AIDS programs at APA
Office on AIDS
The APA Office on AIDS provides training and capacity-building assistance on a wide range of HIV/AIDS–related topics including mental health services, technology transfer of HIV prevention science, community collaboration, research skills development, public policy and ethics.
John Anderson, PhD, received his doctoral degree in clinical psychology in 1988 from the University of Kansas. He is the senior director of the APA Office on AIDS. Dr. Anderson’s primary area of research and writing has focused on the relationships between hope, coping, adjustment, and health. He has authored numerous articles and training curricula on the mental health and psychosocial aspects of HIV/AIDS. His book Ethics in HIV-Related Psychotherapy: Clinical Decision Making in Complex Cases (APA, 2001) provides mental health practitioners with a practical guide for dealing with complex moral and legal dilemmas posed by clients living with HIV/AIDS. Since 1986, Dr. Anderson has conducted an independent mental health services practice in Washington, DC, where he specializes in individual, couple, family and hypnosis therapies for people living with chronic and terminal illnesses.
Cherie Mitchell, MHS, joined APA as manager of the Office on AIDS in 2010. Ms. Mitchell brings over 20 years of experience in management, policy, evaluation, and research with an emphasis on health disparities, cultural diversity/sensitivity, substance abuse and special populations. She has expertise in health policy, strategic planning, business development and marketing, program design and operations, organizational development and capacity building, training and technical assistance, and conference management. Before joining APA, she worked as an independent consultant and served in a senior management capacity at several consulting firms, including the Lewin Group, where she managed federal and foundation contracts with the W. K. Kellogg Foundation, the Substance Abuse and Mental Health Services Administration (SAMHSA) agencies, the Centers for Medicare and Medicaid Services, and others. She also worked at the Office of the Assistant Secretary for Health in the Office of Planning and Evaluation.
Ms. Mitchell is the founder of the Annual Dr. Lonnie E. Mitchell National Historically Black Colleges and Universities (HBCU) Substance Abuse & Mental Health Conference, which evolved into the Lonnie E. Mitchell HBCU Behavioral Health Policy Academy. Sponsored by SAMHSA, the Academy builds collaborative frameworks to address emerging trends in behavioral health, elimination of health disparities and awareness of workforce opportunities and health care policies.
Ms. Mitchell received her MHS from Johns Hopkins School of Public Health and her BA from Yale University.
The BSSV program
Translating HIV prevention science into culturally relevant practice
Psychologists and other behavioral and social scientists are in a unique position to contribute to the prevention of and care for those with HIV/AIDS. In 1996, the Behavioral and Social Science Volunteer (BSSV) Program, operating from the APA Office on AIDS, began to link behavioral and social scientist volunteers (BSSVs) with community-based organizations delivering HIV/AIDS–related services. The BSSV Program has now established a diverse nationwide network of highly skilled BSSVs who provide free capacity-building assistance (CBA) services to community-based organizations involved with selecting, adapting, implementing, and evaluating science-based approaches to HIV prevention. Our network of BSSVs has provided assistance to over 600 organizations in its 14-year history.
The BSSV Program translates HIV prevention science into culturally relevant practice. We pride ourselves on building trust and mutual respect with the communities with which we work. Not only are our volunteers culturally competent, but over half are people of color themselves. Over 92 percent of the organizations served by the BSSV Program have rated their overall experience as either “very good” or “outstanding.” Our BSSVs offer their time and expertise because of their personal commitment to HIV prevention and their desire to contribute in a meaningful way.
In 2009, the BSSV Program became an official part of the CBA Provider Program funded through 2014 by the Centers for Disease Control and Prevention (CDC). BSSV has been assigned to provide CBA in connection with six evidenced-based interventions (EBIs) disseminated broadly by the CDC: CLEAR, Community Promise, Healthy Relationships, SISTA, NIA, and Many Men Many Voices (visit the DEBI website for details about these proven interventions). By May 2011, the BSSV Program will complete a series of online trainings for our BSSVs on each of the six EBIs.
