June 11 - UPDATED training on PrEP for HIV prevention from Chicago's Project Ready, Set, PrEP! (RSP!). Visit the Project RSP!'s My PrEP Experience blog at www.myprepexperience.blogspot.com for more informational resources, including the personal stories of individuals who have chosen to use PrEP.
PrEP Community Opportunities and ChallengesJim Pickett
Plenary talk by AIDS Foundation of Chicago's Jim Pickett, given at the PrEP Forum in San Francisco on March 10, 2014. Info on the forum can be found here: http://stdhivtraining.org/presentation_description.html?id=82
PrEP training slides - Lisle, April 16, 2015Jim Pickett
These slides are part of a one-day training by Illinois Department of Public Health, Midwest AIDS Training and Education Center, and AIDS Foundation of Chicago (AFC) called "PrEP: What is it and How Am I to Integrate it in My Conversations with Clients?" They were presented by Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at AFC.
Project RSP Training on PrEP - November 13, 2015Jim Pickett
This training was conducted by AIDS Foundation of Chicago for members of Chicago's HIV workforce - in partnership with the Chicago Department of Public Health. It took place on Friday, November 13, 2015. Presenters included the CORE Center's Dr. Sybil Hosek, Jim Pickett of AFC, and two PrEP consumers - Gabe Bahena and Curtis Lewis.
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
PrEP Training Slides - Austin CBC, CORE Center, AFCJim Pickett
These slides were used for the HIV workforce PrEP training conducted by AIDS Foundation of Chicago on June 23, 2015 at Austin CBC in collaboration with the CORE Center.
Project Ready, Set, PrEP! training on PrEP for HIV Prevention - UPDATED NOV 17Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health on November 17. Other partners on this training included University of Chicago. These slides comprise a 3.5 hour training designed for people in the HIV workforce that AFC and partners conduct at various times in the year. They are continually updated.
Project RSP! Training on PrEP - Peoria, IL - August 18, 2015Jim Pickett
This AIDS Foundation of Chicago training on PrEP for the HIV workforce took place in Peoria, IL on August 18, 2015. The training was conducted in collaboration with the Illinois Public Health Association and Central Illinois FRIENDS of PWA, Inc.
PrEP Community Opportunities and ChallengesJim Pickett
Plenary talk by AIDS Foundation of Chicago's Jim Pickett, given at the PrEP Forum in San Francisco on March 10, 2014. Info on the forum can be found here: http://stdhivtraining.org/presentation_description.html?id=82
PrEP training slides - Lisle, April 16, 2015Jim Pickett
These slides are part of a one-day training by Illinois Department of Public Health, Midwest AIDS Training and Education Center, and AIDS Foundation of Chicago (AFC) called "PrEP: What is it and How Am I to Integrate it in My Conversations with Clients?" They were presented by Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at AFC.
Project RSP Training on PrEP - November 13, 2015Jim Pickett
This training was conducted by AIDS Foundation of Chicago for members of Chicago's HIV workforce - in partnership with the Chicago Department of Public Health. It took place on Friday, November 13, 2015. Presenters included the CORE Center's Dr. Sybil Hosek, Jim Pickett of AFC, and two PrEP consumers - Gabe Bahena and Curtis Lewis.
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
PrEP Training Slides - Austin CBC, CORE Center, AFCJim Pickett
These slides were used for the HIV workforce PrEP training conducted by AIDS Foundation of Chicago on June 23, 2015 at Austin CBC in collaboration with the CORE Center.
Project Ready, Set, PrEP! training on PrEP for HIV Prevention - UPDATED NOV 17Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health on November 17. Other partners on this training included University of Chicago. These slides comprise a 3.5 hour training designed for people in the HIV workforce that AFC and partners conduct at various times in the year. They are continually updated.
Project RSP! Training on PrEP - Peoria, IL - August 18, 2015Jim Pickett
This AIDS Foundation of Chicago training on PrEP for the HIV workforce took place in Peoria, IL on August 18, 2015. The training was conducted in collaboration with the Illinois Public Health Association and Central Illinois FRIENDS of PWA, Inc.
Project RSP Training on PrEP - July 31, 2015Jim Pickett
This PrEP training - a collaboration between AIDS Foundation of Chicago and the Chicago Department of Public Health - was provided to members of Chicago's HIV workforce on Friday, July 31, 2015.
Project RSP! Training on PrEP - Oct 2013Jim Pickett
This training was conducted for members of the HIV workforce in Chicago on October 21, 2013 at the Chicago Department of Public Health's Mile Square location.
Project Ready, Set, PrEP! training on PrEP - Updated 9/5/14Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health and MATEC on September 5, 2014. Other partners on this training included John Stroger Hospital and Gilead. These slides comprise a 3.5 hour training designed for people in the HIV workforce AFC and partners conduct at various times in the year.
Project RSP! training on PrEP for the HIV workforce (March 19, 2015)Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health on March 19, 2015. These slides comprise a 3.5 hour training designed for people in the HIV workforce in Chicago and throughout Illinois that AFC and partners conduct at various times in the year. They are continually updated - this presentation includes recent PrEP data presented at CROI 2015 in late February.
Philadelphia FIGHT's PrEP Retention and Adherence Coordinator Devon Clark presented on HIV Pre-exposure Prophylaxis (PrEP) at the September 2016 meeting of the Positive Committee.
PrEP Training - Springfield, IL - May 14, 2015Jim Pickett
This PrEP training was delivered by Jim Pickett to people working in HIV in Springfield, IL on May 14, 2015. This training was conducted in collaboration with AIDS Foundation of Chicago, Illinois Department of Public Health, and the Midwest AIDS Training and Education Center.
Donna E. Sweet, MD, AAHIVS, MACP, prepared useful practice aids pertaining to HIV prevention for this CME/MOC/CNE/CPE activity titled "Creating an HIV Prevention–Certified Provider Workforce: A Training and Certificate Program Designed to Improve the Competencies of Providers in Delivering Comprehensive HIV Prevention." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at http://bit.ly/33e2CQt. CME/MOC/CNE/CPE credit will be available until November 18, 2020.
