This document summarizes guidelines for non-occupational post-exposure prophylaxis (nPEP) for HIV. It recommends that nPEP be offered for exposures over 72 hours prior only if the source patient is known to be HIV positive or of unknown status. For exposures within 72 hours, nPEP is recommended if the source patient is HIV positive or of unknown status. The decision to offer nPEP should be made on a case-by-case basis. The document also discusses factors that influence decisions to start nPEP and reasons some may not start it after exposure. It concludes by providing contact information for the presenting author.
Contemporary Management of HIV. New Data From IDWeek 2018 and Other Fall 2018...hivlifeinfo
Contemporary Management of HIV. New Data From IDWeek 2018 and Other Fall 2018 HIV Conferences
Format: Microsoft PowerPoint (.ppt)
File Size: 690 KB
Released: December 5, 2018
Pre and Post Exposure Prophylaxis and HIV Prevention presented by Dr. Ken Mayer, Research Director of the Fenway Health Center at the Fenway Health Center community education conference: An End To AIDS - How A State Bill Can Change Everything hosted by SearchForACure.org, the Fenway Health Center, and the MA Dept. of Public Health
Examples of Traditional vs. Precision Therapies
1) James Kennedy, Centre for Addiction and Mental Health
2) Niya Chari, CBCN
3) Michael Duong, Roche
4) Linsay Davis, AveXis
5) Josh Silvertown, Bayer Canada
David L. Wyles, MD of UC San Diego Department of Medicine presents"Acute HCV Infection in HIV+ MSM: Sexual Transmission of a Non-Sexually Transmitted Disease?"
Contemporary Management of HIV. New Data From IDWeek 2018 and Other Fall 2018...hivlifeinfo
Contemporary Management of HIV. New Data From IDWeek 2018 and Other Fall 2018 HIV Conferences
Format: Microsoft PowerPoint (.ppt)
File Size: 690 KB
Released: December 5, 2018
Pre and Post Exposure Prophylaxis and HIV Prevention presented by Dr. Ken Mayer, Research Director of the Fenway Health Center at the Fenway Health Center community education conference: An End To AIDS - How A State Bill Can Change Everything hosted by SearchForACure.org, the Fenway Health Center, and the MA Dept. of Public Health
Examples of Traditional vs. Precision Therapies
1) James Kennedy, Centre for Addiction and Mental Health
2) Niya Chari, CBCN
3) Michael Duong, Roche
4) Linsay Davis, AveXis
5) Josh Silvertown, Bayer Canada
David L. Wyles, MD of UC San Diego Department of Medicine presents"Acute HCV Infection in HIV+ MSM: Sexual Transmission of a Non-Sexually Transmitted Disease?"
Clinical Impact of New HIV Data From CROI 2019hivlifeinfo
March 4-7, 2019; Seattle, Washington
In this downloadable slideset, expert faculty members summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File Size: 576 KB
Released: March 22, 2019
Clinician's perspective on PrEP - Dr Dan ClutterbuckHIVScotland
This presentation was given by Dr Dan Clutterbuck of NHS Lothian and NHS Borders, at the HIV Scotland 'PrEP Roundtable Discussion' event on 25 August 2015.
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Hivlife Info
In this downloadable slide set, Marcy S. Gelman, RN, MSN, MPH, and Kevin M. O’Hara, PA, review essential considerations for midlevel providers administering PrEP
Format: Microsoft PowerPoint (.ppt)
File size: 825 KB
Date posted: 9/29/2014
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
Andrew Grulich, (Kirby Institute) presents the science underlying the revolution in biomedial prevention, likening it to the 'protease moment' of 1996, and discusses actions likely to be required to maximise population-level effectiveness and the need for a strategic research response. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jean-Michel Molina, Assistance Publique Hôpitaux de Paris
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Trevor Hawkins, M.D., M.P.H. of the Univeristy of New Mexico and Southwest CARE Center, presents "Top Ten HIV Clinical Controversies 2014" at AIDS Clinical Rounds
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
Clinical Impact of New HIV Data From CROI 2019hivlifeinfo
March 4-7, 2019; Seattle, Washington
In this downloadable slideset, expert faculty members summarize key studies from this important annual conference.
Format: Microsoft PowerPoint (.ppt)
File Size: 576 KB
Released: March 22, 2019
Clinician's perspective on PrEP - Dr Dan ClutterbuckHIVScotland
This presentation was given by Dr Dan Clutterbuck of NHS Lothian and NHS Borders, at the HIV Scotland 'PrEP Roundtable Discussion' event on 25 August 2015.
