WIXLIB

HIVTHE AMERICAN ACADEMY OF HIV MEDICINE www.aahivm .org JULY 2016Patient Care, Practice Management & Professional Development Information for HIV CARE ProvidersSpecialistTransgenderHealthExcellence inthe Care ofTrans Patients11TransgenderWomen & PrEP24HormoneTherapy29PartnerServices32

Brian had his HIV under controlwith medication. But smoking withHIV caused him to have serioushealth problems, including astroke, a blood clot in his lungsand surgery on an artery in hisneck. Smoking makes living withHIV much worse. You can quit.Call 1-800-QUIT-NOW.#CDCTipsHIV alonedidn’t cause theclogged arteryin my neck.Smoking withHIV did.Brian, age 45, California

HIVSpecialistCONTENTSTHE AMERICAN ACADEMY OF HIV MEDICINEPatient Care, Practice Management & ProfessionalDevelopment Information for HIV Care ProvidersCHAIR/BOARD OF DIRECTORSZelalem Temesgen, MD, AAHIVSEXECUTIVE DIRECTORJames Friedman, MHADIRECTOR OF MARKETING& COMMUNICATIONSAmber McCrackenEDITORRobert GattyG-Net Strategic Communicationsbob@gattyedits.comPUBLICATION DESIGNAND ART DIRECTIONBonoTom Studio, Inc.703-276-0612, info@bonotom.comADVERTISINGJane Dees RichardsonAAHIVM Advertising Salesc/o Ad Marketing Group, Inc.703-243-9046 ext. 102, Fax: HERThe American Academy of HIV Medicine1705 DeSales St., NW, Suite 700Washington, D.C. 20036202-659-0699 202-659-0976info@aahivm.org www.aahivm.orgEDITORIAL ADVISORY GROUPJULY 2016 Volume 8, No. 2 www.aahivm.orgF E AT U R E S8 From the Marginsto the MainstreamJoseph S. Cervia, MD, MBA, FACP,FAAP, FIDSA, AAHIVSClinical Professor of Medicine and Pediatrics,Hofstra North Shore-LIJ School of Medicine;Regional Medical Director, HealthCarePartners, IPA & MSO,Garden City, NYD. Trew Deckard, PA-C, MHS, AAHIVS,Steven M. Pounders, MD, PADallas-Fort Worth, TXTeresa Mack, MDSt. Lukes—Roosevelt HospitalNew York, NYRichard C. Prokesch, MD, FACP,FIDSA, AAHIVSInfectious Diseases Associates,Riverdale, GAJeffrey T. Schouten, MD, AAHIVE,Attorney at LawDirector HIV/AIDS Network Coordination(HANC) Project, Fred Hutchinson CancerResearch Center, Seattle, WASami Shafiq, PharmD, CPH, AAHIVELead HIV/AIDS Clinical PharmacistWalgreens PharmacyMiami, FLWilliam R. Short, MD, MPH, AAHIVSSidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphia, PACarl Stein, MHS, PAC, AAHIVSOwen Medical GroupSan Francisco, CANot Simply a ClinicianChallenges Remain forTransgender Health, Best PracticesNeeded for Proper CareInfluence of IntegratedTransgender Healthcare onART Adherence and OutcomesBY ASA RADIX, MD, MPH, AAHIVS andPETER MEACHER, MD, AAHIVSBY STEVEN R. KLEMOW, MD11 Excellence in theCare of Trans PatientsExpanding the Base of GenderAffirming Healthcare ProfessionalsBY LINDA WESP, RN, MSN, NP-C, AAHIVS,OSCAR E. DIMANT, MD CANDIDATE andTIFFANY E. COOK, BGS24 Transgender Women& PrEPPrEP as a Viable Option forHIV Incidence Reduction AmongTransgender WomenBY ELENA CYRUS andASA RADIX, MD, MPH, AAHIVS17 Culturally Sensitive In-Office 29 TransgenderHormone TherapyCare for the TGNC PatientBY ANDREW GOODMAN, MDPractical Guidelines for theHIV Care ProviderBY MEERA SHAH, MD, MS andASA RADIX, MD, MPH, AAHIVSCHAIRJeffrey T. Kirchner, DO, FAAFP, AAHIVSMedical DirectorPenn Medicine/LGHP Comprehensive CareLancaster General Hospital, Lancaster, PA20 Be a Healer,D E PA R T M E N T S2 LETTER FROM THE DIRECTORMaking a Change for GoodBY JAMES M. FRIEDMAN, MHA,EXECUTIVE DIRECTOR, AAHIVM3 LETTERS TO THE EDITORHIV Workforce CrisisPHIL BOLDUC and AIMEE CASTELLON-MAESTRI4 AT THE ACADEMYDan Ebeling Joins AAHIVMas Credentialing Director5 IN THE NEWSCDC Offers New Materials FeaturingTransgender Women Living with HIV; ‘Do Ask,Do Tell’ Toolkit; Biomarker Tracks AcceleratedHIV-Associated Aging; President Reflects on35th Anniversary of HIV/AIDS in America;Johns Hopkins Performs First TransplantsBetween HIV Donors and Recipients;Pentagon Ends Transgender Troops Ban32 BEST PRACTICESBenefits of Ongoing Small TalksAbout Partner Services in HIV CareBY RONALD WALCOX, MD35 AT THE FOREFRONTTraining Opportunities in HIV Medicine for Residents and Medical StudentsBY JEFFREY T. KIRCHNER, DO, FAAFP, AAHIVS andPHILIP J. BOLDUC, MD, AAHIVS36 HC/HIVU.S. Study Looks at Long-Term Durabilityof Hepatitis C Cure, Risk of Relapseand Liver Cancer37 HIV & AGINGHigh Prevalence of Geriatric ConditionsAmong HIV People Over Age 50in SanFranciscoSharon Valenti, NP, AAHIVSSt. John Hospital and Medical CenterGrosse Point Woods, MIwww.aahivm.orgHIVSpecialistJULY 20161