At the end of the training, participants will be able to:
State the indications for PrEP
State the eligibility for PrEP
Name the 5 main eligibility criteria for PrEP
Explain how to exclude Acute HIV Infection
Project RSP! training on PrEP - updated November 2013Jim Pickett
This is a training for the HIV workforce on PrEP, and is a part of Chicago's Project Ready, Set, PrEP! (RSP!) Project RSP! is an education and awareness initiative of the AIDS Foundation of Chicago. Visit us at www.myprepexperience.blogspot.com.
Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.
Post exposure prophylaxis- HEALTH SECTOR WELLNESS SERVICES SEJOJO PHAAROE
HIV and HIV transmission
Indicators for PEP
Pre—requisite for PEP
-baseline and follow up tests
Pre-requisite for PEP Provision
PEP package
ARV- Treatment and adherence
David Wohl, MD, prepared useful Practice Aids pertaining to HIV pre-exposure prophylaxis for this CME/CE activity titled "Breaking Down the Barriers to PrEP: The Patient Journey From Misconceptions to Effective HIV Prevention." For the full presentation, monograph, complete CME/CE information, and to apply for credit, please visit us at http://bit.ly/2JovTyb. CME/CE credit will be available until April 19, 2019.
HPTN 067/ADAPT methods and results from women in Cape TownИлья Антипин
Grant R. и др. «HPTN 067/ADAPT methods and results from women in Cape Town» 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Vancouver, 2015. MOSY0103.
Случаи и разногласия по ВИЧ в 2019 году: европейские перспективы / Cases and...hivlifeinfo
Learn unique perspectives across Europe on PrEP, rapid ART initiation, ART in women, and options for switching ART.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.33 MB
Released: July 10, 2019
Project RSP Training on PrEP - July 31, 2015Jim Pickett
This PrEP training - a collaboration between AIDS Foundation of Chicago and the Chicago Department of Public Health - was provided to members of Chicago's HIV workforce on Friday, July 31, 2015.
Project RSP! Training on PrEP - Oct 2013Jim Pickett
This training was conducted for members of the HIV workforce in Chicago on October 21, 2013 at the Chicago Department of Public Health's Mile Square location.
Project Ready, Set, PrEP! training on PrEP - Updated 9/5/14Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health and MATEC on September 5, 2014. Other partners on this training included John Stroger Hospital and Gilead. These slides comprise a 3.5 hour training designed for people in the HIV workforce AFC and partners conduct at various times in the year.
Project RSP! training on PrEP for the HIV workforce (March 19, 2015)Jim Pickett
This training on PrEP for HIV prevention was conducted by AIDS Foundation of Chicago (AFC) in collaboration with the Chicago Department of Public Health on March 19, 2015. These slides comprise a 3.5 hour training designed for people in the HIV workforce in Chicago and throughout Illinois that AFC and partners conduct at various times in the year. They are continually updated - this presentation includes recent PrEP data presented at CROI 2015 in late February.
Philadelphia FIGHT's PrEP Retention and Adherence Coordinator Devon Clark presented on HIV Pre-exposure Prophylaxis (PrEP) at the September 2016 meeting of the Positive Committee.
PrEP Training - Springfield, IL - May 14, 2015Jim Pickett
This PrEP training was delivered by Jim Pickett to people working in HIV in Springfield, IL on May 14, 2015. This training was conducted in collaboration with AIDS Foundation of Chicago, Illinois Department of Public Health, and the Midwest AIDS Training and Education Center.
Donna E. Sweet, MD, AAHIVS, MACP, prepared useful practice aids pertaining to HIV prevention for this CME/MOC/CNE/CPE activity titled "Creating an HIV Prevention–Certified Provider Workforce: A Training and Certificate Program Designed to Improve the Competencies of Providers in Delivering Comprehensive HIV Prevention." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at http://bit.ly/33e2CQt. CME/MOC/CNE/CPE credit will be available until November 18, 2020.
At the end of the training, participants will be able to:
State the indications for PrEP
State the eligibility for PrEP
Name the 5 main eligibility criteria for PrEP
Explain how to exclude Acute HIV Infection
Project RSP! training on PrEP - updated November 2013Jim Pickett
This is a training for the HIV workforce on PrEP, and is a part of Chicago's Project Ready, Set, PrEP! (RSP!) Project RSP! is an education and awareness initiative of the AIDS Foundation of Chicago. Visit us at www.myprepexperience.blogspot.com.
Kathleen Brady of the PDPH presented the annual report on the HIV epidemic in Philadelphia at the February 2017 meeting of the Philadelphia Ryan White Part A Planning Council.
Post exposure prophylaxis- HEALTH SECTOR WELLNESS SERVICES SEJOJO PHAAROE
HIV and HIV transmission
Indicators for PEP
Pre—requisite for PEP
-baseline and follow up tests
Pre-requisite for PEP Provision
PEP package
ARV- Treatment and adherence
David Wohl, MD, prepared useful Practice Aids pertaining to HIV pre-exposure prophylaxis for this CME/CE activity titled "Breaking Down the Barriers to PrEP: The Patient Journey From Misconceptions to Effective HIV Prevention." For the full presentation, monograph, complete CME/CE information, and to apply for credit, please visit us at http://bit.ly/2JovTyb. CME/CE credit will be available until April 19, 2019.
HPTN 067/ADAPT methods and results from women in Cape TownИлья Антипин
Grant R. и др. «HPTN 067/ADAPT methods and results from women in Cape Town» 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Vancouver, 2015. MOSY0103.
Случаи и разногласия по ВИЧ в 2019 году: европейские перспективы / Cases and...hivlifeinfo
Learn unique perspectives across Europe on PrEP, rapid ART initiation, ART in women, and options for switching ART.
