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Telemedicine and HCV- Telemedicine and other Conditions

  • 1.  Telemedicine and HCV- Telemedicine and other Conditions

    Posted 03-31-2020 07:30
    Hi All, 
    How quickly practice has changed for so many of us.  I am working from home using telemedicine.  I have written two telemedicine protocols for PrEP and STI screening for my community health center. 
    Having just "seen"  two new HCV monoinfected patients whose laboratory evaluations are pending, I am wondering if any of you might have telemedicne protocols that you are using for treatment of patients with HCV- feel free to respond to other conditions as well- in treating patients that you will not be able to put a hand on.  
    As a hotspot for Covid-19, where I practice,  patient care still needs to go on.  Routine testing for diagnostic imaging is more difficult in my setting at the present time,  although I believe I can still get ultrasonography- though not elastography.  Differentiating patients with compensated vs decompensated cirrhosis is certainly the most crucial diagnostic decision point, and laboratory and serum markers are available for this of course.
    Have any of you been using telemedicine and treating patients with HCV that you have never personally seen in real life?
    Thanks for sharing your stories and experience. 

    Gary

    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------


  • 2.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-01-2020 12:23
    Thank you so much Mr. Gary, I am actually a newbie in the world of HIV treatment and I am pleased to be part of this community. I really do not have an answer to your question but it is quite interesting how you had developed a telemedicine protocol with PrEP and STI and I wondering if you can share that with me. I am currently working in an HIV clinic, seeing patients with diagnoses of HIV, STI's, STD's, and PrEP. Any information to help me deliver adequate care to my patients will be greatly appreciated. 

    Thanks

    Lucy Efobi, DNP, FNP-BC

    ------------------------------
    lucy efobi
    Linden NJ
    ------------------------------



  • 3.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-02-2020 06:44
    Interesting that you developed your own protocol for PrEP. I have been using telemedicine for some of my anal dysplasia follow up "visits", and would like to expand that to include patients needing PrEP. It would be helpful if you were willing to share your protocol.

    ------------------------------
    Theresa Schwartz
    Rochester Colon & Rectal Surgeons
    Pittsford NY
    ------------------------------



  • 4.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-02-2020 10:18
    Hi Theresa, 
    I have uploaded the protocols  I drafted, along with  the self swabbing instructions that I found on line, courtesy of New South Wales, Australia where there has been a highly successful PrEP program.

    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 5.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-02-2020 10:39

    Thanks!  I didn't scroll down to Lucy's comment.

     

    Theresa M Schwartz NP

    Anal Dysplasia Screening and Treatment

    Rochester Colon and Rectal Surgeons

    585-244-5670

     






  • 6.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-23-2020 17:57
      |   view attached
    Gary just as an FYI Aptima, actually includes self swabbing instructions in their package inserts. I provide the PreP care for LA Teleprep program . we have had good luck working with Labcorp and a reginal referal lab CPL , who will provide swabs to Pt at Patient Service centers (PSC)  to self swab. Quest has not been as cooperative.  Which labs that you work with are providing swabs to pt for self swabing, or do you need to get the swabs to the pts?  the more info we have to share with the larger lab system, perhaps it will encourage them to get on board.

    ------------------------------
    Christine Brennan
    LSU Health Sciences Center
    New Orleans LA
    ------------------------------

    Attachment(s)



  • 7.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-02-2020 10:16
    Hi Lucy
    Attached are the protocols I drafted.  If others look at this and have modifications, please let me know.  I just tried to make it as easy as possible to provide the same needed services for STI treatment and prevention and PrEP access, while minimizing the the need for patients to come to clinic.  They obviously need to go to the lab for lab tests and dropping off self swab specimens, or to get injectables in clinic when warranted, but otherwise the services are virtual.
    Gary

    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 8.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-02-2020 11:19
    Thanks you so  much Gary!

    ------------------------------
    lucy efobi
    Linden NJ
    ------------------------------



  • 9.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-16-2020 19:22
    Hello All - 

    Our clinic has been allowing patients to self collect GCC swabs (oral/rectal) for some time now. Now with Covid-19 our clinic is doing all virtual visits and our patients are going to lab locations closer to where they live (not in our clinic as it is currently closed). We are learning and getting push back from our lab leadership that self collection of GCC swabs is only approved by the FDA for vaginal collection (not oral or rectal). The labs are now refusing to give swabs to directly to patients to self collect oral and rectal specimens. The patients need to schedule visits with a provider for collection purposes. We know self collection is a common and patient preferred practice (for many). Any thoughts on how to approach this or is there some FDA regulation that we are missing that would allow self collection? 

