a definite and serious public health threat, according to the CDC.

However, social determinants of health caused by systemic racism only explain so much of the disparities. Stigma and implicit bias related to racism also have a hand in creating or exacerbating limited access to appropriate, quality, and affordable treatment and care. Study after study shows that some people in the U.S. are more likely to die from cancer, heart disease, and diabetes, simply because of their race or ethnicity, not because they lack access to healthcare.
Equally important, HIV-related stigma can result in fewer patients accessing treatment and care, or even realizing they’re at-risk of acquiring HIV, and this stigma can come from healthcare providers too. Stigma is difficult to address, with providers with limited stigma reduction education being more likely to exhibit stigmatizing behaviors towards patients. To help healthcare staff work to recognize and overcome stigma and implicit biases, NASTAD has put together a stigma toolkit, including a Resource Guide for Facilitating Stigma Conversations.

Misinformation is difficult to combat too, requiring clear communication and trusting relationships between patients or communities, and healthcare workers and organizations. Outdated information on treatment and prevention can act as misinformation for patients, preventing them from seeking care or providing incorrect prevention and treatment options; we see this misinformation with both HIV and COVID-19. In an effort to help educate healthcare professionals on how to overcome misinformation, MATEC-WI developed a three-part series: “Cutting through COVID-19 and HIV Misinformation.” Throughout the series, our moderator and various panelists have discussed how misinformation impacts patients, healthcare professionals, and health equity (Session 1), and where community partnerships can take an active role in addressing misinformation (Session 2). Archived webinars of Session 1 and Session 2 are also available for those who’d like to view them. In the third and final part of this series, on March 8, 12-1PM CST, we’ll discuss what techniques clinicians can utilize with their patients to overcome misinformation about build trust. We invite you to learn more about Session 3 and register. We look forward to seeing you!

Navigating Cabotegravir for PrEP

Long-acting injectables (LAI) continue to change the way clinicians prevent and treat HIV. Cabotegravir for PrEP (CAB-LA) received FDA approval on December 20, 2021, and the CDC updated their PrEP guidelines to incorporate the new prevention option. However, providing injectable PrEP can be difficult to implement. Cabotregravir for PrEP (CAB-LA) is currently only available from Viiv Healthcare under the brand name “Apretude.” CAB-LA is administered by a healthcare worker every 2 months, after an initial 2-dose initiation period administered monthly. Testing and timing are critical when administering CAB-LA, and patients are required to have a negative HIV-1 test before starting CAB-LA and prior to every injection. There is also a 7-day injection window, wherein patients should receive their dose 7 days before or after their scheduled injection date.

The FDA hopes that CAB-LA will increase access to PrEP, particularly amongst key populations that have difficulty adhering to daily oral PrEP. But at $3700 a dose, and with regular lab requirements, in-clinic administration, and unclear insurance coverage, many organizations are unsure about their ability to provide this PrEP option. As of yet, CAB-LA is not available for purchase, so organizations have time to determine their strategies. MATEC-WI reached out to organizations across the state to determine their concerns about implementing CAB-LA; we respond to these concerns below.

CAB-LA F.A.Q.s

• Clinical Guidance: What are the dosing details and timelines for CAB-LA? What are the testing and adherence requirements for CAB-LA? What are the mutation risks with CAB-LA?
  • The CDC’s updated PrEP for HIV Clinical Practice Guidelines provide clinical guidance on injectable PrEP, starting on page 47.
• Patient Education: What patient education should we be providing for those thinking of starting CAB-LA?
  • The CDC’s updated PrEP for HIV Clinical Practice Guidelines outline key information patients should be educated about with CAB-LA on page 51. The keys focuses are the importance of keeping follow-up appointments, and the risk of developing drug-resistant HIV if acquired during the long “tail” when discontinuing CAB-LA.
• Insurance Coverage: Will insurances cover CAB-LA doses, labs, and administration? What coverage options exist for patients wanting to get CAB-LA?
  • Currently, insurers are not required to cover all costs for CAB-LA. Though Viiv Healthcare offers an Apretude Savings Program and a Patient Assistance Program for Apretude. However, there will likely be changes in insurance coverage over time. The Centers for Medicare and Medicaid Services (CMMS) stated in summer 2021 that insurers would be required to cover PrEP with no cost sharing, including clinic visits and lab tests. Additionally, over 50 Congressmembers signed a letter to the CDC and the CMMS asking them to make CAB-LA free for patients.
• Billing: How should we be billing the various parts that go into administering CAB-LA?
  • Though not yet updated for CAB-LA, the NASTAD Billing Coding Guide for HIV Prevention provides billing codes for PrEP, screening, and linkage services to help providers navigate billing and reimbursement for HIV prevention services. We encourage organizations to check out the guide when talking with their billing departments in preparation for implementing CAB-LA.
• Implementation focuses: What should we consider when implementing CAB-LA? Are there strategies to make CAB-LA administration work
  • Overall, CAB-LA requires strong workflows and logistics. MATEC-WI encourages organizations to:
    • have a clinic champion with leadership support;
      work with their billing department as a priority step;
      develop interprofessional workflows for HIV testing and administering CAB-LA;
      ensure access to timely and accurate labs and pharmacy;
      and utilize systems that can track multiple patients’ dosing schedules.

Community Spotlight – Justin Roby

Justin Roby (he/him), is the Director of HIV Care for Diverse & Resilient and is the newly elected co-chair for the Statewide Action Planning Group (SAPG). Roby is newer to the HIV prevention and care field, joining Diverse & Resilient after learning more about HIV as a WI Health Leaders Fellow. However, he is no stranger to being an agent of change, with 12 years of experience with youth development making transformational change within his own communities.

Over the last 40 years, much has changed in the way of HIV care, and there continue to be improvements made. However, disparities still exist despite the advancements with science. Black and queer communities are at the forefront of the response to the HIV epidemic, but their presence on boards and decision making bodies continue to remain low. It’s important to uplift the lived experiences of people from these communities to end the HIV epidemic and effectively combat issues like HIV stigma and misinformation. Working with folks to ensure Diverse & Resilient’s program provides necessary care to those who need it, is just one of the tasks Roby has taken on in his role as Director of HIV Care.

Roby has continued to strive to make transformational change within his communities, by working to normalize people with HIV living full lives, and bringing people and communities back into critical conversations. He hopes his colleagues will join him in his efforts. Roby stated, “People need to know their status, and that PrEP or ART are options, but stigma often keeps Black and queer communities from talking about HIV, even amongst [themselves]. We have to normalize people with HIV living full lives, and even thriving, with every conversation we have. And we need to ensure we’re speaking with Black families and Black queer kids to encourage HIV testing and PrEP usage.” Additionally, Roby hopes that if there’s ever a need, his colleagues will reach out to him about sharing his story with those needing some support.

Other News and Resources

• Sixteenth Street Community Health Centers Hiring for Multiple Positions
• IDSA updates COVID Treatment Guidelines
• The Medical Letter updates “COVID-19 Vaccine Comparison Chart”
• DHHS OARAC updates Guidelines for Use of ART Agents in Adults and Adolescents with HIV Updated
• DHHS OARAC updates Perinatal HIV Clinical Guidelines Updated
• UW HIV Program offers Patient Education Webinar “PLWH and COVID-19: What you need to know” on March 8, 2022, 6-7PM CST (click link to join webinar)

For Upcoming Programs, check out our events and Treaters Meetings, or go to the MATEC Training Calendar.