In helping to further prepare and train BSSVs, a 2-day Advanced Training and Collaborative Work Group session was held on December 3–5, 2010, in New Orleans. The purpose of this interactive training and work session was to bring together a group of diverse BSSVs, including the members of the BSSV Intensive CBA Leadership Team, to discuss topics such as the integration of mental health, substance abuse, and HIV/AIDS; effective marketing of the BSSV Program; and the creation of worksheets and other resources for our BSSVs to use when delivering CBA services. Also, the meeting in New Orleans provided BSSVs with an opportunity to meet, network and share experiences and resources.
In addition to CBA services, the BSSV Program offers training in the areas of integrating mental health, substance abuse and HIV prevention services. John Anderson, PhD, senior director of APA’s Office on AIDS, and Edna Davis-Brown, MPH, director of the BSSV Program, presented on this topic with other experts in conjunction with the U.S. Conference on AIDS in Orlando, Florida, in September 2010 and with the Substance Abuse and Mental Health Services Administration Grantee Meeting in Arlington, Virginia, in November 2010.
During the national HIV Prevention Leadership Summit held on December 12–15, 2010, in Washington, DC, BSSV Program Director Edna Davis-Brown presented a workshop with two other CDC-funded CBA providers on the topic “How to Recruit and Retain the ‘Right’ People for Your CBA Program.” In addition, the BSSV Program staff and local BSSVs worked at a BSSV Program exhibit booth developed for the conference.
To find out more about the program or to become a volunteer, contact Edna Davis-Brown at (202) 336-6176. You can also check us out on the BSSV website.
Edna Davis-Brown, MPH
Edna has over 20 years of experience in program development, management, and implementation; training development and delivery; cultural sensitivity; and conference/event management and publications support. She has managed numerous concurrent federal and nonfederal projects related to conference management, emergency disaster response mental health, training and technical assistance and publications. She previously worked with various consulting firms in the VA/MD/DC area, where she directed and managed projects with federal agencies such as the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment, the Health Services and Resources Administration, the Administration on Children and Families, and the National Institute on Drug Abuse.
Edna is also the president of the Gregory B. Davis Foundation, a small family foundation formed in honor of her youngest sibling, who died of AIDS in 2000. This is part of what inspires her to work in the field of HIV/AIDS prevention. She received her BA in Community Health Education from the University of North Carolina at Greensboro and her MPH from the University of North Carolina at Chapel Hill.
Sharon Asonganyi, MPH
Sharon’s interest in the HIV/AIDS field was kindled during her travels and involvement in HIV response efforts at rural clinics in her native country of Cameroon. Sharon obtained dual concentration BA degrees in biology and psychology at Boston University. She subsequently pursued an MPH in social and behavioral sciences, focusing on HIV/AIDS in adolescents. During her graduate studies, Sharon codeveloped a pilot intervention study at Boston Children’s Hospital on using technology to promote treatment adherence in adolescent clients. She has experience conducting HIV counseling and testing through outreach at youth homeless centers and college campuses. Sharon joins the BSSV Program from Boston, where she worked in the Boston Public Health Commission’s Ryan White Part A HIV Health Services Planning Council and Quality Management units. Motivated by a drive to help communities develop high-quality and effective service delivery infrastructures, she is excited to be a part of the APA and the BSSV team.
Danielle N. Pope, BS
Danielle, a native of West Philadelphia, holds a BS degree from Beaver College in Pennsylvania. In 1989, she moved to Washington, DC, to work for the Federal Bureau of Investigation (FBI) in the Identification Division. After her 7-year tenure with the FBI, Danielle began working for the APA Office on AIDS in 1998. She is now the administrative coordinator for the BSSV Program, where she keeps track of more than 200 volunteers to ensure that they remain connected with the program. She is the primary contact person for BSSV resources and support, and she conducts and coordinates all administrative functions of the program.