    Any feedback would be greatly appreciated.

    Will Sharp, APRN-CNP AAHIVS

    ------------------------------
    William Sharp
    Orono MN
    ------------------------------



  • 10.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-17-2020 07:23

    We have packaged up self collection kits which contain 2 tubes and a screw top urine container along with self swab graphic instructions.  We have them available for patients to pick this up at our clinic (Quest) lab, or from the department (internal med, ob/gyn or Pedi.    Picking them up at the department could eliminate your lab problem not dispensing the supplies. 



    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 11.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-17-2020 08:14
    Edited by A.C Demidont 04-17-2020 08:14
    Hi Will,
    It is true that NAATs are not FDA approved for self-swab; however, the NAAT itself was only approved by the FDA for testing of extra-genital GC/CT in May of 2019.  FDA approval arrived 10 years after the CDC recommendations began for extragenital testing.  This is the natural history of it.
    2009: MMWR where the CDC started to first recommend extra genital screening for GC/CT: 2009 Jul 10;58(26):716-9.
    2010: CDC changed the treatment guidelines for GC secondary to developing quinolone resistance.
    2011: Ken Mayer published Clinical Infectious Diseases, Volume 53, Issue suppl_3, 15 December 2011, Pages S79–S83, https://doi.org/10.1093/cid/cir696 and
    Luckily, providers kept doing extra genital screenings because we now have data on how many infections we were actually missing prior to extra-genital screening and it is quite scary.  My guess is that it likely will not come unless there is a lot of pressure from the community.  
    At my LGBTQ practice in Connecticut we have been doing "express STI" testing for about 18 months and as I'm sure you have experience, the uptake is spectacular.  However, we did send all of the uninsured sample to the state labs and received a reminder letter from the STI prevention chief that the swabs are not FDA approved for self-collection.
    Quest will absolutely take the swabs back from the patient if you mail them the labeled swabs and instructions on how to do the test, the same ones you probably use.  It is great, because for TelePrEP the patient just returns the swabs to Quest when they go for their routine labs.  
    The FDA approval again is a tricky business for this test, but pointing out the long history and benefit of doing the test is often beneficial when discussing the issue.

    ------------------------------
    A.C Demidont, DO AAHIVS
    Principal Medical Scientist, HIV Prevention
    Medical Affairs, East (CT,MA,RI,NH,VT,ME and Upstate NY)
    Email: ac.demidont@gilead.com
    cell: 203.299.6076
    ------------------------------



  • 12.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-23-2020 18:33
    William, we were having this issue as well  in Louisiana but were able to over come as coming to a site to pick up swabs was not an options. we worked with the managers of  LabCorp PSC state wide and who then passed this on to their staff and it is actually happening. In most Labcorps in the state any patient that goe sin for an order for rectal or Pharyngeal GC/CT  will be given swabs and instructions ( from the swabs package insert) to self collect. we have been fortunate as we have a great regional marketing person, any time a pt gets push back from PSC staff, we let him know, he sends a message to the PSC manager who re educates staff.  we rarely have and issue with the sites. We also have good responds form a regional Reference lab CPL  it with Labcorp and a local reference lab, CPL, who has also provide swabs to pt.  Unfortunately Quest has not be as eager to work with us on this. Self collection is not a FDA issue, the appropriateness of swab to test for CT/GC NAAT from a rectal or pharyngeal sample WAS an issue but that has since been resolved.  teh sensitivity and specificity of self swabbing has been reported in Yared et al  2018 May;45(5):294-300. doi: 10.1097. As it would significantly increase teh possible number of extra genital swab testing you would think the lab would be excited to start passing swabs out.  What I have found to be  the issue is that PSC staff are not comfortable explaining how or trained to answer questions or concerns patients may have around self-collecting STI'S at the PSC.  I have also been told that the swabs would need to validate the testing for at "home collection" in order to provide such a service via a PSC.  As I do not work in the system I can not respond to the first concern and I do not believe the second one is valid ( I am not sure what "Home collection" means.) I do know there is a cost associated with "deploying" swabs to all PSC, and as atleast for Aptimu, they expire quickly, there coudl be a high degree opf "waste".   BUt as I have witnessed we were able to over come these barriers with one lab system in LA and a LA system.

