DISCLOSURE TO PARTICIPANTS

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1 Course Handout Program # Program Title Treatment As Prevention? Pre-Exposure Prophylaxis (PrEP) Discipline Nursing/Public Access Expiration Date 8/31/2015 This program addresses elements from the following regulatory bodies: The Joint Commission; IC The hospital implements its infection prevention and control plan. CMS; CoP (c)(2) The patient has the right to receive care in a safe setting. Release Date: 9/1/2013 Presenter - Arlene Hudson, MD The Texas Tech University Health Sciences Center Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Provider approved by California Board of Registered Nursing, Provider #CEP11800, for the designated number of contact hours for each program. Provider approved by Florida Department of Health Board of Nursing, Provider #FBN2060. Provider approved by West Virginia Board of Examiners for Registered Professional Nurses, Provider #WV RN. Iowa Board of Nursing approved provider #325. Accepted by the North Carolina Board of Nursing. Reminder to all PARTICIPANTS, certificates should be retained for a period of four (4) years. Health.edu reports Florida Continuing Education (Contact Hours) to CE Broker. This activity is presented for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of nursing. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field. DISCLOSURE TO PARTICIPANTS Requirements of successful course completion: Complete the program via video presentation, PowerPoint slides, audio presentation, and/or manuscript. Complete the course evaluation. Complete the posttest with a score of 80% or greater. Complete the time utilized in course completion including the posttest. Conflicts of Interest: Arlene Hudson, MD has disclosed that no financial interests, arrangements or affiliations with organization/s that could be perceived as a real or apparent conflict of interest in employment, leadership positions, research funding, paid consultants or member of an advisory board or review panel, speaker s bureau, major stock or investment holder, or other remuneration. Commercial Support: There is no commercial support and/or relevant financial relationships related to this educational activity. Commercial support is defined as financial (or in-kind) contributions given by a commercial interest, which is used to pay all or part of the costs of a CNE activity. Relevant financial relationships are defined as financial relationships of any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner that could create a conflict of interest. Non-endorsement of Products:

2 Arlene Hudson, MD has disclosed that no significant relationships with commercial companies whose products or services are discussed in educational presentations. For speakers, significant relationships include receiving from a commercial company research grants, consultancies, honoraria and travel, or other benefits or having a self-managed equity interest in a company. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Off-label Use: Arlene Hudson, MD has disclosed that no products with off-label or unapproved uses are discussed within this activity. Individual programs are provided for a two (2) year period. Participants should check with their site coordinator, sign in to Health.edu s internet site, or call Education Services at for information on the date through which this learning activity is provided. For questions or comments regarding accreditation, please call Education Services at Health.edu participants: To speak to a Health.edu Customer Service representative, please call Swank participants: To speak to a Swank Customer Service representative, please call Institutional refund is available to subscribing organizations according to Health.edu s tuition refund policy. See your site coordinator to view this program. This activity provides 0.5 contact hours. SUMMARY Discusses strategies for pre-exposure prophylaxis in treatment of human immunodeficiency virus infection (HIV). GOAL/PURPOSE: The goal of this program is for the registered nurse to apply to his/her practice an understanding of preexposure prophylactic measures for at-risk patients. OBJECTIVES By the end of this presentation, the participant should be able to: 1. Indicate why treatment of human immunodeficiency virus (HIV) may be considered as a preventative measure in controlling the epidemic. 2. Recognize the pre-exposure prophylaxis (PrEP) used to prevent HIV infection in men who have sex with men (MSM) and transgender women. 3. Identify the controversy regarding PrEP in women. OUTLINE I. Pre-exposure prophylaxis (PrEP) A. Human Immunodeficiency Virus (HIV) Prevention Trials Network 052 (HPTN 052) Study B. Pre-exposure prophylaxis initiative (iprex) 1. Results 2. Conundrums