Latonia Coryatt, BS
Latonia, a first-year graduate student at the George Washington University School of Public Health and Health Services, is a candidate for the MPH in health promotion. She earned her undergraduate degree from Cornell University in human development, with a concentration in social inequality and social and personality development. Latonia has worked for a nonprofit organization in Brooklyn, NY, in their HIV/AIDS program and the Infant Mortality Reduction Initiative program, where she conducted HIV risk reduction through outreach, educational sessions, and support groups. Latonia has been trained in and has implemented several of the DEBI group interventions and is a certified HIV counselor and tester. Active in the community, she was a member of the HIV/AIDS Advisory Committee and has served on several other task forces and coalitions focused on improving community health. Latonia plans to continue to help underserved and underprivileged individuals, families, and communities make strides toward becoming healthier. She is very excited to contribute to, and learn from, the BSSV Program.
Elena Lumby, MPH
Elena is pursuing her DrPH at George Washington University to further develop her technical skills and become a resource for minority communities seeking to create change. She is a graduate of Bucknell University, where she double majored in biology and East Asian studies. As an undergraduate, she received intensive language study in Mandarin through Hamilton College’s Beijing-based immersion program. Between pursuit of her undergraduate and master’s degrees, Elena spent a year in Alaska working in a therapeutic group home for emotionally disturbed teenage boys. During her time in Fairbanks, she developed a passion for Alaska Native culture and hopes one day to provide capacity-building assistance for Alaska Native tribal health corporations. In 2010, she graduated with her MPH in community-oriented primary care from GWU. Presently, Elena is a research assistant for both the BSSV Program and the Mid-Atlantic Public Health Training Center. Her current research interests include qualitative/quantitative methods and community-based health behavior interventions in the area of HIV/AIDS prevention.
Kristina Rerucha, BS
Originally from Nebraska, Kristina (Krissy) is currently finishing course work for her MPH at George Washington University in Washington, DC. Krissy earned her undergraduate degree from Clark University with a dual concentration in biology and chemistry. Krissy brings a diverse background to our team, drawing from her work at both the national and international level. Her past experience includes Peace Corps service in West Africa, where she focused on health education, maternal mortality, infant death prevention, and youth empowerment through health knowledge. Since arriving in DC, she has worked with several nonprofit organizations to supplement her classroom learning, including PreventionWorks!, DC’s needle exchange program; the DC Campaign to Prevent Teenage Pregnancy; the DC Office on Aging; and the National Center for Creative Aging. Krissy has contributed to the missions of these programs as a program consultant and research assistant. She initially worked with the BSSV Program but now works with the HOPE Program.
A training program for HIV/AIDS researchers working on health disparities
The Cyber Mentors Program is an innovative research mentorship program designed for researchers who have not yet received R01-level funding and who are either from underrepresented groups and/or are interested in HIV/AIDS research with racial and ethnic groups that are overrepresented with HIV/AIDS.
Three cohorts of mentee/mentor pairs have participated in the 2-year mentorship program over the course of the past 3 years. The Cyber Mentors Program matches mentees with volunteer mentors who are leaders in the field of HIV/AIDS research and who have a track record of receiving R01 grants supported by the National Institutes of Health (NIH). One-on-one mentoring, which takes place via phone, e-mail, and face-to-face meetings, has two general goals: (a) to develop and implement a career development plan focused on building the strengths of the mentee to conduct independent research and (b) to assist mentees in developing and submitting high-quality research funding applications to the NIH.
Mentee/mentor pairs are provided with up to $5,000 to support research or career development activities (e.g., preliminary data collection, attending conferences and workshops, purchasing needed research hardware and software, etc.). In addition to one-on-one mentoring, mentees participate in a sequenced series of monthly online career development seminars and quarterly online small group discussions. Monthly webinars cover various research, methodology and administrative topics relevant to research careers. During small group discussions, mentees apply concepts learned during webinars to the development of their own proposals and receive feedback on specific sections of their applications from a variety of program mentors.
Mentees participate in full-scale mock reviews in which their grant applications are reviewed and scored by outside experts. Written feedback is offered by reviewers, with emphasis placed on recommendations for improvement. Mentees revise their applications in response to the mock review feedback before submitting finalized proposals to funding agencies.