Why, when, and how to use pre exposure prophylaxis for hiv acquisition. 2014Hivlife Info
In this downloadable slide set, Marcy S. Gelman, RN, MSN, MPH, and Kevin M. O’Hara, PA, review essential considerations for midlevel providers administering PrEP
Format: Microsoft PowerPoint (.ppt)
File size: 825 KB
Date posted: 9/29/2014
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
Andrew Grulich, (Kirby Institute) presents the science underlying the revolution in biomedial prevention, likening it to the 'protease moment' of 1996, and discusses actions likely to be required to maximise population-level effectiveness and the need for a strategic research response. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Jean-Michel Molina, Assistance Publique Hôpitaux de Paris
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Trevor Hawkins, M.D., M.P.H. of the Univeristy of New Mexico and Southwest CARE Center, presents "Top Ten HIV Clinical Controversies 2014" at AIDS Clinical Rounds
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
The Health Center Program and the NHAS and VHAPhealthhiv
Seiji Hayashi, MD, MPH, FAAFP
Chief Medical Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
SYNCing Government Agencies with NHAS and VHAP healthhiv
Warren W. Hewitt, Jr. DrPH, M.S.
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Temporal, Infratemporal & Pterygopalatine BY Dr.RIG.pptx
Pep and prep smith
1. Dawn K. Smith, MD, MS, MPH
Centers for Disease Control and Prevention
20 April 2012
2.
3.
4. Substantial No substantial
exposure risk exposure risk
< 72 hours since >72 hours since
exposure exposure
Source patient Source patient of nPEP not
known to be HIV+ unknown HIV status recommended
Case-by-case
nPEP recommended
determination
5. 200 MSM given 4-day starter packs (ZDV/3TC)
Instructed when to start nPEP
Used PrEP after No PrEP after No PrEP and
high risk sex high risk sex no high risk sex
N (%) 68 (34%) 86 (43%) 46 (23%)
HIV infections 1 10 0
HIV incidence 1.5% 11.6% 0%
Reasons for not starting nPEP
◦ Sex with a steady partner believed to be HIV-negative
◦ Did not consider the exposure high-risk
◦ Concerns about side effects
Schechter et al, JAIDS, 2004
6. Efficacy
Study mITT (CI)
Behavior Change NS
(Explore)
18% (–5, 36)
TDF/FTC oral-PrEP in MSM 44% (15, 63)
(iPrEx)
TDF/FTC oral PrEP in heterosexuals 63% (22, 83)*
(TDF2)
TDF/FTC oral PrEP in HIV-discordant couples 75% (55, 87)*
(Partners PrEP)
TDF/FTC oral PrEP in men 84% (54, 94)*
(Parters PrEP)
TDF/FTC oral PrEP in women 66% (28, 84)*
(Parters PrEP)
TDF/FTC oral PrEP in women NS 18% (-36,51)*
(FEM-PrEP)
Early ART in serodiscordant couples 96% (73, 99)
(HPTN 052)
0 10 20 30 40 50 60 70 80 90 100
% Efficacy
*Provisional
7. Recruit PrEP Flow Diagram - Provider Perspective
Self-referral
Network referral
Venue outreach
Health services
CBOs
Low
Risk
HIV Risk High Educate Lab
Test Neg Screen Yes Screen Eligible Consent? Yes
Risk Interest?
