Health Centers On The Front Lines

Guests featured in this episode:

Keosha Bond, M.D., Assistant Medical Professor, City University of New York School of Medicine

Tori Cooper, Director of Community Engagement for the Trans Justice Initiative, Human Rights Campaign

Latesha Elopre, M.D., Associate Professor, Division of Infectious Diseases, University of Alabama at Birmingham


Moderator: Alexandra Walker, Director of Digital Communications, National Association of Community Health Centers

Alexandra:. Welcome to Health Centers on the Frontlines, the podcast of the National Association of Community Health Centers. Today is the third and last in a three-episode series we've been doing about an epidemic that the nation's health centers have been battling for decades: HIV and AIDS. PrEP access and use remain unequal in the United States, with women overall accessing it at a fraction of the rates of men. Meanwhile, one in five new HIV cases annually occurs in women. The overwhelming majority of Black women. Transgender women specifically, are at an even greater risk for HIV acquisition and oftentimes lack access to competent care to access primary care. When we think about health centers and all the work that is done with Black communities, we cannot leave HIV prevention and care for Black women out of the conversation.

To discuss today, we are joined by a panel of experts, Dr. Keosha Bond, Assistant Medical Professor at the City College of New York. Tori Cooper, Director of Community Engagement for the Trans Justice Initiative at Human Rights Campaign, and Dr. Latesha Elopre, Associate Professor in the Division of Infectious Diseases at the University of Alabama at Birmingham.

We start this conversation about ways that health centers can improve the engagement of Black cisgender and transgender women in HIV testing, prevention, and care. So if we could start with you, Latesha, how can we improve messaging about HIV prevention and care to improve acceptance of services among all Black women?

Latesha: Thank you. So, my name's Latesha and my pronouns are she and her, and I am really excited to be able to talk about this topic. I think that when we’re talking about access and we’re talking about it for specific populations, we have to do it in the framing and the understanding that access is not equitable to begin with. So number one, there is a system-level barrier in regards to who's able to receive the services. So when we’re understanding why, we’re seeing inequalities in regards to certain geographic locations. We're talking about things like being in a non-Medicaid expansion state, having poor public transit opportunities available to you where you live, being impoverished, and being a victim of systemic racism, those are all barriers that communities of color face a lot of times on a day-to-day basis that make access difficult.

But when we're talking about specifically, how do we improve messaging and understanding around PrEP and HIV testing and prevention, I think that we have to do it from a framework where we're not talking about risk, but we're talking about health. And that's something that we haven't been doing well in regards to public health in general. So I've been very excited, I think, where a lot of conversations have been moving and shifting, because right now if you were to ask many people in America right now, do you think you're at risk for HIV? Should you be tested? They would say no. And based on how we've defined risk from a public health standpoint, you know, the answer actually would be not based on CDC guidelines and recommendations, a lot of times would put people, quote-unquote, at risk is nothing more than where you live. And that's social determinants of health that are currently impacting you.

So, I think we just have to change our messaging, be more sex-positive, be more health-focused and oriented, more talking about HIV testing, PrEP, and messaging.

Alexandra: Thank you. And turning to you, Tori, thank you for joining us. What are some of the things that you believe health centers can do to improve engagement of Black, cisgender, and transgender women, HIV testing and prevention, like PrEP?

Tori: Well, thank you for having me. My name is Tori Cooper and my pronouns are she and her. And I'm a Black trans woman. So I speak on behalf of a lot of women who have similar backgrounds as I do. We're Black, we're transgender, we live in the South. One of the things really kind of going along with what we just heard, Black women, regardless of how you got to your Black woman, how you got to your womanhood, we often put others' needs ahead of ours. We trust people, perhaps, who don't deserve our trust, and yet we're distrustful of medical systems. And so one of the programs I'm involved with is changing Risks to Reasons (From Risk to Reasons)where we're actually helping Black women to reframe what risk is in terms of reasons.

When we think about risk for HIV, we really are putting the responsibility, the power in someone else's hands. Sex for me as a Black woman is risky because my partner may have HIV versus when we reframe our thinking, when we collectively reframe as Black women and think, well, “You know what? My reason for protecting myself against HIV is because I don't want to have to take this medicine for the rest of my life, or I have children, or I want to be healthier, I want to take, my reason for taking PrEP is because I don't want HIV.” “My reason, if I do have HIV, to get into care is because I want to be able to take better care of myself.”