By the end of the 2-year mentorship period, mentees in the Cyber Mentors Program:
Develop and implement a career development plan that will include 6-month goals to address relative weaknesses identified during a formalized self-assessment process.
Periodically revise 6-month goals in a thoughtfully sequenced way that improves their chances of becoming independent HIV/AIDS researchers who are competitive for obtaining grant funding.
Identify specific funding mechanisms to support their research interests.
Establish workable routines for writing and submitting articles to peer-reviewed journals.
Develop networks of peers and other professionals that can be accessed for consultation.
Draft high-quality research proposals in the area of HIV/AIDS and racial and ethnic groups that are overrepresented with HIV/AIDS.
Submit their proposals to targeted NIH funding mechanisms.
Want to be a mentor?
Mentors are expected to:
Attend a 3-hour Cyber Mentors Program meeting at the annual APA convention.
Spend an average of 5 hours per month for 2 years:
• reading and commenting on drafts of mentees’ research proposal or manuscripts,
• providing general consultation via telephone and e-mail,
• assisting the mentee with networking.
Conduct Web-based training about topics related to the mentor’s area of exptertise.
Assist the mentee in developing an individualized career development plan.
Assist the mentee in developing and submitting an HIV/AIDS research proposal to an NIH institute.
If you are interested in becoming a mentor, please send an email indicating your interest and whether you have ever received R01 funding in the area of HIV/AIDS research, and attach a recent copy of your curriculum vitae. Applications should be submitted electronically to Esraa Bani, the Cyber Mentors program coordinator. For more information call (202) 218-3596 or visit the Cyber Mentors webpage.
Esraa Bani, MPH
Cyber Mentors Program Coordinator
Esraa facilitates the activities associated with the Cyber Mentors Program. She also currently works part-time as the Strategic Planning and Initiatives officer with the Diaspora African Women’s Network. Prior to joining APA’s Office on AIDS, Esraa was an advocacy coordinator and co-chair of the Young People’s Working Group at Population Action International. She also has experience working at the Lorna Sundberng International Center, the United Nations, the Sudanese AIDS Prevention Program, Planned Parenthood Federation of America, and Habitat for Humanity. Esraa earned her MPH from the University of Virginia with a concentration in epidemiology and research. Her interests lie in gender-based violence, global sexual reproductive health and rights, and HIV/AIDS prevention in Africa. She was a 2007 Center for Global Health Scholar. Esraa was born in Sudan, raised in Saudi Arabia, and immigrated to the United States in 1998.
HIV Office for Psychology Education (HOPE) program
The HIV Office for Psychology Education (HOPE) Program, a national mental health training initiative administered by the APA Office on AIDS and funded by the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA), was awarded a 5-year renewal contract (280-09-0290) in October 2009.
The HOPE Program endeavors to enhance psychologists’ ability to competently and compassionately respond to people infected and affected by HIV. Using a train-the-trainer model, the HOPE Program has trained and certified more than 480 HOPE Program volunteer trainers to deliver interactive workshops for mental health providers. These trainers have in turn provided HOPE curriculum training in their communities to more than 29,000 mental health professionals since 1991.
In the first year of the contract renewal, HOPE staff have made significant strides in recruiting and training new volunteer trainers, updating and expanding the HOPE Program Training Resource Package, and expanding the number of trainers trained in the Ethical Issues & HIV/AIDS Curricula. HOPE staff are now hard at work to launch new online continuing education (CE) courses hosted by the APA Office of Continuing Education in Psychology online education platform.
Originally funded in October of 1991 by a 3-year contract with the CMHS, the HOPE Program created and pilot tested seven, 7-hour CE curricula on effective mental health service delivery for HIV-positive persons and those affected by HIV. As the epidemiology and treatments for HIV evolved, so did training needs for mental health practitioners. Today, volunteer HOPE trainers use flexible topical modules to create individualized training events. HOPE trainers conduct an extensive training needs assessment with staff at a training site. From this assessment, the trainer designs a unique didactic and interactive training to meet the needs of the audience. Training events are developed using either the HOPE Program Training Resource Package or the Ethical Issues & HIV/AIDS Curriculum.