    ------------------------------
    Christine Brennan
    LSU Health Sciences Center
    New Orleans LA
    ------------------------------



  • 13.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-03-2020 10:21
    I love these, Gary, thank you!  I have been trying to talk my institution into allowing self-swabbing for a while now, and having your protocol will help strengthen the argument.  I know that I got influenza A from swabbing a patient's throat for STDs a month ago, and I continue to get coughed on or almost vomited on whenever I try to collect STDs.  Thank you for this!

    ------------------------------
    James Adams
    Rancho Mirage CA
    ------------------------------



  • 14.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-18-2020 10:40
    Thanks for the insight from everyone. Does anyone have a telemedicine protocol for HCV yet?

    ------------------------------
    Katherine Huynh
    PHMC Care Clinic
    Philadelphia PA
    ------------------------------



  • 15.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-19-2020 10:22
    Hello,
    Risk management with HepC infection.
    At Borrego, I have about 8 HepC patients a week and usually start about 3/week. After meeting with the 7 other Borrego HIV/HepBC/Transgender specialists like me I follow a new protocol. Now with the isolation orders, I am screening the patients past labs and history and a tele visit for any signs of cirrhosis. I might see an image of their feet, palms, spiders, abdominal profile. If I need more info, then I weigh the risks of SarsCoV2 and getting labs at one of our clinics or a contracted lab draw station vs. being in isolation for months and months and progressing cirrhosis. I explain these risks to the patient and we will agree on getting more labs to stage them more accurately or pausing till they feel comfortable going into a lab. I do phone visits from their home or their cars for all appointments, e.g. picking up their meds at our clinic every 4 weeks. I am aware that cirrhotic patients are immune impaired so they need to have a healed liver ASAP, but they might die if they get SarsCoV2 or other infections, such as influenza if in public now or later and the cirrhosis is inexorably progressing.
    I welcome any thoughts on this protocol. Thank you.

    ------------------------------
    Daniel Pearce, DO FACOI, AAHIVS
    Borrego Community Health Foundation
    San Bernardino, Riverside, San Jacinto California
    ------------------------------



  • 16.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-21-2020 15:10
    Hello All,
    Daniel P, I think this is a great summary of what we are facing, trying to decide (guess) what path will better serve our patients, to risk adding person to person contact or to prolong being treated. The clinic I work at is co-located at an inpt substance abuse program. Therefore, we are treating HCV patients even with minimal fibrosis because we recognize the opportunity for treatment while in a controlled environment. Other patients who may be going out daily for methadone dosing may also be good candidates if HCV treatment can be linked to the same trip out. And of course we are also balancing putting those that work in labs/clinics at risk as well, if it is not "medically necessary." In addition I take into account a patient's motivation to be treated and if that is high or especially important to a patient, I try to make that happen if possible.
    We are definitely skipping any labs while on treatment and even EOT labs, to decrease contact.
    Thanks,
    Katie Huynh

    ------------------------------
    Katherine Huynh
    PHMC Care Clinic
    Philadelphia PA
    ------------------------------



  • 17.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-21-2020 17:04
    NEW IDEA
    One of our pediatricians came up with a strategy that seems to be 30 clinic-wide practice at Borrego (community clinics) here in SoCal: The clinics only let in well patients in the AM for labs, med pickups, provider visits and save the PM for anyone that might be ill with Covid19.  Not only are we doing parking lot and phone/video visits with spatial separation, but separating them by time also.

    I would feel a large medical building with multiple floors would have more surface danger than smaller clinics; we have a couple of 2 story clinics.