So part of that is speaking to Black women the way that we understand. Risk implies danger. Reasons imply empowerment, and for Black women, we get it all done all the time. We can speak from an empowerment standpoint and are stronger and better and can make healthier decisions when we speak from an empowerment standpoint when we speak from the standpoint of a victim.

Alexandra: Thank you. And Keosha, turning to you. What do you believe needs to change in the broader public health system to help Black, cisgender, and transgender women who are living with HIV achieve the goal of sustained viral suppression?

Keosha: Well, thank you again for inviting me. My name is Keosha Bond, and my pronouns are she and her. And I think that's a really great question, because it is something that constantly comes up, and especially in our research setting and in our health settings. We had so long spent so much time focused on the individual in the sense of thinking that it’s the individual issue, that's the problem, that's why people are vulnerable to HIV. instead of looking at the environments that people are living in and the policies that are influencing those environments.

So, I honestly think it starts from multiple levels. We do need a lot of policy changes, that is on the larger societal level, as well as in our health care facilities and how they are engaging in care, centering the patients, which we don't do in all honesty in our health care settings. And we have, honestly, have separated how we look at sexual health from overall primary care. And that in itself has created a barrier to women of all experiences engaging in health care because we are not training our providers to provide gender-affirmative care. We're not training them in cultural humility and competency, and that creates barriers for people when they are in, and encourages, I feel like it increases the medical mistrust because why would you want to engage in a system that constantly disrespects you and doesn't see you as a full person? So when I think about what needs to change, it's on so many different levels, but really what we're looking at are the policies and how we are giving people access to health care, as well as how we are engaging people in this health care and not assuming that it is the individual who needs to change, but the system that they are living in that needs to change.

Alexandra: I'm wondering, can you think of off the top of your head any examples of that type of patient-centered care that's an example of what we need to see more of?

Keosha: I think even how we approach one of the lectures I usually give our medical students is about how to engage in, do sexual health assessments in primary care and prioritizing different things being so that people are aware of your vulnerability, but really they are aware of the different factors that influence your overall sexual health.

So it's not just about if you're having sex, but who you having sex with, what type of sex you're having, are you engaging in, what kind of practices you're engaging in, what are your plans? And so these are things that are inclusive of it. And so, I think combining frameworks like gender affirmative framework as well as the reproductive or social justice framework really will kind of center that if you're speaking to the person and asking in them in general, like what, who, how would you like to engage in care,basically, what are your options? We have so many missed opportunities, especially when it comes to women and PrEP engagement. Women are coming in and they are may be presenting with an STI and no one's talking to them beyond that, they're treating the STI, but they're not talking to them about other options of what they can do, like maybe PrEP is an option for them, maybe PEP is an option, and giving them those choices, and giving them the right accurate information of what that may entail.

This episode, Long-Acting Injectable PrEP and HIV Treatment, is the second in a three-episode series about new evidence-based strategies for addressing HIV and AIDS.


Guests featured in this episode:

Jeremiah JohnsonProgram ManagerPrep4All

Amy Killelea, J.D., Killelea Consulting

Aviva Cantor, PA-C, AAHIVS, PhD, Callen-Lorde Community Health Center

Moderator: Alexandra Walker, Digital Communications Director, NACHC

Alexandra: Hello and welcome to Health Centers on the Frontlines, the podcast of the National Association of Community Health Centers. Today is the second in a three-episode series we're doing about an epidemic that the nation's health centers have been battling for decades: HIV and AIDS. During these episodes, we're sharing promising news about how community health centers, health center controlled networks and primary care associations are employing the latest strategies to link people to ongoing HIV prevention, treatment, and care services.
Today, we're happy to be joined by a panel of experts, Jeremiah Johnson, who is the Program Manager at Prep4All, an organization of professionals and patients based in New York City who advocate for greater access to lifesaving medication for HIV. Also joining us is Amy Killelea, JD, an expert in policy, medication access, and health care financing to develop sustainable HIV and Hepatitis programs. And Dr. Aviva Cantor, HIV specialist and primary care provider at Callen-Lorde Community Health Center, which serves New York City's lesbian, gay, bisexual, and transgender communities.
So in late 2021, the US public was introduced to a bi-monthly injectable form of PrEP, which stands for Pre-Exposure Prophylaxis. Taken in pill form and now also available as an injectable this medication reduces the chance of getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV, a landmark push to end the HIV epidemic. At the same time, people living with HIV have been introduced to a monthly injectable form of treatment that similarly puts them in charge of their healthcare needs without having to remind themselves to take a daily oral medication. This is revolutionizing the field of treatment and prevention of HIV because we never have had a form of either that was this long lasting. Also, it's exciting news because it expands the number of tools we have in our hands to fight HIV. Health centers have been taking their first steps in implementing these tools. So, starting with our health center guest. Aviva, can you explain to our audience the two types of injectable antiretroviral medication? We've heard that one can be used as PrEP for people who are HIV negative and the other as an HIV treatment for people who are living with HIV. Can you tell us about the similarities and differences?Aviva: Sure. Yeah. So the two medications and we use brand names here. I normally don't like to use brand names, but we’ll use them so that they're more clear for patients in the community. So one is called Cabenuva. That's the medication that's used for HIV treatment. And the other is called Apretude. That is the medication that's used for HIV prevention. What they both have in common are that they are both what I describe to patients and my colleagues as deep intramuscular injections. So they're a little different than your regular intramuscular injections. They have to be done by nurses who have been trained just a little bit differently to make sure they do it the right way. So they're both these deep intramuscular injections. They're actually both now available as bi-monthly or every-two-month injections. They actually sort of follow the same schedule where you're given your initial injection, you're given one one month later as a loading dose, and then you take an injection every two months, every eight weeks, essentially. The big difference between these medications is, first of all, for HIV treatment (Cabenuva), it's two (injections;) it's a combination of two medications. So it's two separate injections, one in each buttock (one medication in each buttock). For HIV treatment, for Apretude, for prevention, it's just the one injection in one buttock.Alexandra: Yeah, that's a good first start. We can get back to some of those issues in more depth. Jeremiah, drawing from your experience as a community member and advocate, what do you think is important for the community health centers that we represent around the country to know and consider as they see these new options for prevention and treatment?Jeremiah: Yeah, happy to talk about that. Thanks for having me on the podcast today. And really, you know, I think, Dr. Cantor, you really set us up really well because I think you clearly have a clear sort of centering of your patients and the way that you're sort of talking about things. Because I think one of the first things that I'll say about long acting injectable is it is exciting. I also, as a community advocate, am very cognizant of the price issue with this, so when you're looking at $22,500 a year for Apretude compared to less than $20 a month for generic TDF FTC (Tenofovir/emtricitabine) or generic Truvada, this is going to be a complicated intervention to get to people. And I do worry as a community advocate, given that there's such important adherence requirements if you're going to be on this, that, you know, community health centers are checking with patients and really making sure that they're not going to run into any sort of unexpected coverage issues or anything that's going to interrupt their ability to continue with their treatment in terms of all of this. And so, you know, one thing that I like to put out there at these sorts of conversations is that, you know, sometimes I think we get really excited about the new modality. We get excited about the new way to sort of put things out there and forget the old classics, you know, and in this case, we have, you know, new sort of access to these generic medications that can be more nimble in a complicated health care system to get to people and we can be more creative in terms of getting that out to people. And so, you know, one thing that we're working a lot here at PrEP4all right now is to try and build a national PrEP program calling for a federal program with centralized reimbursement of laboratory costs and medications, particularly for uninsured and underinsured individualsAlexandra: Thank you. Some really good points there. I want to turn it to Amy. As health centers consider delivering these services, what are the financial or policy hurdles that they need to be aware of?Amy: Yeah. So I think this is a really good question. And, and, you know, the short answer is that there are a lot. So, I think the first one is that, and this has been mentioned several times, the price of the drug and combined with the fact that it is a provider- administered injectable product, so that is just a different administration route than the vast majority of the antiretrovirals that are available right now. And those two things, both apart and combined, do, I think, add some complexity to the finances and the procurement and delivery of both Apretude and Cabenuva. And I'm going to go through some of these challenges and note throughout that the challenges are different depending on what population you're talking about, whether the population is insured or uninsured. So I'm going to try to underscore what some of those differences look like. And, you know, the number one piece and to sort of tie this to specifically for community health centers, so that the price of both drugs was raised, and it is, you know, pretty, it could be higher. Right? But in the grand scheme of things, over $22,000 a year for a list price for an ARV is in the upper threshold of ARVs that are available for HIV treatment and prevention, so it's not an insignificant list price. If we talk about community health centers and their status as 340B entities, there is a discount available to purchase that drug for your uninsured population, and yet even with the discount, the price is still fairly significant. So that's an important factor as community health centers look at budgeting and programmatic decisions on both routes, on both Apretude and Cabenuva. And when we talk about the insured, I think even now when these products have been on the market and available in the case of Apretude for, you know, a little less than a year and for Cabenuva longer than that, we still have sort of complexity challenges and, and murkiness, I would say, with regard to payer behavior for insured clients.