Format: Microsoft PowerPoint (.ppt)
File Size: 1.33 MB
Released: July 10, 2019
" Treatment of Co-Infections and Innovative Methods in Prevention of HIV": Prof.dr. Josip Begovac: Opening theme at the 6th Regional Conference in Sarajevo, May 17 2012.
Project RSP! Training on PrEP for HIV PreventionJim Pickett
This is a training on PrEP (pre-exposure prohylaxis) for HIV prevention, designed for people who work in the HIV prevention field. The training is designed by AIDS Foundation of Chicago's Project Ready, Set, PrEP! (RSP!). For more information on PrEP, visit the project's blog at www.myprepexperience.blogspot.com.
Project RSP Training on PrEP - September 11, 2015Jim Pickett
This training was conducted by AIDS Foundation of Chicago for members of Chicago's HIV workforce - in partnership with the Chicago Department of Public Health. It took place on Friday, September 11, 2015. Presenters included the CORE Center's Dr. Sybil Hosek, Jim Pickett of AFC, and Gabe Bahena, a PrEP consumer. .
This workshop will cover best practices for HIV prevention in adolescents with a focus on the implementation of Pre-Exposure Prophylaxis (PrEP) and Post Exposure Prophylaxis (PEP) in SBHCs. Join this workshop to hear an overview of the HIV epidemic among adolescents in California, best practices for determining eligibility for PrEP and PEP, instructions for labs and prescriptions, and suggestions for case management and training of all SBHC staff.
HIV Prevention: Combating PrEP Implementation ChallengesCHC Connecticut
Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.,
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
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.
Expert panelists:
Dr. Tafadzwa Chakare, Technical Director, Jhpiego, Lesotho
Dr. More Mungati, STAR-L Director, EGPAF Lesotho
Facilitator:
Dr. Seema Ntjabane, Care & Treatment Specialist, USAID-Lesotho
Dr. Sarah Wood and Kimberley Desir's presentation to the RWPC's Positive Committee on Children's Hospital of Philadelphia's PrEP program, Project PrEPare, from April 2013.
Dr. Sarah Wood and Kimberley Desir's presentation to the RWPC's Positive Committee on Children's Hospital of Philadelphia's PrEP program, Project PrEPare, from April 2013.
Provides information on pre-exposure prophylaxis (PrEP) to prevent HIV acquisition, including clinical recommendations and key points regarding PrEP efficacy and candidates, contraindications, lab testing, prescription, and monitoring PrEP.
Find more information at https://www.hivguidelines.org/prep-for-prevention/prep-to-prevent-hiv/
Sponsored by the New York State Department of Health (NYSDOH) AIDS Institute (AI) and the HIV Clinical Guidelines Program
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.
Speakers discuss PrEP eligibility, management, and other topics covered in training modules one and two. During this webinar, expert speakers will review key highlights from the first two modules, share Nigeria specific guidance, and respond to questions from participants.
Part 2: https://www.slideshare.net/jsi/prep-elearning-discussion-2
Chair, Donna E. Sweet, MD, AAHIVS, MACP, prepared useful Practice Aids pertaining to HIV for this CME/MOC/NCPD/CPE activity titled “The HIV Prevention–Certified Provider Program: A Training and Certificate Program Designed to Improve Competencies and Expand the HIV Prevention Workforce.” For the full presentation, downloadable Practice Aids, monograph, and complete CME/MOC/NCPD/CPE information, and to apply for credit, please visit us at https://bit.ly/34T9Mfk. CME/MOC/NCPD/CPE credit will be available until November 11, 2022.
Expert Panelists: Dr. Jason Reed, Biomedical HIV Prevention
Technical Advisor, Jhpiego & Dr. More Mungati, STAR-L Director, EGPAF, Lesotho
Moderator: Dr. Seema Ntjabane, Care & Treament Specialist, USAID-Lesotho
Similar to Project RSP! Training on PrEP for HIV Prevention (19)
The Rectal Revolution is Here - January 29, 2015 - New Orleans, LAJim Pickett
IRMA's Jim Pickett provided an update on rectal microbicide research and advocacy at the "Building Healthy Communities by Breaking Down Barriers - 2015 CBO Orientation", presented by Louisiana Department of Health and Hospitals. Presentation was made on Jan 29, 2015.
January 29, 2015 – New Orleans
Dec 11, '14 WEBINAR - Lubes, Rings, Films, Fibers, and Shots 4 HIV PreventionJim Pickett
Project RSP+ Webinar - December 11, 2014. Presentation explores the pipeline of new HIV prevention technologies in the research and development phase. This project is an initiative of the AIDS Foundation of Chicago.
Exploring the Pipeline: Lubes, Rings, Films, Fibers, and Shots 4 HIV PreventionJim Pickett
This is a training on the research and development pipeline for new HIV prevention technologies - including PrEP, microbicides, and new male and female condoms. It was conducted by AIDS Foundation of Chicago's Jim Pickett on Thursday, October 9, 2014 in Chicago, Illinois. These slides have been revised and updated from the same training conducted in Bloomington, IL on Sept 29.
This is a training on the research and development pipeline for new HIV prevention technologies - including PrEP, microbicides, and new male and female condoms. It was conducted by AIDS Foundation of Chicago's Jim Pickett in partnership with the Illinois Public Health Association, on Monday, September 29, 2014 in Bloomington, Illinois.
Marvin Thompson's, advocate, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Beyond PrEP: Intersectionality, Resilience & the Health of Black MSMJim Pickett
David Malebranche's, University of Pennsylvania, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Jim Pickett's, AIDS Foundation of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Kali Lindsey's, amfAR, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Invisible Men who have Sex with Men and Survival: From Practice to Research a...Jim Pickett
John Schneider's, University of Chicago, presentation at the Sex in the City II: Men, Sex, Love and HIV conference, held in Chicago on September 25, 2014. Sponsored by AIDS Foundation of Chicago and other partners.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Our time together
• Intros
• What is Project RSP?