  • 18.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-20-2020 11:15
    I am working on getting a telemedicine HCV treatment clinic at our local needle exchange as an extension of our Infectious Disease clinic where I work. We have a local epidemic of Hep C in PWIDs. We have had abysmal follow-up rates to our clinic in clients who screen positive for chronic Hep C at the needle exchange, so I thought now would be a good time to try to bring telemedicine to them at the needle-exchange where they already go. Working on getting this set up now, including writing a protocol. I can try to return and share it later. Basically they will complete intake questionnaires with the needle exchange staff about their medical history, med list, allergies, any past complications from Hep C/cirrhosis or past Hep C treatment history, and current readiness for treatment. I will review and talk to them by Zoom visit set up at a laptop in the needle exchange site. I will try to do physical exam assessment for stigmata of cirrhosis over video- not sure how accurate this will be compared to in person exam. I will order appropriate labwork to our local lab, and follow-up with them (hopefully) by telemedicine appointment within 1-2 weeks to discuss appropriate treatment plan. If they have cirrhosis they will need gastroenterology referral. Otherwise, I will prescribe appropriate Hep C treatment and we have a specialty pharmacy liaison who helps with getting Hep C treatment authorizations from insurance, the medication will then be delivered to needle exchange instead of my office for client to pick-up from needle-exchange staff. We also have insurance navigators in a suite adjacent to the needle exchange for help enrolling uninsured clients into Massachusetts Medicaid- so that is helpful. Clients will need to commit to monthly telemedicine appt with med pick-ups and labs while on treatment to monitor for adherence and adverse effects, and follow-up as needed after treatment. I hope it works!

    I am also trying to get telemedicine PrEP clinic set up for the same reasons at the needle exchange which is also an STI testing site- few patients show up who are referred to my office. This is a little more complicated because of collecting self-swab specimens, but there are a lot of resources for that already.

    ------------------------------
    Rachel Picone
    Lenox MA
    ------------------------------



  • 19.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-20-2020 11:32
    That's awesome! I am a nurse practitioner and I am treating HCV​ for the past 3 years. From last year I only see reinfection cases and offer them suboxone. Having X- waiver is great because  I complete my counseling for HCV, liver disease, HIV and SUD all in one visit.
    Keep us update of your Zoom telemed. I am in California and does telemed for correctional setting.

    Ladan
    FNP, AAHIVS

    ------------------------------
    Ladan Hashemi
    El Dorado Hills CA
    ------------------------------



  • 20.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-21-2020 06:25

    Hi Rachael
    For the past month (seems like a whole lot longer) I have been treating HCV patients without ever laying a hand on them. I am comfortable with serum markers helping distinguish Cirrhosis from non-cirrhotics, and I am getting meds delivered to the patients. A real upside to telemedicine has been my ability to start treatment while patients are in substance use treatment programs and recovery houses. In the past most would have had to wait to finish their program before finding their way to my clinic. I think post-Covid-19- is there such a thing?- I will continue using telemedicine to reach vulnerable populations who might otherwise not make it to my clinic. 



    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 21.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-21-2020 09:18
    I would be careful using a video platform that isnt secure like Zoom. there are been multiple problems with zoom lately with people hacking into meetings even with passwords. We are using doxy.me at our office, which is specifically for healthcare providers and does not allow for recording which is nice, and also allows for multiple patients to be "in the waiting room" checked in and ready.

    ------------------------------
    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
    ------------------------------



  • 22.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-23-2020 10:05
    Hey Angela, 

    My Name is Crystal and I new to treating HCV/HIV and we are using doxy. me as well and I fine it very easy to use.  



    ------------------------------
    Crystal Miller-Williams
    Fredericksburg VA
    ------------------------------



  • 23.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-29-2020 01:14
      |   view attached
    Dear Rachel,

    I wanted to offer you this reference which I think is very helpful for any primary care-based HCV telemedicine treatment program. I'm a family nurse practitioner who works in a very busy community health center north of Boston and our team specifically provides integrated primary care and outpatient treatment for substance use disorders (mainly MAT with Suboxone for OUD). Regarding HCV pre-treatment assessment, I think this reference is extremely helpful and concise whereby the patient's platelet count really drives your plan. I am fortunate that I'm able to schedule liver elastography for most of my patients.

    Dieterich DT, et al. A simplified algorithm for the management of hepatitis C infection. Gastroenterology & Hepatology. 2019;15(5);1-11.

    ------------------------------
    Morgan Mako, APRN, FNP-C, AAHIVS
    Pronouns: he/him/his
    Lynn Community Health Center
    mmako@lchcnet.org
    ------------------------------

    Attachment(s)

    pdf
    Dieterich et al (2019).pdf   1.31MB 1 version


  • 24.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-21-2020 00:06
      |   view attached
    Hello Gary,

    Attached, is copy of my Telehealth PrEP treatment protocol. My clinic likes the ideal, we are working to provide education for clients on self specimen collection. I am currently working on the STI protocol.