You know, on the PrEP side, we don't have a U.S. Preventive Services Task Force grade for long-acting Cabotegravir. The grade A that we have is based on the oral products for PrEP. We are waiting for a USPSTF grade and that would carry with it a requirement that the vast majority of payers cover long-acting Cabotegravir/Apretude without cost sharing.
Alexandra: Thank you. Would you like to add to that in terms of considerations that other community health centers who are considering offering these should factor in?

Aviva: Yeah, I mean, Amy brought up a lot of things that we are currently dealing with. I present on PrEP and on long-acting medications for PrEP and HIV a lot. And I have this slide (Slide 1) that shows how incredibly excited we are for these medications to be here. And then the next slide (Slide 2) is just total chaos because that's what it feels like. It's sort of like, “Hold up, wait, yes we're excited, but let's be realistic about this.” This is really hard. It's really hard right now. You know, you need the people to do the work, but you also need the fu

The first in a three-part series of conversations about an epidemic health centers have been on the front lines of addressing for decades: HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome). In this episode, HIV expert Nick Diamonds leads a conversation about new strategies for preventing HIV transmission.

Guests featured in this episode:

• Robyn Neblett Fanfair, MD, MPH, Acting Division Director, Division of HIV PreventionCenters for Disease Control and Prevention
• Juan Carlos Loubriel, Director of Community Health and WellnessWhitman-Walker Health
• Craig Thompson, CEO, AIDS Project Los Angeles (APLA) Health

Moderator: Nick Diamond, Manager, Editorial Services, Elizabeth Glazer Pediatric AIDS Foundation