• What do YOU think about PrEP?
• Overview of ARV-based prevention
• Understanding PrEP
– What is PrEP?
– What is research telling us about PrEP?
– How do you use PrEP?
– How do you get PrEP?
• Talking to clients about PrEP
2
3. • Trainings: Help Chicago providers, educators, and others
working directly with our community to understand PrEP
and what it means for us and HIV prevention.
• Community forums: Interactive and fun discussions done
“talk show” style – first was May 22 at Center on Halsted.
Next will be in fall and on south side. Stay tuned.
• Give voice/provide facts: Platform for PrEP users to share
experiences, interested individuals to get info –
click myprepexperience.blogspot.com.
3
8. What is ARV-based prevention?
• Strategies that use HIV treatment
drugs (antiretrovirals or “ARVs”) to
prevent HIV infection
– TLC+ (testing, linkage to care, plus
treatment)
– ARV-based microbicides
– PEP (post-exposure prophylaxis)
– PrEP (pre-exposure prophylaxis)
8
9. Testing drugs for prevention
• Phase I – small number of
ppl, short duration, safety
and acceptability
• Phase II – more
people, longer, safety and
acceptability
• Phase IIb, III – LARGE
trials, lots of people, multi-
year, does this thing work?
9
10. • Provide ARV treatment to HIV+
people who accept it voluntarily
– Improve treatment access for
HIV+ , improve health
coutcomes
– Offer treatment earlier in the
course of the disease
– Reduce individual viral
load, reduce community viral
load
– Reduction in onward HIV
transmissions
Testing, linkage to care, plus treatment – TLC+
10
11. What research says about TLC+
HPTN 052 trial
demonstrated 96%
reduction in sexual
transmission of HIV
between (mostly)
heterosexual
serodiscordant
couples.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3486734/
Limitation – how applicable for
gay men or IDU?
11
12. ARV-based microbicides
• Substances in development that would
reduce sexual transmission of HIV ( they
don’t exist outside of clinical trials)
• Applied rectally or vaginally
– Gels, vaginal rings
• Future formulations could include
films, rectal enemas
• Microbicides don’t have to be ARV-
based, though most products
currently under investigation are
• Other compounds have been tested;
scientists are exploring non-ARV
formulations
12
13. Microbicides, the research says:
• CAPRISA 004 – reported 2010, first to show
efficacy
• 1% tenofovir reduced HIV in women by
39%, in South Africa
• Tested product efficacy, before and after sex
• VOICE – reported 2013, no efficacy, low
adherence
– African women in Uganda, S.
Africa, Zimbabwe
– Daily use 1% tenofovir gel, tenofovir
tablet, Truvada tablet
• FACTS – confirmatory trial
underway, CAPRISA protocol, S. Africa
13
14. Rectal microbicide trial
• MTN 017– first Phase II ever, safety and
acceptability (not efficacy)
– Modified version of tenofovir gel (booty
friendly) and Truvada tablet
– Open-label, cross-over design
• Daily gel, gel w/sex, daily Truvada (8wks ea)
– 186 gay men, transgender women
– US, Peru, South Africa, Thailand
• US = Pittsburgh, Boston, San
Francisco, Puerto Rico
– Starting later this year (US sites in
June?) 14
16. Post-exposure prophylaxis (PEP)
Provide 2 or 3-drug regimen of ARVs after HIV
exposure to stop infection
• Typically offered to health care
providers exposed to HIV via needle
stick
• nPEP – offered for non-occupational
exposure, sexual exposure, injection
drug use exposure
• Must be taken within 72 hours of
initial exposure, small window
• ARVs must be taken for 28 days
16
17. Accessing PEP
• Any doctor is able to prescribe
• HIV docs the best to manage PEP, most likely to
prescribe
• Available at no cost through CORE Center’s walk-in
clinic M-F 8:30am-3:30pm, 312.572.4700. Also
available at HBHC.
• Person must come in weekly for meds and monitoring
• ERs can/do start PEP, but only provide 3 days of meds
– Necessary that person is engaged with provider for
duration of regimen for monitoring and HIV testing
17
20. Hold up, what is prophylaxis?
• Prophylaxis is simply the provision of
medications prior to germ or virus
exposure to prevent infection.
• This is not a new concept.
• This is not a new practice.
• Example: taking malaria drugs
before traveling to countries with
high malaria incidence
• What are examples of similar concepts?
20
21. So, what is PreP?
• PrEP involves an HIV-negative person taking
ARVs to reduce risk of infection BEFORE HIV
exposure. It prevents HIV from reproducing in a
person’s body.
• In current approved formulation, PrEP is taken
in a single pill once a day, every day (Truvada).
.
21
22. So, what is PreP?
• Need to take 7 days of Truvada before enough
drug is “on board” for protection. Then daily.
• Truvada is currently the only drug (actually a
combination of 2 drugs) approved by the FDA
for PrEP.
• Truvada is a combination of tenofovir disoproxil
fumarate (aka tenofovir or TDF) and
emtricitabine.
22
23. 23
“Taking the Truvada does not
make me ‘reckless’ in my decision
to have unprotected sex, it makes
me feel supported by a
community of doctors and
advocates who recognize the
nuances of my situation, and are
doing all they can to
help me stay negative.”