    Thanks for your help.

    ------------------------------
    lucy efobi
    Linden NJ
    ------------------------------



  • 25.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-02-2020 12:57

    Hello

     

    I am new at HIV treatment and  I am using Telehealth.

    Thank you for sharing the Telehealth prep protocol information.

     

    Kathy Davis, FNP-BC

    Houston, Texas



    ------------------------------
    Kathy Davis
    Houston TX
    ------------------------------



  • 26.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-02-2020 14:04
    Hi Kathy,
    I'm glad the protocol might be helpful.  
    I have continued providing PrEP throughout the Pandemic, including new PrEP starts, using telemedicine.
    Gary

    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 27.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-02-2020 18:28
    So I have a question for the group.  What are your thoughts regarding Rapid Start HIV treatment via telemedicine? I was going to present a  scenario that resulted in a Telemedicine visit and HIV ARV start within 48 hours vs a in clinic visit and HIV ARV start within 96 hours but I would rather just have feed back  Telemedicine  vs in clinic, the patients does not have a preference they just want to get start ASAP.  Now that many of us have been using telemedicine for a couple of weeks ( if not months) how strongly would you agree or disagree with the statement: Newly Diagnosed HIV persons should only be started on ART Rapidly if there can have a in person clinic visit. Providing clinical care for such a case via telemedicine is not recommended. 

    ------------------------------
    Christine Brennan
    LSU Health Sciences Center
    New Orleans LA
    ------------------------------



  • 28.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-02-2020 19:31

    Hi Christine
    Other than a physical exam which would be done in the office and which would be very unlikely to change starting ART, starting a newly diagnosed patient with HIV and then having them go to the lab for baseline lab tests is really little different. I Would have no hesitation to do a rapid start via telemedicine.  Your patient wants to start and we know the benefits of starting ART as soon after diagnosis as possible. 



    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 29.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-15-2020 18:14
    Gary, I concur.  I wanted to see if others had other points.  Locally I have had providers, for which the only patients they would see in person during COVID PHE clinic closures, were newly diagnosed HIV.  This determination was not based on the presence of psycho social issues or significant symptoms, just straight out.  When I suggested we offered Rapid Start via telemedicine I was told, "it is irresponsible to start a person newly diagnosed with HIV on any therapy without having a face to face encounter". Ironically, the decision was also made that GC and Syphilis would be treated with oral antibiotics as bring a patient in for IM antibiotics would present to high a risk to patient and staff, thus the only case that would be seen in clinic was a newly diagnosed HIV patient for rapid start, and that they all must come in to be started ( in other words if the newly dx person did not want to come to the clinic for chance of exposure rapid start would not be provided).  I am highly suspicious that these providers "missed something"..but I wanted to get others input.  By the way it also had nothing to do with the need to assess for meningitis s/s...it was based on the assessment that a newly diagnosed person was too fragile not be seen in person

    ------------------------------
    Christine Brennan
    LSU Health Sciences Center
    New Orleans LA
    ------------------------------



  • 30.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-16-2020 15:43
    ​I work in Alaska and we have been doing telemedicine for many years and we have always had to adapt to challenging access to  care.  Of course seeing a new patient face to face is by far the best scenario, but right now this is not necessarily practical or desirable.  I have had to give 3 new diagnoses via telemedicine and treat 4 new patients and some PrEP patients as well. Not to my liking, but much better than delaying care.  Since the patients would have to get on multiple planes to get to me, it was definitely not worth the expense and risks and quarantine on both ends.  Fortunately we are able to get most of the labs from the local health aide clinic, but I am comfortable starting ARVs remotely if they are not having any acute medical issues. If possible they see a local PCP for physical exam, but unless they have advanced disease, that generally turns up little. 
     We have just switched from Vidyo to Zoom.  Vidyo worked fine for video to clinic but not well at all for direct to patient.  We can open the Zoom room from within the patients chart... I can have my nurse be part of the visit as well and the patients really seem to like the visual contact, as do I.

    ------------------------------
    Theresa Bramel
    Alaska Native Tribal Health Consortium
    Anchorage AK
    ------------------------------



  • 31.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-02-2020 15:27
      |   view attached
    Hello Kathy!