Episode transcript


Episode transcript
Nick Diamond: I want to start with Robyn by asking you, "What excites you the most about the new evidence based-strategies introduced for people who are HIV negative and want to stay that way?"
Dr. Robyn Neblett Fanfair: Thanks to a robust toolbox that includes pre-exposure prophylaxis, post-exposure prophylaxis, treatment as prevention, and syringe service programs, we now have more tools than ever available for HIV prevention, and we must realize the full potential of these tools, we understand how important it is to make sure that it gets into the hands of everyone who needs them. So what excites me a lot right now is a status neutral approach to HIV prevention, which we believe can really help improve access, reduce stigma, and help prioritize health equity. So as far as exciting strategies go, it's really about reframing how we think about traditional HIV service models to better reach people where they are with the services that they need. So no matter their HIV status, we know that people need similar health care as well as essential support services. These can include medical care, housing, transportation, and employment. A status neutral approach can create a one door approach for HIV prevention and treatment, which can help normalize both. It eliminates HIV stigma by integrating prevention and care instead of supporting separate systems. And we believe it can enable people to know their status by making HIV testing and next approaches, whether they're behavioral or biomedical prevention, more accessible, and it can advance health equity by connecting people to the services they need regardless of their HIV status. So those are just a few things that I think are really exciting in HIV prevention right now.
Nick Diamond: And Juan Carlos, I want to turn it over to you to ask about your experience and programs at Whitman-Walker. Would you talk a little bit about what your health center is doing to improve HIV prevention services in the community? I know Robyn just talked about this toolkit; are you seeing the implementation of things in those toolkits at the health center?
Juan Carlos Loubriel: Yes, indeed. We are very excited about this new approach. Whitman-Walker Health delivers tailored education and sexual health services that are sex-positive and inclusive. Our training and linkage efforts are community-based service delivery interventions. They promote access to effective tools for HIV prevention and timely diagnosis. We also provide immediate access to nPEP (non-occupational post exposure prophylaxis) and PrEP (post exposure prophylaxis) for HIV prevention. We provide early diagnosis and prompt linkage to medical care, including ART (antiretroviral therapy). And these efforts occurred alongside treatment of HIV and other chronic diseases. We strive to eliminate barriers to care. And to do this, we deliver status neutral services and connect clients to medical, behavioral health, harm reduction, and social services through customized risk reduction. Staff provide health literacy and education for clients on understanding and navigating the medical system at every stage of the care continuum. And we need to understand that education is also a necessary component to normalize conversations around sex, so we want to increase client’s active participation in care decisions so they can make informed decisions about their sexual health and HIV risk. And these services help move these clients along the continuum from prevention to care, and there are entry points to care in each of our programs.
Nick Diamond: One thing that's really exciting about this conversation is that we're convening a really diverse group of stakeholders, from government to community health centers, and the response to HIV, and Juan Carlos, I might ask if you have a question for Dr. Fanfair related to HIV prevention from your perspective, working in community health, you know, with an opportunity to engage government?
Juan Carlos Loubriel: Yes, definitely, Doctor Fanfair, you know, over the past 40 years, there have been many HIV prevention best practices, including condom use and PrEP. And my question is, what do you see as an HIV prevention best practice coming in the next decade and beyond?
Dr. Robyn Neblett Fanfair: I think there could be so many. I do think one that is of interest and it also ties in a little bit to our upcoming question, but when we really look at the revolution, I would say in treatment modalities, it's been remarkable. So this year marks a decade since pre-exposure prophylaxis was approved. And we know that there are still incredible gains to be made in making sure that's accessible to all people, as we know that there are still very large racial and geographic disparities that we see in PrEP uptake. But I'm very excited about the investigations and research going into longer modalities. So if we've just seen long acting injectables for pre-exposure prophylaxis approved almost one year ago and I know that there's a lot of investigations going on into six-month injections or even implants that could be there longer. So I'm really excited to see over the next decade even longer-acting modalities for pre-exposure prophylaxis while we also work very critically to make sure that all of these new modalities are able to reach all populations equitably.
Nick Diamond: So, Robyn, you just spoke about some of these new tools in our toolkit for people who are HIV negative. And I also want to ask you about some of the new and exciting evidence-based strategies that are now working for people living with HIV to achieve undetectable status and maintain viral suppression.
Dr. Robyn Neblett Fanfair: Absolutely. So, you know, it's really critical that people with HIV continue to have access and remain in ongoing, high quality care and continue to receive support services that they need. One exciting strategy is that treatment is prevention, and we now know that undetectable equals transmittable, or U equals U. Just as we were talking about with prevention and treatment, in addition now to several one-pill, once a day antiretroviral regimens, there are now long acting injectables that are available to help maintain viral suppression. The National HIV AIDS Strategy, or NHAS, has recently released a new quality-of-life indicator. And we believe this will be really critical to assessing quality of life measures such as housing, employment, food security, and self-rated health because we know there's more to overall well-being than just viral suppression. A status neutral framework really encourages a comprehensive, whole-person assessment of a person's unique situation, allowing for more tailored interventions. As we spoke before, we really believe that a status neutral approach can help limit stigma. And regarding stigma, if someone has HIV, they may not feel comfortable visiting an HIV-focused provider. They may be concerned about the possibility of being defined only by their HIV status. And they can encounter providers who may not take into consideration all of the other factors that affect their health. So for a person with HIV in a status-neutral approach, health care providers can obtain key information to better link persons to health-related and wraparound services, which will help keep them engaged in care, which can improve their ability to maintain a low or undetectable viral load.
Nick Diamond: Craig I'd like to also bring you into this conversation and thinking about your work at APLA Health, could you talk a little bit about your health center and the HIV care program?
Craig Thompson: Sure. I think the first thing we need to acknowledge is that we talk about the HIV epidemic. But the HIV epidemic is really HIV epidemics, and our epidemics are very different in parts of the country, who we serve, where the growth is, the number of women impacted, for example, or the number of injection drug users impacted, for example is very different. So I'm coming from Los Angeles, which is an epidemic that has been driven from the very beginning by gay men and members of the trans community. So in Los Angeles, the demarcation for us has never been HIV positive and HIV negative in care. It's been around connecting people to LGBTQ+ services. So we market our services as having LGBTQ+ friendly, competent, and that brings HIV negative folks and HIV positive folks into the same services, into the same sites, with the same providers. And so we've been doing status-neutral care from that perspective for many, many years. What we do find, though, is that primary care in a very busy community health center can take a while. And as much as we try to streamline the approach, what we've done now is try to pull out sexual health services, PrEP services, whether for folks who are HIV negative or HIV positive in the case of STD services, and create a streamlined approach for it to get people in and out for sexual health services, so they're not in the pri

In this episode, we hear from Dr. John W. Hatch about the history of Community Health Centers and how it intersects with the Civil Rights Movement. Dr. Hatch is a professor emeritus of public health at the University of North Carolina, Chapel Hill, and a legend in the health center movement. He was instrumental in establishing one of the nation's first community health centers in Mound Bayou, Mississippi, which was an all African American town founded in the 1860s.