Recruitment and training of new trainers
The HOPE Program has recruited and trained 34 new volunteer trainers. These trainers have completed HOPE’s first online Training-of-Trainers (TOT) — an intensive three-module series completed over five prerecorded training sessions and 11 live training sessions. This new approach to our TOT takes advantage of new technologies and provides time flexibility for individual schedules, and at no cost to our trainers.
The online TOT modules cover adult learning theory, the experiential learning model, individual learning styles and the ingredients for training assessment and design. Newly recruited trainers completed numerous homework assignments, quizzes, and conducted a real-time training teach back to their peers. With the successful completion of the TOT, our trainers are equipped with the tools to deliver interactive HIV and mental health training events. A primary tool used in conducting a training event is the HOPE Program Training Resource Package.
The HOPE Program Training Resource Package
The HOPE Program Training Resource Package offers a selection of 10 topic-specified modules designed to further develop knowledge regarding mental health and HIV. These modules may stand alone yet are flexible enough to lift information from one area and combine it with information from other areas geared to the audiences’ specific needs. In the first year of the new contract, HOPE Program staff integrated state-of-the-science information to update the Resource Package. Resource Package modules include: (a) HIV Virology, Clinical Courses, Medical Treatments, Epidemiology, and Antibody; (b) Integrating Primary and Behavioral Health Care; (c) Assessment Issues and Strategies; (d) Intervention Strategies; (e) Prevention Issues for the Mental Health Provider; (f) HIV and Families; (g) Work in the Lives of People Living With HIV Disease; (h) HIV and Correctional Systems; (i) Drug Use and HIV/AIDS; and (j) Transgender and HIV/AIDS.
New trainers certified to train the Ethical Issues and HIV/AIDS Curriculum
When most attendees of the 2010 APA Annual Convention in San Diego were packing their luggage and heading home, 14 HOPE trainers were rolling up their sleeves and preparing to take part in a 2-day intensive training-of-trainers (TOT) in Ethical Issues and HIV/AIDS.
The Ethical Issues and HIV/AIDS: a Multi-Disciplinary Mental Health Services Curricula comprises three curricula versions: 60/90 minute, 2-hours, and half-day. The systematic decision-making process on which the curricula are based offers several advantages over less structured methods of ethical analysis. Because it requires clinicians to analyze cases from a variety of perspectives while carefully documenting each step of analysis, it serves to reduce impulsive judgments that frequently occur when therapists feel pressured to act quickly because they are worried about the possibility of HIV transmission or law suits. The curricula also helps to sharpen thinking and clarify the clinical issues at hand because it requires one to perform separate, sequenced analyses.
At the completion of the TOT, one attendee noted, “The ethics model offers a clear, systematic process that will help practitioners avoid legal trouble and improve their standard of care.”
More than 60 HOPE trainers across the country are certified to conduct an Ethical Issues and HIV/AIDS training. Each of the curricula is approved for APA CE credit. Should you be interested in receiving training in the HOPE ethics model, please contact David DeVito. Contact information may be found at the end of this article.
Providing online training to all practitioners
HOPE will launch three online CE courses offered through the APA Office of Continuing Education in Psychology this summer. Available to you on demand (i.e., available 24 hours per day/7-days a week), the three courses are HIV and Drug Use, HIV and Trauma, and HIV and Older Adults. Each course includes conceptual, theoretical, research, and clinical issues associated with each topic. We look forward to providing the courses and alerting our readers as soon as the courses are launched.
Can a HOPE trainer help you?
Are you interested in having a HOPE trainer provide training to your staff or students? HOPE training workshops are designed to be highly interactive, and they include didactic presentations, facilitated discussions, and skills-building exercises. If CE credit in the field of psychology is required for your staff or attendees of a HOPE-sponsored training event, a HOPE trainer will complete and submit an application to the APA’s Office of Continuing Education in Psychology. Applications must be submitted for review at least 6 weeks prior to the training event.
To locate a HOPE trainer in your area, please contact HOPE Program Training Director David DeVito or call him at (202) 216-7603. You may also visit the HOPE Program.