– Woman with HIV+ partner who started
PrEP because they wanted to have a child
24. PrEP Truvada
• PrEP will not always be only Truvada
• Researchers are currently exploring
other ARV drugs that could also be used
for PrEP
• For instance, the ARV drug Maravoric
(brand name Selzentry) is currently in
clinical trials as a potential PrEP drug
• Scientists are also researching the
possibility of intermittent use of PrEP
– May not have to be taken daily
– PrEP could be delivered via injection, and
could be longterm
24
25. Dateline: July 16, 2012
Today, the US Food and Drug Administration
approved Truvada (emtricitabine/tenofovir
disoproxil fumarate), the first drug approved
to reduce the risk of HIV infection in
uninfected individuals who are at high risk of
HIV infection and who may engage in sexual
activity with HIV-infected partners. - FDA
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312210.htm
25
26. • Truvada is approved for use as part of a comprehensive HIV
prevention strategy that includes other prevention methods, such
as safe sex practices, risk reduction counseling, and regular HIV
testing. - FDA
– Must be confirmed HIV-negative before prescription
– FDA required development of Risk Evaluation and Mitigation
Strategy (REMS) for use of Truvada as PreP to ensure safe use
• Medication guide
• Community education
• Provider training
• Implementation
Dateline: July 16, 2012
26
28. How did we get here? (Research!)
• All completed trials done on tenofovir & Truvada
• 3 trials = PrEP reduced risk of HIV infection
– i-PrEX (Truvada in gay men and trans women)
44% reduction overall (reported 2010)
Efficacy at 90% + with good adherence
– Partners PrEP (Truvada and tenofovir in het couples)
75% reduction Truvada (reported 2011)
– TDF2 (Truvada heterosexual men & women)
63% reduction overall (reported 2011)
28
29. How did we get here? (Research!)
• 2 trials = PrEP did not work
– FEM-PrEP (Truvada in women – stopped 2011)
– VOICE (Truvada, tenofovir – reported 2013)
• Both had very low adherence – though
self-reports were high)
• Low/undetected drug levels
• SOON - Bangkok Tenofovir Study (BTS)
– CDC study of injection drug users (2,400 +)
• Median age 31, 80% male
– Daily tenofovir (75% chose directly-observed therapy)
– BTS results being reported in the next couple
of months
29
30. Home-grown Chicago PrEP research
• Project PrEPare
– Feasibility and acceptability trial of PrEP
– Enrolled 68 young gay/MSM
• ages 18-22
• 53% African-American, 40% Latino
– Randomized to Truvada, placebo, or
no-pill arm
– On study for 6 months
• very high retention (98.5%)
• self-reported adherence averaged 62% (range 43% - 83%);
detectable drug levels ranged from 63% - 20%
• unprotected sexual activity
decreased across all study arms
30
31. Home-grown Chicago PrEP research
• iPrEx OLE (Open Label Extension)
– First – what does “Open Label” mean?
– iPrEx randomized trial was diverse
worldwide, but not in the US
– Missing representation from
communities most affected
domestically
– Asked Chicago’s Project PrEPare
participants if they would like to join
iPrEx; 46 of 68 agreed
– Data soon!
31
32. Home-grown Chicago PrEP research
• Project PrEPare II
– Open label demonstration project AND
safety study of PrEP in young gay/MSM
ages 15-22
– Actively enrolling 300 youth in 13 US
sites, including Chicago
– Research questions:
1. How safe is PrEP use is among HIV-
uninfected young gay/MSM?
32
33. Home-grown Chicago PrEP research
• Project PrEPare II
2. What is acceptability, patterns of use, rates of
adherence and measured levels of drug exposure
when YMSM are provided PrEP and info re: safety
and efficacy of PrEP?
3. When YMSM are provided behavioral intervention
as well as PrEP and info re: the safety and efficacy of
PrEP, what are the patterns of risk?
4. Is implementing an efficacious group level or
brief individual level sexual risk reduction
intervention prior to provision of PrEP
acceptable and feasible?
33
34. Home-grown Chicago PrEP research
• Project PrEPare II
5. Is implementing a text messaging adherence
reminder intervention for youth whose adherence is
less than 80% acceptable, feasible?
6 . Are there demographic and/or behavioral
differences between youth who stay on PrEP
compared to those who discontinue?
7. Are there demographic and/or behavioral
differences between youth who interested in
participating in a PrEP study versus those who are
not?
34
35. Key research findings/Truvada
• Adherence! Adherence! Adherence!
• High adherence achieved 90%+ reduction in risk
• There appears to be a general “start-up
syndrome” w/Truvada that includes
nausea, diarrhea, abdominal pain and
headaches.
• Mild nausea most common (about 6% or less) and
resolved in 4 to 6 weeks
35
36. Key research findings/Truvada
• Truvada PrEP trials to date have not shown
increases in sexual risk behavior among
participants
• Across all PrEP studies of Truvada, there have
been no serious safety problems
• Very little drug resistance has been seen for
those that seroconvert, mostly among those
with unidentified HIV infection when they
started the study
36
41. 41
Relative efficacy of TLC+, PrEP, other strategies
HPTN 052 (ARV treatment as prevention)1
Medical male circumcision1
STD treatment1
Partners PrEP (FTC/TDF) in discordant couples1
Subjects with detectable drug levels3
TDF2 (FTC/TDF) in men & women1
iPrEx (FTC/TDF) in MSM1
Subjects with detectable drug levels2
CAPRISA 004 (1% TFV vaginal gel) in
women1
FEM-PrEP (FTC/TDF) in women6, VOICE (FTC/TDF, TDF, TFV vaginal gel) in women7,
HIV vaccine (RV144)1
96%
75%
90%
62%
54%
94%
42%
39%
0 10 20 30 40 50 60 70 80 90 100
Efficacy (%)
Study
Reduction in HIV
Transmission
Not Significant
Condoms in heterosexuals4
Condoms in US MSM5
80%
70%
44%
1. Adapted from Abdool Karim S and QA. Lancet 2011;S0140-6736:1136-7
2. Amico R, et al. IAC 2012. Washington DC. #TUPE310
3. Baeten J, et al. NEJM 2012;367:399-410
4. Weller S, et al. Cochrane Database Syst Rev 2002:CD003255
5. Smith DK, et al. CROI 2013; Atlanta, GA. Oral #32
6. van Damme L, et al. NEJM 2012;367:411-422
7. Marrazzo JM, et al. CROI 2013; Atlanta, GA. Oral #26LB
42. What PrEP does not do
• Truvada as PrEP does not
– Guarantee 100% protection from HIV (what does?)