Dr. Hatch pioneered approaches to addressing social drivers of health and describes building latrines, installing window screens, and starting a farm cooperative to provide affordable, nutritious food to the community. He explains how community input was part of the health center model from the very beginning. He also calls for more activism and policy change to address the challenges facing health centers and their patients today.

Featured in this Episode

Benjamin Money Jr
Senior VP, NACHC
Linkedin: https://www.linkedin.com/in/ben-money-6133436
Profile: https://www.ncdhhs.gov/about/leadership/benjamin-money

Dr. John W. Hatch
Professor Emeritus of Public Health
University of North Carolina, Chapel Hil

Chapters

00:00 Introduction
01:31 The changing of terms
02:35 The social drivers and how to address them
12:30 Moving in the area of environmental health
15:18 Establishing the Co-op
16:49 Adding benefits like non-medical things
21:18 Envisioning what Health Centers could become
25:12 Continuing the legacy
29:42 Addressing racial inequality
34:18 Communities addressing the public health issues
45:54 The incredible community health workers
52:54 The communities of today
56:05 Giving Thanks

Produced by Heartcast Media.
www.heartcastmedia.com

In the United States, access to and use of HIV and AIDS Prep remain unequal, with women generally utilizing it at a rate that is much lower than that of men. In contrast, each year, one in five new HIV cases affects women. The vast majority of black women, and transsexual women, in particular, are at an increased risk of contracting HIV and frequently do not have access to effective primary care. HIV prevention and care for black women must be discussed when talking about health facilities and all the work done with black communities.

In today’s episode, we invited Dr. Keosha Bond, an Assistant Medical Professor at City University of New York School of Medicine, as well as Tori Cooper, the Director of community engagement for the Trans Justice Initiative at Human Rights Campaign, and lastly, Dr. Latesha Elopre, an associate professor in the Division of Infectious Diseases at the University of Alabama at Birmingham. We will discuss what are the ways to improve communication about HIV prevention in community health centers, especially among black, cis, and transgender women. Moreover, We will give some thoughts on what changes are needed and the opportunities that can be provided among the said audiences.

Quotes

When I think about what needs to change, it's on so many different levels. the policies, access to health care, as well as how we are engaging people in health care. - Keosha
The minute that you reach sexual maturity, you start engaging in sexual practices, and you should be educated about prep. - Latesha
The first thing I think could and should happen across the country regarding community health centers is to hire more people from the communities that they’re serving. - Tori

Featured in the Episode

Alexandra Walker
Linkedin: https://www.linkedin.com/in/alexandra-walker-25b5844

Keosha Bond
Linkedin: https://www.linkedin.com/in/keosha-bond-6324bba

Tori Cooper
Twitter: https://twitter.com/MsToriCooper1

Latesha Elope
Linkedin: https://www.linkedin.com/in/latesha-elopre-54192868

Chapters

00:00 Introduction
01:57 Improving communication about HIV prevention
04:09 Improving engagement among Black, Trans, and cis-gender women
06:25 Necessary changes in public health
16:40 Suggestions to improve the community health centers
21:55 The opportunities regarding Medicaid Expansion

Produced by Heartcast Media
https://www.heartcastmedia.com/

In 2019, an estimated 1.1 million people in the United States were infected with HIV, with the number rising each year. The federal government has implemented numerous HIV prevention strategies while also conducting research to evaluate new prevention methods. Recently, new evidence-based strategies for preventing HIV transmission have been introduced and are being implemented. In today’s podcast, we are joined by Dr. Robyn Fanfair, Acting Division Director, Division of HIV Prevention, Centers for Disease Control and Prevention, and she discusses this exciting news in HIV prevention. We are also joined by Juan Carlos Loubriel, Director of Community Health and Wellness at Whitman-Walker Health, and Craig Thompson, CEO at APLA Health.

Quotes
What excites me is a status neutral approach to HIV prevention, which can really improve access, reduce stigma, and help prioritize health equity. Dr. Robyn Fanfair

We have too many people drop out of our care, and they say that it's burdensome. So we're really looking at ways to use technology to streamline that and really meet the patient where the patient is. Craig Thompson

We need to recognize that there is an enduring stigma that prevents patients from having open conversations about sexual health and HIV status and undermines their efforts to seek care. Juan Carlos Loubriel

Featured in the episode
Juan Carlos Loubriel
Director of Community Health and Wellness
Whitman-Walker Health
Profile: https://www.whitman-walker.org/staff-member/loubriel-juan-carlos/
Linkedin: https://www.linkedin.com/in/juan-carlos-loubriel-228b8123