LETTER FROM THED IR ECTO RBY JAMES M. FRIEDMAN, MHAEXECUTIVE DIRECTOR, AAHIVMMaking a Change for GoodIMET KEN SOUTH on my first day as executive director of the Academy in September,2007. When I joined AAHIVM, Ken had been with the organization for only six weeks asdirector of membership. Ken did an excellent job building and managing the AAHIVMmembership until he transitioned over as head of credentialing following the untimelypassing of Director Peter Fox in 2012.The Academywill greatlymiss Ken’sleadership,insight andpassion foradvancingthe care andtreatment ofHIV patients.2JULY 2016HIVSpecialistUnder Ken’s leadership, the CredentialingBesides providing a forum for me to thankProgram doubled in size, the credential for HIV Ken and welcome Dan, this is an important HIVPharmacists (AAHIVP) was introduced, and the cre- Specialist because it explores a topic many of ourdentials were extended to three years. The Academy providers have asked us to cover, transgender health.will greatly miss Ken’s leadership,While the transgender communityinsight and passion for advancing thehas been in the news as a topic ofcare and treatment of HIV patients.societal debate, one fact is not deBut on a personal level, it will bebatable: the provider communityme who will miss him the most. Hewants and needs to learn more aboutwas the only one on staff that I couldthe unique health challenges facingtalk to about black and white TV, thetransgender individuals.Studebaker, the Kingston Trio, or ViceAs it relates to HIV, studies revealPresident Nixon. Thankfully, he willhigh HIV prevalence rates amongbe staying on for one day per weektransgender women in the UnitedStates, with African-American transto direct and manage our HIV andAging project—which he developed.gender women being more likely toJames M. FriedmanWe have been fortunate to findhave HIV than transgender womenand hire Dan Ebeling, who held a management of other races/ethnicities. We know that manyposition at the Registry of Interpreters for the social and structural factors pose challenges toDeaf (RID), where he was responsible for the preventing HIV among transgender people. Thismanagement and growth of their credentialing edition explores many of those issues, along withprogram. The RID program is both larger and clinical insight into treatment and prevention.more complicated than our credentialing programI would like to extend my sincerest gratitudein that it included over 1,800 individual exams per to Dr. Asa Radix and Dr. Peter Meacher of Callenyear, including management of a network of over Lorde Community Health Center in New York, NY,40 remote test sites. Dan will provide a fresh per- for serving as our guest editors for this issue. Thespective and new insight into strategically growing pages that follow provide the valuable insight intoour credentialing program. I have no doubt he is transgender health that our providers requested,the right person to accept the baton from Ken as thanks to their contribution and their collaborationHIVwe continue to run the race to end this epidemic. with top experts in the field. www.aahivm.org

