Faculty

Gregg Alleyne, MD
Associate Professor
Director of HIV and Women’s Health
Director of Global Women’s Health Initiatives
Department of Obstetrics and Gynecology
Associate Professor
Department of Family, Community and Preventive Health
Drexel University College of Medicine
Philadelphia, Pennsylvania

Christian B. Ramers, MD, MPH
Assistant Medical Director, Research/Special Populations
Director, Graduate Medical Education
Family Health Centers of San Diego
Clinical Associate Professor
UC San Diego School of Medicine
San Diego, California

Statement of Need

Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) affect women, and both infections can be screened for in the women’s health setting of obstetric and gynecologic care. Once a woman with either or both of these infections is linked to care, she has a better chance of preventing transmission to others, including her unborn child.

The proportion of HIV cases in women tripled from 1985 to 2013 (7% to 24%).1 In 2017, adult and adolescent women represented 19% (7401) of the 38,739 new HIV diagnoses.2 Today, one-quarter of people living with HIV are women; 86% were infected via heterosexual transmission and 32% through injection drug use. HIV disproportionately affects black women, who represent only 15% of the female population in United States, yet 59% of cases of HIV in women.2 Only 1 in 8 HIV-positive Americans are unaware that they are infected3; 91.5% of new HIV infections were transmitted from people who were not in medical care.4

Furthermore, approximately 25% of all individuals infected with HIV are coinfected with HCV.5 Importantly, HIV increases the rate of progression of HCV-related hepatic fibrosis, and HCV is associated with a 3-fold increase in HIV antiretroviral therapy–induced liver toxicity.5

In addition to the problem of HIV, HCV infections are increasing in the United States, with an increase from 850 cases in 2010 to 2436 cases in 2015.6 The most rapid increase is among 20- to 29-year-olds who inject drugs, and many of these cases are women.6

Whereas HIV infection is now effectively manageable, chronic HCV infection is curable. Yet, despite new, highly effective direct-acting antiviral treatment regimens for HCV, their broad-scale use and associated therapeutic successes remain stymied by barriers at the patient, clinician, and healthcare system levels.7

OB/GYN clinicians are uniquely positioned to screen for these infections and, importantly, to link patients who test positive for HIV, HCV, or both, to appropriate specialist care. Linking patients to care has significant benefits, not only for the patient, but for others by minimizing transmission, including mother-to-child transmission to an unborn child.

References

  1. Centers for Disease Control and Prevention. HIV Surveillance Report. www.cdc.gov/hiv/library/reports/surveillance. Accessed March 19, 2018.
  2. Centers for Disease Control and Prevention. HIV Among Women. www.cdc.gov/hiv/group/gender/women/index.html. Accessed March 20, 2019.
  3. Centers for Disease Control and Prevention. HIV in the United States and Dependent Areas. www.cdc.gov/hiv/statistics/overview/ataglance.html. Accessed March 19, 2019.
  4. Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588-596.
  5. Sulkowski MS, Benhamou Y. Therapeutic issues in HIV/HCV-coinfected patients. J Viral Hepat. 2007;14(6):371-386.
  6. New hepatitis C infections nearly tripled over five years [press release]. Atlanta, GA: Centers for Disease Control and Prevention. May 11, 2017. https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html. Accessed March 19, 2019.
  7. National Viral Hepatitis Roundtable. Hepatitis C: The State of Medicaid Access. October 23, 2017. https://stateofhepc.org/wp-content/uploads/2017/10/State-of-HepC_2017_FINAL.pdf. Accessed March 19, 2019.

Target Audience

The educational design of this activity addresses the needs of OB/GYN physicians, nurse practitioners, nurse midwives, and physician assistants.

Educational Objectives

After completing this activity, the participant should be better able to:

  • Identify patients who have risk factors for HCV and HIV and obtain appropriate screening tests
  • Discuss principles of linkage of care for patients who have confirmed HCV and/or HIV infection
  • Counsel patients on the implications of HCV and/or HIV infection, including measures to prevent transmission

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Integritas Communications. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

The Postgraduate Institute for Medicine designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours. 

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high-quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty

Gregg Alleyne, MD: Nothing to disclose
Christian B. Ramers, MD, MPH: Consulting Fees: AbbVie, Gilead Sciences, Inc. Fees for Non-CME/CE Services Received Directly from a Commercial Interest or Their Agents (eg, speakers’ bureaus): AbbVie, Gilead Science, Inc., Merck, Viiv. Contracted Research: Gilead Sciences, Inc.

Planners and Managers

The PIM planners and managers have nothing to disclose. The Integritas Communications planners and managers, Julia Muino and Jim Kappler, PhD, have nothing to disclose.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. PIM and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must receive a minimum score of 70% on the post-test.

PIM Contact Information

For information about the accreditation of this program, please contact PIM via email at inquiries@pimed.com.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

 

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