Robyn Neblett Fanfair, MD, MPH
Acting Division Director, Division of HIV Prevention
Centers for Disease Control and Prevention
Linkedin: https://www.linkedin.com/in/robyn-neblett-fanfair-95a47677

Craig Thompson
CEO
APLA Health
https://aplahealth.org/

Chapters
00:43 Exciting things are happening in HIV prevention right now.
02:48 The experience of health centers in improving HIV prevention
05:40 The next generation of HIV prevention
07:21 Evidence for people with HIV to achieve undetectable status and maintain viral suppression
09:27 The APLA Health and its HIV Care Program
13:32 Addressing the HIV stigma
15:49: Dr. Robyn’s message to community health centers about contributing to HIV prevention
18:22 Thoughts on Dr. Robyn’s message

Produced by Heartcast Media
www.heartcastmedia.com

In 2019, an estimated 1.1 million people in the United States were infected with HIV, with the number rising each year. The federal government has implemented numerous HIV prevention strategies while also conducting research to evaluate new prevention methods. Recently, new evidence-based strategies for preventing HIV transmission have been introduced and are being implemented. In today’s podcast, we are joined by Dr. Robyn Fanfair, Acting Division Director, Division of HIV Prevention, Centers for Disease Control and Prevention, and she discusses this exciting news in HIV prevention. We are also joined by Juan Carlos Loubriel, Director of Community Health and Wellness at Whitman-Walker Health, and Craig Thompson, CEO at APLA Health.

QUOTES

"What excites me is a status neutral approach to HIV prevention, which can really improve access, reduce stigma, and help prioritize health equity." Dr. Robyn Fanfair

"We have too many people drop out of our care, and they say that it's burdensome. So we're really looking at ways to use technology to streamline that and really meet the patient where the patient is." -Craig Thompson

"We need to recognize that there is an enduring stigma that prevents patients from having open conversations about sexual health and HIV status and undermines their efforts to seek care." -Juan Carlos Loubriel

FEATURED IN THIS EPISODE

Juan Carlos Loubriel
Director of Community Health and Wellness
Whitman-Walker Health
Profile: https://www.whitman-walker.org/staff-member/loubriel-juan-carlos/
Linkedin: https://www.linkedin.com/in/juan-carlos-loubriel-228b8123

Robyn Neblett Fanfair, MD, MPH
Acting Division Director, Division of HIV Prevention
Centers for Disease Control and Prevention
Linkedin: https://www.linkedin.com/in/robyn-neblett-fanfair-95a47677

Craig Thompson
CEO
APLA Health
https://aplahealth.org/

CHAPTERS

00:00 Intro
00:43 Exciting things are happening in HIV prevention right now.
02:48 The experience of health centers in improving HIV prevention
05:40 The next generation of HIV prevention
07:21 Evidence for people with HIV to achieve undetectable status and maintain viral suppression
09:27 The APLA Health and its HIV Care Program
13:32 Addressing the HIV stigma
15:49: Dr. Robyn’s message to community health centers about contributing to HIV prevention
18:22 Thoughts on Dr. Robyn’s message

Produced by Heartcast Media
https://www.heartcastmedia.com/

In 2019, an estimated 1.1 million people in the United States were infected with HIV, with the number rising each year. The federal government has implemented numerous HIV prevention strategies while also conducting research to evaluate new prevention methods. Recently, new evidence-based strategies for preventing HIV transmission have been introduced and are being implemented. In today’s podcast, we are joined by Dr. Robyn Fanfair, Acting Division Director, Division of HIV Prevention, Centers for Disease Control and Prevention, and she discusses this exciting news in HIV prevention. We are also joined by Juan Carlos Loubriel, Director of Community Health and Wellness at Whitman-Walker Health, and Craig Thompson, CEO at APLA Health.

Quotes
What excites me is a status neutral approach to HIV prevention, which can really improve access, reduce stigma, and help prioritize health equity. Dr. Robyn Fanfair

We have too many people drop out of our care, and they say that it's burdensome. So we're really looking at ways to use technology to streamline that and really meet the patient where the patient is. Craig Thompson

We need to recognize that there is an enduring stigma that prevents patients from having open conversations about sexual health and HIV status and undermines their efforts to seek care. Juan Carlos Loubriel

Featured in the episode
Juan Carlos Loubriel
Director of Community Health and Wellness
Whitman-Walker Health
Profile: https://www.whitman-walker.org/staff-member/loubriel-juan-carlos/
Linkedin: https://www.linkedin.com/in/juan-carlos-loubriel-228b8123