– Protect a person against other STIs like
chlamydia, syphilis, herpes, or gonorrhoea
– Prevent pregnancy
– Cure HIV
– Function, on its own, as a treatment regimen for someone
already living with HIV.
– Why is Truvada, on it’s own, not considered adequate for
treatment?
42
43. Why PrEP does not work for treatment
• People with HIV require taking
at least three ARVs together
• The two drugs in Truvada are
not sufficient to control the
virus
• A HIV+ person taking Truvada
on its own runs the risk of
developing resistance to the
drug, which will limit drugs
s/he can take for treatment
43
44. CDC – Clinical Practice Guidelines
• For clinicians – not “all purpose”
• Being drafted – expect to publish second half 2013
– Now – peer review, public engagement draft guidelines
– Next step to HHS for approval – then publish
• Includes info on evidence, guidelines for
screening, providing PrEP to gay men and
heterosexuals, discontinuing PrEP, clinical
considerations, improving adherence, reducing risk
behaviors, info on financial case management, fact
sheets, risk index, counseling info, and quality measures
44
45. Taking PrEP – what does it take?
• Adherence! Taking the pill every
day.
• Take 7 days before enough drug
is “on board” to provide
protection
– Still must take Truvada every day
• Honest, open, and ongoing
discussions with a medical
provider about sexual activity
and HIV risk
• HIV antibody test – before first
prescription, and then every 3
months. Rx renewal tied to
renewed HIV-negative test.
45
46. Taking PrEP – what does it take?
• Hepatitis B testing
• Kidney function testing
• Bone density testing
• STI screening (and
treatment if necessary)
• Pregnancy testing
• Doctor visits approx. every
3 mos to conduct all the
above
46
48. Who might be a good fit for PrEP?
• Person indicates an interest in taking PrEP
• Person is in a “magnetic” relationship
–HIV-negative and has HIV+ partner
–Serodiscordant
48
49. Who might be a good fit for PrEP?
• Sexual activity within high prevalence area or
social network, and/or:
– Doesn’t use male or female condoms consistently
– Diagnosed with STI(s)
– Exchanges sex for money, food, shelter, drugs, etc.
– Uses illicit drugs or depends on alcohol
– Is or has been incarcerated
– Does not know partner’s HIV status and one of the
above factors is true for partner
49
53. Is PrEP cost-effective?
• Modeling studies show the following factors to impact the cost-
effectiveness of PrEP:1-13
– Medication cost and availability of insurance coverage
– Targeted use among men and women at high risk
– Efficacy
– Changes in risk behavior
• Several analyses show PrEP to be cost-effective, particularly
when targeted to individuals at high risk of HIV acquisition2-5
1. Smith D. National Prevention Conference 2011. Atlanta. #E04
2. Juusola JL, et al. Ann Intern Med 2012;156:541-550
3. Desai K, et al. AIDS 2008;22:1829-1839
4. Walensky R, et al. CID 2012;epub April 3
5. Anderson J, et al. EACS 2009. Cologne.
6. Buchbunder S, et al. CROI 2012. Seattle. #1066
7. Grant R, et al. IAC 2006. Toronto. #THLB0102
8. Supervie V, et al. PNAS 2010;107:12381–12386
9. Paltiel DA, et al. Clin Infect Diseases 2009;48:806-15
10. Hill A, et al. CROI 2006. Denver. #Y-127
11. Hallett T, et al. CROI 2011. Boston. #99LB
12. Pretorius C, et al. PLoS ONE 2010;5:e13646
13. Abbas U, et al. PLoS ONE 2007;2:e875
53
55. Accessing PrEP
• Any doctor who can write a
prescription can write one for
Truvada as PrEP
• Most HIV docs are familiar
with PrEP
• CORE, John Stroger
Hospital, HBHC, ACCESS Grand
Blvd, TPAN (for referrals) and
more
55
56. Accessing PrEP – Howard Brown
• Howard Brown Health Center –
primary care
services, including PrEP access
• HBHC providers experienced
with PrEP, existing patient
population accessing PrEP
• Dedicated adherence
counselor, like case manager
for PrEP patients
56
www.howardbrown.org
57. Accessing PrEP – Howard Brown
• Assists w/accessing medication
assistance, copay programs
• Walgreens onsite – reduce anxiety over
filling prescription some might think
“embarrassing”
• Pediatrician on-staff for 18 to 25
• Trans Health Advocates, Adherence
Counselors support transgender
patients accessing hormones, PrEP
57
www.howardbrown.org
58. PrEP ed for your doc
• Bring along a fact
sheet if you think
your doctor may
need some PrEP ed
58
www.myprepexperience.blogspot.com
59. Accessing PrEP— insurance
FDA approval of
Truvada enables
private ins to cover
Truvada
on
Medicaid
formulary
Ins companies
covering, so far
ADAP
does not
cover PrEP
59
60. Accessing PrEP – Gilead
1. Visit
www.truvada.com
2. Click on the link to
access information
about Truvada for a
PrEP indication
60
61. Medication assistance
• Gilead will provide Truvada for PrEP at no cost* for
individuals who qualify for the assistance program
Program
Element
Truvada PrEP Medication Assistance Program
Eligibility
Criteria
US resident, uninsured or no drug coverage, HIV-
negative, low income (200% FPL)
Drug
Fulfillment
Product dispensed by Covance Specialty
Pharmacy, labeled for individual patient use and
shipped to prescriber (30 day supply); no card or
voucher option
Recertification
Period
6 months, with 90 day status check
6161*Still need to consider costs of medical care
63. www.Truvada.com – Providers
• Allows providers to:
– Access to free male and female condoms
– Obtain lab forms for free HIV-1 and HBV testing provided
that HCP has completed the online training and registered
– Gilead Medical Affairs Contact Number for subsidized
resistance testing for individuals who seroconvert
– Receive similar training on the indication to the REMS
website
– Access to Gilead’s Medication Assistance Program for
download
– Access to all REMS materials for download
63
64. www.Truvada.com – HIV neg people
• Allows HIV-1 uninfected individuals to:
– Common questions, safety information
– Access to free male and female condoms
– Opt-in for reminder service regarding regular testing for HIV-1
and other STDs (coming soon)
64
65. HIV franchise co-pay card program
• Covers all Gilead HIV Products: Stribild, Complera, Atripla,
Truvada, Viread, Emtriva
• Assists patients with commercial insurance who reside in
the US, or US Territories
• Not valid for Rx that are eligible to be reimbursed by any
federal or state funded healthcare benefit program
• Co-pay benefit provides assistance for co-pays above $0
• Monthly benefit provided for 12 mos after activation of
card
• Maximum benefits: Stribild, Complera Atripla
– Monthly $400
– Annual $4,800
• Maximum benefits Truvada, Viread, Emtriva
– Monthly $200
– Annual $2,400
• Benefit automatically renews after 12 mos without need
to re-enroll
• Service Provider: McKesson
• 877.505.6986
67. Messages to emphasize to clients
• PrEP is an OPTION
– Not forever, but maybe for a “season”
• Person must test HIV-negative to initiate
and continue PrEP.