HOPE Program Director
David is responsible for the recruitment, retention, training and coordination of mental health professionals who provide HIV/AIDS education and care training events to improve mental health outcomes for people living with HIV. He has more than 23 years of nonprofit management and administration experience from myriad staff positions at national membership organizations.
HIV prevention in K–12 schools
APA’s Healthy Lesbian, Gay and Bisexual Students Project
APA receives funding from the Division of Adolescent and School Health of the Centers for Disease Control and Prevention (CDC/DASH) to help increase the capacity of state and local K–12 education agencies to deliver effective school-based HIV prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, particularly young men of color who are attracted to men.
The Healthy Lesbian, Gay and Bisexual Students Project, which is housed in APA’s LGBTC office, assists states and large school districts in providing specialized professional development to school counselors, nurses, social workers, psychologists and other “school professionals who have doors that close.” The heart of the project is a full-day Healthy LGBTQ Students workshop with the goal of encouraging schools to implement practices and promote policies that help LGBTQ students prevent HIV infection, other sexually transmitted infections and pregnancy.
Workshop participants study available data from the handful of states that have chosen to ask optional questions about sexual orientation or the sex of sexual partners on the Youth Risk Behavior Survey (YRBS), which is administered to representative samples of high school students. States that ask these questions — 11 states in 2009 — have discovered important, previously unknown, risk-behavior and health-outcome disparities. For example:
Massachusetts found that lesbians and young gay men, respectively, are three times more likely to become pregnant or get someone pregnant than other youth — a surprising finding that led to widespread reexamination of pregnancy prevention efforts in the state. Sexual minority youth are also three times as likely to report ever having been diagnosed with a sexually transmitted infection.
Wisconsin found that 41 percent of youth who have engaged in same-sex sexual behavior have seriously considered suicide, compared to 16 percent of youth who reported engaging in sexual activity only with members of the opposite sex.
Rhode Island found that LGB students and those who marked “unknown” on the sexual identity question were at greater risk for 25 of the 30 reported problem behaviors than were heterosexual students, including tobacco use, illicit drug use, obesity, and lack of physical activity, in addition to risky sexual behaviors.
Participants of the Healthy LGBTQ Students Workshop explore factors that can lead to the health risk behaviors of LGBTQ students, particularly the harmful effects of psychological distress brought on by pervasive stigma surrounding LGBTQ youth in schools, at home, and in the community. Workshop participants also study evidence-based protective factors that help develop resiliency and self-confidence among LGBTQ individuals. Finally, the Healthy LGBTQ Students Workshop provides skill-building instruction and practice in advocating for safe and supportive schools and in motivating sexually active students to use condoms and seek HIV/STI testing. Participants are encouraged to identify at least one action they will take once they return to their schools and to list additional needs for future professional development. APA project staff members then work with state and district officials to establish ongoing sources of technical assistance and support to the school staff professionals who have taken the workshop.
The 5-year agreement between APA and the CDC to operate the Healthy LGB Students Project concludes in May 2011. APA anticipates applying for another 5 years of funding to conduct a series of regional training-of-trainers workshops across the nation and to work with more states and districts to implement the professional development program.
Jim Bogden, MPH
Director of the Healthy Lesbian, Gay and Bisexual Students Project
Jim has been the director of the Healthy LGB Students Project since 2008. Before joining the staff at APA, he spent 17 years at the National Association of State Boards of Education working on a wide range of school health policy issues. Jim earned an MPH degree in health education from the University of California, Berkeley. He previously spent 10 years working in education and health in the Republic of the Marshall Islands in the central Pacific Ocean. He began his career as a Peace Corps school/community health educator in 1979–1982 in small outer island communities of the Marshalls. He is originally from Oregon, is an avid square dancer, and lives in a Civil War–era rowhouse in Washington, DC.