Robyn Neblett Fanfair, MD, MPH
Acting Division Director, Division of HIV Prevention
Centers for Disease Control and Prevention
Linkedin: https://www.linkedin.com/in/robyn-neblett-fanfair-95a47677

Craig Thompson
CEO
APLA Health
https://aplahealth.org/

Chapters
00:43 Exciting things are happening in HIV prevention right now.
02:48 The experience of health centers in improving HIV prevention
05:40 The next generation of HIV prevention
07:21 Evidence for people with HIV to achieve undetectable status and maintain viral suppression
09:27 The APLA Health and its HIV Care Program
13:32 Addressing the HIV stigma
15:49: Dr. Robyn’s message to community health centers about contributing to HIV prevention
18:22 Thoughts on Dr. Robyn’s message

Produced by Heartcast Media
www.heartcastmedia.com

The pandemic made our nation aware of the importance of the people who raise, pick, and process our food. We now understand that farmworkers, as well as grocery store cashiers and shelf stockers can be counted among our country’s Essential Workers. However, it’s not always clear to the Community Health Center care team what a patient’s occupation is. Occupation is one of the most important social drivers of health, affecting patients’ health and access to healthcare in many different ways. This episode of Health Centers on the Front Lines takes us behind the scenes at a health center and their partner network as they change the culture around disclosure of occupation among patients. Our guests talk about what it takes to collect data about a patient’s occupation and why it improves care when the care team knows what work their patients do.


Featured in the Episode

Katherine Chung-Bridges, MD
Director of Research at Health Choice Network
Linkedin: https://www.linkedin.com/in/katherine-chung-bridges-8a0127170/

Daniel Parras
Research Data Scientist
Health Choice Network
Website: https://www.hcnetwork.org/

Yvonne Armijo
Director of Operations/Information System Analyst
La Casa Family Health Center
Website: https://www.lacasahealth.com/

Giddel Thom, MD
Chief Medical Director
La Casa Family Health Center
Website: https://www.lacasahealth.com/

Chapters
00:00 Introduction
01:56 The story of dairy farm workers
07:49 What is occupational data and how does it affect health care?
10:18 The difficulty of collecting these data
12:19 The challenge of integrating occupational data into the E-health records
15:44 The importance of occupation in health and in socioeconomics
20:00 Reactions when meeting new patients having to know their past medical records
24:03 Takeaways from our guests

Produced by Heartcast Media
https://www.heartcastmedia.com/

After a long wait, children younger than 5 are finally eligible to get vaccinated for COVID-19. What does this mean for parents and caregivers? Wanda Montalvo, PhD, RN, FAAN, a senior fellow and team lead for public health integration and innovation at NACHC, interviews pediatrician Lisa Costello, M.D., MPH, about vaccine benefits as well as answers some commonly asked questions.

For more resources about vaccines, view the U.S. Department of Health and Human Services’ COVID-19 Public Education Campaign, We Can Do This provider and patient education materials on pediatric COVID-19 vaccines: Resources About COVID-19 Vaccinations for Children

Key Takeaways
The systematic process for approving the COVID-19 vaccine for children
The risk assessment on children getting vaccinated
The definition of Long CoVid and what it means to children
Engaging with parents and communities to promote vaccination for children

Quotes
From what I've experienced, choosing vaccination is the safest path for the protection of your children - Dr. Costello

The communities trust their local health care provider and if we provide them with resources, we can do a great deal in improving vaccine confidence - Dr. Costello

Featured in the Episode
Wanda Montalvo, PHD, RN, FAAN
Senior Fellow, Public Health Integration,
National Association of Community Health Centers
Linkedin: https://www.linkedin.com/in/wmontalvophdrn
Twitter: https://twitter.com/Montalvo501
Company Website: Nachc.org

Lisa Costello MD, MPH, FAAP
Pediatrics Dept. West Virginia University School of Medicine
Profile: https://directory.hsc.wvu.edu/Profile/35594
Linkedin: https://www.linkedin.com/in/lisa-m-costello-b1329391
Twitter: https://twitter.com/lisacostellowv?lang=en
Contact Details 304-598-4835

Chapters
00:00 Intro and Guest's background
02:28 the process of approval
06:37 Risk assessment
11:25 Long Covid, and what it means to children
13:34 Promoting children's vaccination
18:25 post-vaccination for children
21:43 Final thoughts

Produced by Heartcast Media
https://www.heartcastmedia.com