LETTE RS TO TH E E DITO RHIV Workforce CrisisTHANK YOU for writingthat important piece inthe March HIV Specialistabout the HIV workforcecrisis.I wanted to let youknow that there is anotherFM-based HIV fellowship,now in its second year, thatI started at UMass in Julyof 2014, in response to theneed you outline in yourarticle and the NHAS.Here is a link to ourhomepage: http://www.umassmed.edu/fmch/fellowships/hiv/, whichis listed on both theAAHIVM and HIVMAwebsites.I was the lead authoron the most recent AAFPHIV/AIDS CurriculumGuideline you mentioned,and Jeff Kirchner was acontributing editor.Later this month theFP Essentials MonographCare of the HIV Patientwill be published, writtenby myself and three ofmy colleagues at UMass/Worcester. /editions/443-ed.html, and here is the linkto the AAFP CurriculumGuideline: ation residency/program directors/Reprint273 HIV.pdfTHE ISSUE of primarycare physician shortagesis very concerning for thehealthcare delivery in ournation. I was pleased to readthat one solution to thisshortage is to engage morenurse practitioners intoproviding HIV care in thearticle titled “One solutionto looming physicianshortage” in the March 2016issue of HIV Specialist.It is a fact that as ofMarch 2016, only 21states and the District ofColumbia, allow nursepractitioners full scopeauthority/practice; however,the three states mentionedas having the highestprevalence of HIV (NewYork, California, andFlorida) ALL have restrictedscope of practice. The articleAlong with ChrisBositis, of Lawrence, MA,I am also the STFM HIVWorking Group Co-Chair.Chris runs an HIV AOC inLawrence, and we are bothcommitted to addressingthe HIV workforceshortage.I thought that I shouldput Chris’s and my name onyour radar given our similarprofessional passions in thisarea.Thank you,Phil BolducHIV Program andFellowship DirectorAssistant Professor ofFamily Medicine andCommunity HealthUniversity ofMassachusetts MedicalSchoolFamily Health Centerof Worcesterstates California has fullscope authority/practice,which it does not.Thank you for yourtime and for addressingthat nurse practitioners arean integral solution to theoverall transformation ofhealthcare delivery.Sincerely,Aimee Castellon-Maestri,RN, BSN, DNP student HIVHIVSpecialistTHE AMER ICANACADEMY OF HIVPatient Care, PracticMEDI CINEe Managementwww.aahiv m& Professional.org MARC HDevelopment Informa2016tion for HIV CAREProvidersIN CRISKey Datafrom CROIThe HIV WorkfISorce8A Looming CrisisA LoomingShortageASHPGuidelinesThe HIV WorkforceTransgenderCare122228Searching forsolutions to solvethe growing shortageof HIV physiciansBY BOB GATTYSEVEN YEARS AGO in its inaugural issue, HIV Specialistwarned that a critical shortage of practitionerswho treat HIV/AIDS patients in the United Stateswas looming, predicting that more than 32% oftoday’s HIV clinicians would stop providing thatcare over the next 10 years.That report was based on a survey by the AmericanAcademy of HIV Medicine (AAHIVM) of its membersand suggested this would happen as the HIV workforceages and increasing numbers of clinicians reach retirementage. Although the survey showed that specializing in HIVhas been professionally rewarding by the majority ofHIV clinicians, that sense of satisfaction apparently hasnot resulted in enough medical students (and residents)planning to pursue a career in HIV medicine to replacethose who are retiring.In fact, only about one-third of students who decidedto join AAHIVM said they planned to pursue a careerin HIV medicine, with two of three saying that medicalschool debt would influence their ultimate choice ofcareers, prompting them to choose specialties that wouldpay a higher annual salary than working in HIV medicine.Sadly, it appears not much has changed and, in fact,the warnings issued by AAHIVM seven years ago arebeginning to materialize. In April 2011, the Institute ofMedicine (IOM) report HIV Screening and Access to Caresaid projections of the U.S. HIV care workforce, as well asthe primary care workforce generally, indicate there willbe a shortage of providers needed to handle the numberof people in the U.S. who need to be tested and treated.The report noted that many among the “first generation” of HIV providers are reducing their practices orretiring, and that relatively few new health professionalsare choosing to specialize in HIV ecialistHIVSpecialistMARCH 201613JULY 20163