• Daily adherence to PrEP is essential to
reduce person’s risk of HIV – and can be
very effective.
• Taking PrEP does not guarantee 100%
protection from HIV (but does anything?)
67
68. Messages to emphasize to clients
• Daily use of Truvada as PrEP cannot and
does not function as HIV treatment. Why
is Truvada on its own not adequate for
treatment?
• PrEP user must be engaged with regular
health care for prescription, to ensure
remaining negative, staying
adherent, kidney health, etc.
• PrEP doesn’t make male or female
condoms obsolete!
68
69. Tips for talking about PrEP
• Important you feel comfortable and
confident talking about PrEP.
• It’s okay to not have all of
the answers and to refer
your client to additional
resources and/or promise to
have that information next
time you see him/her.
69
www.myprepexperience.blogspot.com
70. Tips for talking about PrEP
• As a provider of prevention services, you are
viewed as a trusted source of information.
• Remember any perspectives/opinions you have
about PrEP and/or people who use PrEP will
translate to your clients.
70
71. Adherence, Adherence, Adherence
• Strategies for adherence include:
– Take pill each day at same time
– Place pill bottle in visible place, same
place
– Set cell phone alarms
– What are some other strategies?
– What should you do if you forget a
dose?
71
72. • My PrEP Experience www.myprepexperience.blogspot.com
(training slides)
• RSP on FB https://www.facebook.com/ProjectRSP
• Project PrEPare www.projectprepare.net
• Howard Brown www.howardbrown.org
• Truvada as PrEP www.Truvada.com
• Project Inform www.projectinform.org/prep
• AVAC www.avac.org
– Thanks to AVAC for several slides.
Web resources on PrEP
72
73. Onward RSP!
• What will you do with the info you learned today?
• How will you educate your clients about PrEP?
– Your colleagues? Your friends?
• Future training?
73
75. Please stay in touch
• Sybil Hosek
sybilhosek@gmail.com
• Jessica Terlikowski
jterlikowski@aidschicago.org
• Michael “Mikey” Landreth
mlandreth91@gmail.com
• Mark Bernstein
mark.bernstein@gilead.com
• Keven Cates
kevenc@howardbrown.org
• Jim Pickett
jpickett@aidschicago.org
• Project RSP!
myprepexperience@gmail.com
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Editor's Notes
Jim and/or Jessica
Jim and/or Jessica
Jim and/or JessicaARV-based prevention strategies refer to a category of methods that use HIV treatment drugs called antiretrovirals (ARVs) to prevent HIV transmission. These methods include TLC+ (testing, linkage to care, plus treatment), vaginal and rectal microbicides, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). TLC+: Provision of ARV treatment and care to HIV-positive people with the aims of preserving the health of people living with HIV and reducing the likelihood of transmitting the virus to others by reducing the amount of virus in their blood. TLC+ involves expanding testing and treatment efforts. It also requires offering treatment to people as soon as they test positive for HIV, regardless of their T cell count. This strategy is also known as Treatment as Prevention (TASP) and Treatment for Prevention (T4P). PrEP: Provision of ARV drugs to an HIV-negative person with the aim of reducing the risk of contracting HIV. All trials to date have tested Truvada and tenofovir. This approach is also known as oral prevention, oral PrEP.ARV-Based Microbicides: Substances that can be applied to the vagina or rectum to reduce sexual transmission of HIV. Formulations could include gels, vaginal rings, films, enemas. The majority of compounds currently in trials are ARV-based.PEP: Provision of ARVs after to person after HIV exposure. The drugs must be taken within 72 hours of exposure and for 28 days. The term n-PEP is used to describe non-occupational use.
Jim and/or Jessica
Jim and/or Jessica
Jim and/or JessicaARV-based prevention strategies refer to a category of methods that use HIV treatment drugs called antiretrovirals (ARVs) to prevent HIV transmission. These methods include TLC+ (testing, linkage to care, plus treatment), vaginal and rectal microbicides, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). TLC+: Provision of ARV treatment and care to HIV-positive people with the aims of preserving the health of people living with HIV and reducing the likelihood of transmitting the virus to others by reducing the amount of virus in their blood. TLC+ involves expanding testing and treatment efforts. It also requires offering treatment to people as soon as they test positive for HIV, regardless of their T cell count. This strategy is also known as Treatment as Prevention (TASP) and Treatment for Prevention (T4P). PrEP: Provision of ARV drugs to an HIV-negative person with the aim of reducing the risk of contracting HIV. All trials to date have tested Truvada and tenofovir. This approach is also known as oral prevention, oral PrEP.ARV-Based Microbicides: Substances that can be applied to the vagina or rectum to reduce sexual transmission of HIV. Formulations could include gels, vaginal rings, films, enemas. The majority of compounds currently in trials are ARV-based.PEP: Provision of ARVs after to person after HIV exposure. The drugs must be taken within 72 hours of exposure and for 28 days. The term n-PEP is used to describe non-occupational use.