Pre-Exposure Prophylaxis (PrEP) for HIV prevention: New tool to reduce the risk of HIV infection among gay and bisexual men
In November 2010, the National Institutes of Health (NIH) announced the results of the iPrEx trial, a large research study examining whether a pill containing drugs used to treat HIV can also help prevent HIV infection — an approach called pre-exposure prophylaxis, or PrEP. These findings represent a major advance in HIV prevention research, providing the first evidence that PrEP, when combined with other prevention strategies, can reduce HIV risk among men who have sex with men (MSM) (see Key Findings box).
The iPrEx results have immediate implications for the United States, because tenofovir-emtricitabine pills are already FDA-approved and available with a prescription for the treatment of HIV infection. As the agency responsible for protecting public health, the Centers for Disease Control and Prevention (CDC) has recently published interim guidance for physicians to help inform clinical practice as formal U.S. Public Health Service guidelines are being developed.
CDC interim guidance on HIV Pre-Exposure Prophylaxis for men who have sex with men
Before initiating PrEP
Document negative HIV antibody test(s) immediately before starting PrEP medication.
Test for acute HIV infection if patient has symptoms consistent with acute HIV infection.
Confirm that patient is at substantial, ongoing, high risk for acquiring HIV infection.
Confirm that calculated creatinine clearance is ≥ 60 mL per minute (via Cockcroft-Gault formula).
Other recommended actions
Screen for hepatitis B infection; vaccinate against hepatitis B if susceptible, or treat if active infection exists, regardless of decision about prescribing PrEP.
Screen and treat as needed for STIs.
Beginning PrEP medication regimen
Prescribe 1 tablet of Truvada* (TDF [300 mg] plus FTC [200 mg]) daily.
In general, prescribe no more than a 90-day supply, renewable only after HIV testing confirms that patient remains HIVuninfected.
If active hepatitis B infection is diagnosed, consider using TDF/FTC for both treatment of active hepatitis B infection and HIV prevention.
Provide risk-reduction and PrEP medication adherence counseling and condoms.
Follow-up while PrEP medication is being taken
Every 2–3 months, perform an HIV antibody test; document negative result.
Evaluate and support PrEP medication adherence at each follow-up visit, more often if inconsistent adherence is identified.
Every 2–3 months, assess risk behaviors and provide risk reduction counseling and condoms. Assess STI symptoms and, if present, test and treat for STI as needed.
Every 6 months, test for STI even if patient is asymptomatic, and treat as needed.
3 months after initiation, then yearly while on PrEP medication, check blood urea nitrogen and serum creatinine.
On discontinuing PrEP (at patient request, for safety concerns, or if HIV infection is acquired)
Perform HIV test(s) to confirm whether HIV infection has occurred.
If HIV positive, order and document results of resistance testing and establish linkage to HIV care.
If HIV negative, establish linkage to risk-reduction support services as indicated.
If active hepatitis B is diagnosed at initiation of PrEP, consider appropriate medication for continued treatment of hepatitis B.
Abbreviations: STI = sexually transmitted infection; TDF = tenofovir disoproxil fumarate; FTC = emtricitabine.
* These recommendations do not reflect current Food and Drug Administration-approved labeling for TDF/FTC.
Source: “Interim Guidance: Pre-exposure prophylaxis for the prevention of HIV infection in men who have sex with men,” CDC Morbidity and Mortality Weekly Report, January 28, 2011.
iPrEx Trial: Key Findings
Efficacy: The trial found that a once-daily pill containing tenofovir plus emtricitabine (brand name Truvada®) provided an average of 44 percent protection to men who have sex with men and transgender women who have sex with men who also received comprehensive prevention services which included monthly HIV testing, condom provision, counseling and management of other sexually transmitted infections.
Consistent use of PrEP: The level of protection varied widely depending on how consistently participants used PrEP. Among those whose data (based on self-reports, bottles dispensed, and pill counts) indicates use on 90 percent or more days, HIV risk was reduced by 73 percent, while among those whose adherence by the same measure was less than 90 percent, HIV risk was reduced by only 21 percent.
Risk behavior: Risk behavior among participants declined overall during the trial both in terms of decreases in the number of sexual partners and increases in condom use, likely as a result of the intensive risk reduction counseling provided as part of the trial.