    Since you are new to HIV treatment, I was wondering if you have heard about the federally-funded National HIV Curriculum yet? The 37 online lessons and 37 corresponding question banks provide up-to-date info needed to meet the core competency knowledge for HIV prevention, screening, diagnosis, and ongoing treatment and care. Free CME, CNE, and pharmacology CE for advanced practice nurses is available as well. I've attached a list of all the units. You can go sequentially or start and stop anywhere.  

    Julia

    ------------------------------
    Julia Freimund
    National HIV Curriculum, University of Washington Infectious Diseases Education and Assessment (IDEA) Program
    www.hiv.uw.edu
    ------------------------------



  • 32.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 06-13-2020 15:50
    Julie


    Thank you for the information.

    ------------------------------
    Kathy Davis
    Houston TX
    ------------------------------



  • 33.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-22-2020 08:46

    Hello,

    I'm treating HCV via video and phone and following the AASLD expedited treatment guidelines. These guidelines are largely (pretty much entirely) lab based. I do not see the patient in clinic ever, but they do need to go to a lab near them.

    I also start PrEP via phone or video. Self collected swabs at the lab, blood draws and urine.  

    George 



    ------------------------------
    George Froehle
    Peter Shalit MD & Associates
    Minneapolis MN
    ------------------------------



  • 34.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-22-2020 16:23
    Thanks for all the feedback and encouragement!

    ------------------------------
    Rachel Picone
    Berkshire Health Systems.
    Pittsfield, MA
    ------------------------------



  • 35.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-23-2020 17:47

    I to star PreP via telemedicine, self collected swabs at the labs.  Which lab is providing swabs for self collection?  IN Louisiana we have worked with Labcorp and CPL who will provide clients swabs at PSC for self collection, but quest will not.  I am working with  group in Fl who did not know of any "lab" that was offering swabs to pt for self collection.  So if there is this would be very helpful.  Did any one listen to New England AETC Telehealth for PreP,,I was surprised by the number of providers that push back regarding self sti swab collection.

     

    Christine

     

    Christine S. Brennan PhD RN NP-BC

     






  • 36.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-24-2020 07:52

    Hi Christine. I attended the NEAETC event as well. I am convinced that each of our practices will need to make our own decisions, but self swab for STIs has been validated for accuracy. Quest accepts selfies-swabs, and my Quest rep even sent me the Aptima self swab instructions for patients, though I have found far better graphic instructions elsewhere. I'm giving the AAHIVM webinar this Thursday on Tele-PrEP and I hope to hear other thoughts on what folks are doing to maintain HIV prevention efforts in time of Pandemic. 

    Gary



    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 37.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-24-2020 07:57
    Hi again Christine
    i realized I did not answer your question about The Who gives out the self swab kits. Patients either pick those up from the department where they would usually get care- internal medicine, pediatrics, or Ob/Gyn, or from our on-site Quest lab if an order has been placed for the testing.

    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------



  • 38.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-27-2020 11:44
    Thank you for reminding me about the new AASLD expedited treatment guidelines. I checked those out and they do not recommend on-treatment Hep C laboratory monitoring except in diabetics and patients taking warfarin.  As I had mentioned, I am working on a new telemedicine protocol at my organization for people who actively inject drugs and access care at our local syringe service program. I am somewhat conflicted about no lab monitoring in this population. On the one hand, it simplifies treatment and removes barriers in this population that historically has a lot of problems with follow-up. On the other hand, my usual practice is to use 4-week Hep C RNA to monitor adherence and treatment response. I think this population could benefit from more intensive adherence counseling and monitoring. They can get adherence counseling along with harm reduction counseling at the SSP and I think they should do this monthly with medication refills (which they will hopefully pick up at the SSP).

    My other question is that Massachusetts Medicaid may require the 4 week Hep C RNA anyway to cover the rest of the treatment. Not sure if they have changed this requirement during COVID.

    Thoughts from you all on whether to do on-treatment monitoring in active IDUs? What are people doing who are already successfully treating this population? Has anyone gotten pushback from insurers about not getting 4-week Hep C RNA under the expedited AASLD treatment guidelines.

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    Rachel Picone
    Berkshire Health Systems
    Pittsfield, MA
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  • 39.  RE: Telemedicine and HCV- Telemedicine and other Conditions

    Posted 04-27-2020 11:57