3 C. The Centre for the AIDS Program of Research in South Africa 004 (CAPRISA 004) D. Partners PrEP E. Tenofovir Disoproxil Fumarate (TDF) 2 Trial F. FEM-PrEP Trial G. Vaginal and Oral Interventions to Control the Epidemic (VOICE) H. Summary Addresses The Joint Commission requirement: IC The hospital implements its infection prevention and control plan. Addresses CMS requirement: CoP (c)(2) The patient has the right to receive care in a safe setting. DISCUSSION/REFLECTION ANALYSIS (Nursing Only) 1. From the information in this program, which do you think is the optimal prevention strategy described in this program? Why? 2. Which of the pre-exposure prophylaxis measures described in this program could be described as emotionally stressful? How could caregivers lessen that stress? 3. List two ways in which you will incorporate the information you learned in this program into your practice. RESOURCES Amico, K.R., Mansoor, L.E., Corneli, A., Torjesen, K., and van der Straten, A. (2013). Adherence support approaches in biomedical HIV prevention trials: Experiences, insights and future directions from four multisite prevention trials. AIDS and Behavior, doi: /s Campbell, J.D., Herbst, J.H., Koppenhaver, R.T. and Smith, D.K. (2013). Antiretroviral prophylaxis for sexual and injection drug use acquisition of HIV. American Journal of Preventive Medicine, 44(1), Supplement 2, S63-S69. doi: /j.amepre Friday, D.C., Yong, M., Bates, C. and Whitehead, C. (2013). Post exposure HIV prophylaxis following sexual exposure: A retrospective audit in a UK HIV Unit. Change, 2(3), 1. Retrieved from: Transmission-and-Prevention/P203.pdf Gupta, R.K., Wainberg, M.A., Brun-Vezinet, F., Gatell, J.M., Albert, J., Sönnerborg, A. and Nachega, J.B. (2013). Oral antiretroviral drugs as public health tools for HIV prevention: Global implications for adherence, drug resistance, and the success of HIV treatment programs. Journal of Infectious Diseases, 207(S2), S101- S106. doi: /infdis/jit108 Hauptman, A. and Carchedi, L. (2013). A case of possible HIV prophylaxis-induced anxiety and obsessive compulsive disorder, General Hospital Psychiatry, In press. doi: /j.genhosppsych Kerr, Z.Y., Miller, K.R., Galos, D., Love, R., and Poole, C. (2013). Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: A systematic literature review of qualitative studies from the United States and Canada. AIDS Patient Care and STDs, 27(2), doi: /apc Koblin, B.A., Andrasik, M. and Austin, J. (2013). Preparing for the unexpected: The pivotal role of social and behavioral sciences in trials of biomedical HIV prevention interventions. JAIDS Journal of Acquired Immune Deficiency Syndromes, 63, S183-S186. doi: /qai.0b013e31829a3a4d Parsons, B.F., Fisher, K., Cordery, D. and Couldwell, D. (2013). Counselling improves follow-up HIV testing at Week 6 for HIV postexposure prophylaxis recipients. Sexual Health, 10, doi: /sh12190 Singh Joy, S.D. (2013). Antiretroviral HIV prophylaxis for HIV-negative partners. The American Journal of

4 Nursing, 113(2). 70. doi: /01.naj Venter, F., Allais, L. and Richter, M. (2013). Exposure ethics: Does HIV pre-exposure prophylaxis raise ethical problems for the health care provider and policy maker? Bioethics, In Press. doi: /bioe SPEAKER BIO Arlene Hudson, MD Family Practice J. O. Wyatt Community Health Center Amarillo, Texas Education: 1986 MD, Loma Linda University, Loma Linda, California 1981 MS, Medical Technology, Loma Linda University, Loma Linda, California 1979 BS, Victor Valley College, Victorville, California Work history: 1995-present Family Practice, J. O. Wyatt Community Health Center, Amarillo, Texas Family Practice, Colorado Springs, Colorado Family Practice, Kaiser Permanente, Fort Worth, Texas Posttest Questions 1. According to the HPTN 052 (HIV Prevention Trials Network 052 Study), a person with a cluster of differentiation (CD4) human immunodeficiency virus (HIV) cell count of cells/mm 3 has acquired immune deficiency syndrome (AIDS). A. Less than 200 B C D The goal of iprex was to see if oral pre-exposure prophylaxis medication decreased HIV acquisition in men and transgender women who have sex with men. A. True. B. False. 3. Which of these is a complicating factor/effect described in iprex? A. High cost B. Ineffective against undiagnosed HIV C. Difficult to reproduce access to care across populations D. All of the above 4. According to The Centre for the AIDS Program of Research in South Africa 004 (CAPRISA 004), women who used tenofovir gel had HIV infections than/as placebo gel users.

5 A. 50% more B. 50% fewer C. The same number of D. None of the above 5. In the FEM-PrEP trial, there was an evident increase of among women taking prophylactic Truvada. A. Pregnancy rates B. Respiratory infections C. At risk behaviors D. HIV counseling