Jim and/or JessicaARV-based prevention strategies refer to a category of methods that use HIV treatment drugs called antiretrovirals (ARVs) to prevent HIV transmission. These methods include TLC+ (testing, linkage to care, plus treatment), vaginal and rectal microbicides, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). TLC+: Provision of ARV treatment and care to HIV-positive people with the aims of preserving the health of people living with HIV and reducing the likelihood of transmitting the virus to others by reducing the amount of virus in their blood. TLC+ involves expanding testing and treatment efforts. It also requires offering treatment to people as soon as they test positive for HIV, regardless of their T cell count. This strategy is also known as Treatment as Prevention (TASP) and Treatment for Prevention (T4P). PrEP: Provision of ARV drugs to an HIV-negative person with the aim of reducing the risk of contracting HIV. All trials to date have tested Truvada and tenofovir. This approach is also known as oral prevention, oral PrEP.ARV-Based Microbicides: Substances that can be applied to the vagina or rectum to reduce sexual transmission of HIV. Formulations could include gels, vaginal rings, films, enemas. The majority of compounds currently in trials are ARV-based.PEP: Provision of ARVs after to person after HIV exposure. The drugs must be taken within 72 hours of exposure and for 28 days. The term n-PEP is used to describe non-occupational use.
Jim and/or JessicaARV-based prevention strategies refer to a category of methods that use HIV treatment drugs called antiretrovirals (ARVs) to prevent HIV transmission. These methods include TLC+ (testing, linkage to care, plus treatment), vaginal and rectal microbicides, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). TLC+: Provision of ARV treatment and care to HIV-positive people with the aims of preserving the health of people living with HIV and reducing the likelihood of transmitting the virus to others by reducing the amount of virus in their blood. TLC+ involves expanding testing and treatment efforts. It also requires offering treatment to people as soon as they test positive for HIV, regardless of their T cell count. This strategy is also known as Treatment as Prevention (TASP) and Treatment for Prevention (T4P). PrEP: Provision of ARV drugs to an HIV-negative person with the aim of reducing the risk of contracting HIV. All trials to date have tested Truvada and tenofovir. This approach is also known as oral prevention, oral PrEP.ARV-Based Microbicides: Substances that can be applied to the vagina or rectum to reduce sexual transmission of HIV. Formulations could include gels, vaginal rings, films, enemas. The majority of compounds currently in trials are ARV-based.PEP: Provision of ARVs after to person after HIV exposure. The drugs must be taken within 72 hours of exposure and for 28 days. The term n-PEP is used to describe non-occupational use.
Jim and/or JessicaTLC+: Provision of ARV treatment and care to HIV-positive people with the aims of preserving the health of people living with HIV and reducing the likelihood of transmitting the virus to others by reducing the amount of virus in their blood. TLC+ involves expanding testing and treatment efforts. It also requires offering treatment to people as soon as they test positive for HIV, regardless of their T cell count. This strategy is also known as Treatment as Prevention (TASP) and Treatment for Prevention (T4P).
Jim and/or Jessica
JimARV-Based Microbicides: Substances that can be applied to the vagina or rectum to reduce sexual transmission of HIV. Formulations could include gels, vaginal rings, films, enemas. The majority of compounds currently in trials are ARV-based.
Jim and/or Jessica
Jim and/or Jessica
Jim/Jessica
StaciPEP: Provision of ARVs after to person after HIV exposure. The drugs must be taken within 72 hours of exposure and for 28 days. The term n-PEP is used to describe non-occupational use.
StaciPeopleare only eligible for PEP if they present within 72 hours of exposure. They provide PEP to people who are sexually exposed to HIV, though they will not turn anyone away. The nurse I spoke with said they restricted it because they are an STI clinic. People have to come in each week for their next week of meds. If a person needs to access PEP during non-clinic hours, they can access it at Stroger ER. Stroger ER then refers to CORE for the full regimen.
StaciPeopleare only eligible for PEP if they present within 72 hours of exposure. They provide PEP to people who are sexually exposed to HIV, though they will not turn anyone away. The nurse I spoke with said they restricted it because they are an STI clinic. People have to come in each week for their next week of meds. If a person needs to access PEP during non-clinic hours, they can access it at Stroger ER. Stroger ER then refers to CORE for the full regimen.
Sybil
Sybil
Sybil
Sybil
This is taken from the My PrEP experience blog piece by a woman whose partner is positive and they want to get pregnant.
Sybil
Sybil
Sybil
Sybil
Sybil
SybilVOICE – Vaginal and Oral Interventions to Control the Epidemic – is a major HIV prevention trial designed to evaluate whether antiretroviral (ARV) medicines commonly used to treat people with HIV are safe and effective for preventing sexual transmission of HIV in women. The study has focused on two ARV-based approaches: daily use of an ARV tablet –PrEP – and daily use of a vaginal microbicide containing an ARV in gel form.VOICE stopped tenofovir gel arms because it failed to reduce women’s risk. Oral Truvada arm also demonstrated no risk reduction for women.
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Sybil
Staci
Jim/Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Jim and/or Jessica
Switch over to Staci
Staci
Staci
Staci
Staci
Staci
Sybil
SybilNOTE: we might make this into a palmcard/cheat sheet for providers
SybilNOTE: we might make this into a palmcard/cheat sheet for providers
Sybil
Sybil
Sybil
Jim and/or JessicaSybil and Staci – other sites to add?