Pos Mod Not
No Eligible No
Risk
Refer for care Refer for risk-reduction services
Refill Pos Prescription
Adherence HIV Adherence Client Receives
Counseling Neg Test 3 months Counseling PrEP Services*
Risk Reduction Risk-Reduction
Counseling Counseling
Serious Toxicities * Including indicated STI diagnosis and treatment
8. MSM
◦ NHANES (2001-2006)
1.8 million men aged 18-59 years reported sex with a man in prior year
and self-identify as gay
47% reported >2 male sex partners in past year
83% HIV-uninfected
◦ National Survey of Sexual Health and Behavior
No condom use among gay men during most recent sexual event was
39%
◦ 275,000 uninfected gay men with >2 male sex partners in
past year and no condom use at last anal sex
Heterosexual discordant couples
◦ Estimated from multiple population-based data sources
◦ At least 140,000 discordant heterosexual couples in the U.S
◦ Approximately ½ intend future pregnancies
Sources: Xu et al. STD 2010; 37(6):399-405. Reece et al. J Sex Med 2010;7(suppl 5):266–
276:
Lampe et al. AJOG 2011: 204(6):488e.1-8
9. Nearly all awareness and acceptability studies
in the US have been done with MSM
◦ Low awareness, substantial acceptability
DocStyles and HealthStyles 2009
Had heard Support use or prescriptipn of PrEP Support
of PrEP public
funding of
PrEP
MSM IDU STD Discordant
clients couples
Physicians 23% 68% 67% 39% 78% 61%
and nurses
General 5% 47% 45% 48% 70% 68%
population
10. MSM HRH IDU Discordant
Couples
Clinical Services
LGBT clinics X X
STD clinics X X
Reproductive health clinics X X
Addiction treatment clinics X
Primary care clinics X X X X
HIV treatment clinics X
Supportive Services
CBOs X X X
Pharmacies X X X X
NSEPs X
11. If safe and ≥75% effective, would provide to… %
Injection drug users 69%
MSM 66%
Patients who change sex partners frequently 57%
Uninfected partner wishing to conceive with an HIV+ partner 55%
Patients with an STD 34%
2009 web survey of 2156 physicians, ½ primary care
12. Users
◦ Unaware of level of personal risk
◦ Unaware of intervention
◦ Don’t know how or where to access the intervention
◦ Delay in seeking clinical preventive care
◦ Uninsured/unable to pay for medication
◦ Low adherence to medication
Providers
◦ Unaware of intervention
◦ Uncertain how to deliver the intervention
◦ Wary of complexity and time involved
◦ Low index of suspicion for indications
◦ Low access to the highest risk populations
◦ Uncertain how to bill for the intervention
13. Open-label Studies Implementation Studies
(Real World Conditions)
Type-specific Acceptability (patients) Acceptability (system)
Questions Medication adherence Retention (patients)
Longer term safety Sustainability (cost)
Practice variation effects
Setting(s) Research clinics Usual clinical care sites
Population(s) Clinical trial participants (or Broad population that may
similar) benefit
Consent Research consent Clinical care consent
Incentives $ for time and effort Clinical services only
Protocol Strict research protocol Very Practice guidelines with
similar to trial protocol formal and informal variance
Care Research staff Community care providers
Provider(s)
Care Funding Research funds Insurance (public, private, or
self)
14. Open-Label Studies Implementation
Studies
MSM and iPrEx- OLE
M-F TG San Francisco, Boston, Chicago
NIAID STD Clinic
None
San Francisco, Miami
California HIV Research Program
East Bay, Los Angeles, San Diego
Heterosexual
None None
Women and
Men
Discordant None None
Couples
15. Primary care benefits?
◦ hepatitis vaccination, reproductive health care
Resistance?
◦ Uncommon if screening for acute infection
Adherence?
◦ Poor in some trials, high in others
Risk compensation?
◦ Not seen (yet), models suggest unlikely to exceed benefit
Cost-effective?
◦ Yes, if targeted to those with high incidence
16. Factor Measures
Reach Coverage and representativeness of patients
Effectiveness Rate of new HIV infections and adverse outcomes
Adoption Availability/representativeness of settings and
clinicians who provide PrEP
Implementation Extent of delivery consistent with guidelines;
resources required and costs
Maintenance Patients: Long-term effects and attrition
Clinician/setting: sustainability of program
17. PrEP
Primarily
Treatment
Biomedical
nPEP as
Prevention
Uninfected
Person
MC Condoms
Sexual Substance
Primarily
Behavior Abuse
Behavioral
Change Change
18. Dr. Dawn K. Smith
dsmith1@cdc.gov
404.639.5166
"The findings and conclusions in this presentation have not been formally dissemination
by CDC
and should not be construed to represent any agency determination or policy."
Editor's Notes
As a proportion of their number in the US population, African-American men and women and Hispanic men have the greatest concentration of HIV infection.But during 2006-2009, young MSM (13-29), especially those that were African American, were the only subgroups to show increasing HIV infection rates. For AA young MSM, HIV infections increased 48% over those years.
Next considered howPrEP might be provided, what are the steps, from the perspective of a clinician. Walk through from upper left (green box) to lower left (refill visit).At any point, not right for PrEP but with HIV risk, refer for other servicesAt any point, if HIV positive, refer to care
One question for coverage and cost, is how many MSM at high risk are we talking about (walk through slide)
However, a substantial proportion of primary care and other physcians are willing to prescribe PrEP to high risk populations.
There have been many calls for “demonstration projects”. When conducted as evaluation of community PrEP practices, these will teach us a lot about what works well, less well, and with what resources to inform delivery in a sustainable way that contributes to reducing HIV infection in highest risk populations of MSM
CDC believes the developing evidence of safety and efficacy of daily oral PrEP is sufficient to add it to the mix of partially effective prevention methods that should be considered to reduce HIV incidence in the US among MSM. Additional trial results need to be reviewed before determination can be made about any possible role for PrEP in other at-risk populations.