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Self-Study Modules and Sections

  1. This module is for any health care provider who would like to establish core competence in testing for HIV, recognizing acute HIV infection, and linking persons diagnosed with HIV to medical care.
  2. The Basic HIV Primary Care module is intended for any clinician who may interact with persons who have HIV infection in a clinical setting, with an emphasis on the primary care management issues related HIV.
  3. The Antiretroviral Therapy module is geared toward clinicians who provide antiretroviral therapy to persons with HIV infection, with an emphasis on initiating antiretroviral therapy and management of virologic failure.
  4. Coming Soon!
    The Co-Occurring Conditions module addresses the prevention and management of infectious and non-infectious complications in persons with HIV infection.
  5. The Prevention of HIV module emphasizes new prevention strategies both for persons with HIV infection and for persons not infected with HIV. This module also addresses occupational and nonoccupational HIV postexposure prophylaxis. 
  6. Coming Soon!
    The Special Populations module is intended for any medical provider involved in the care of special populations of persons with HIV infection.  

Core Competencies for the National HIV Curriculum

It is the goal of the AETC National HIV Curriculum to provide ongoing, up-to-date information needed to meet the core competency knowledge for HIV prevention, screening, diagnosis, and ongoing treatment and care to healthcare providers in the United States.

The following is an outline and list of Core Competency Sections (with sub-competency topics and learning objective performance indicators).

Section 1. Screening and Diagnosis

Section Core Competency
Apply Evidence-Based Recommendations to Provide HIV Screening, Diagnosis, and Linkage to Care
Topics
Learning Objective Performance Indicators
  • Describe the contemporary epidemiology of HIV-1 in the United States
  • Discuss the impact of racial/ethnic disparities and social determinants on HIV epidemiology
  • Identify populations in the United States at risk for HIV-2 infection
  • Explain the rationale for routine HIV screening and identify strategies to overcome potential barriers to routine screening.
  • Discuss current Centers for Disease Control and Prevention (CDC) and United States Preventive Services Task Force (USPSTF) screening recommendations for HIV-1 and HIV-2 infection in the U.S.
  • Compare different types of HIV diagnostic tests and when to use them
  • Summarize the 2014 CDC recommended HIV testing algorithm
  • Discuss interpretation of HIV diagnostic tests and delivery of test results to clients
  • Summarize partner notification and reporting requirements for persons diagnosed with HIV infection
  • Explain the immunopathogenesis, clinical manifestations, and diagnosis of acute HIV infection
  • List the potential public health benefits of diagnosing a patient with acute and recent HIV infection
  • Summarize the rationale for immediate treatment of persons with acute or recent HIV infection
  • Describe strategies for optimizing linkage to care for persons newly diagnosed with HIV in the United States
  • Identify barriers for persons newly diagnosed with HIV infection linking to care
  • List the metrics used to estimate and monitor linkages to care
  • Discuss strategies for linking HIV-negative individuals for preexposure prophylaxis (PrEP), as clinically indicated

Section 2. Basic HIV Primary Care

Section Core Competency
Provide Evidence-Based HIV Primary Care to Persons with HIV Infection
Topics
Learning Objective Performance Indicators
  • Describe the goals and components of the initial evaluation of persons with HIV infection who are entering, reentering, or transferring care
  • Categorize the different stages of HIV disease and the criteria used to define each stage
  • List recommendations for the initial monitoring visit and baseline laboratory tests
  • Recognize common oral manifestations in persons with HIV infection and list appropriate diagnostic procedures when indicated
  • Construct a differential diagnosis for oral lesions of unknown cause and list appropriate diagnostic procedures, when indicated
  • Define appropriate treatment for common oral manifestations
  • Recognize common HIV-related cutaneous manifestations and list appropriate diagnostic procedures when indicated
  • Describe the etiologies of cutaneous findings in persons with HIV infection, including adverse drug reaction, immune dysregulation, infection, or immune reconstitution syndrome.
  • Define appropriate treatment for common dermatological manifestations
  • Summarize recommended immunizations for persons living with HIV infection
  • Explain the principles of safety and efficacy concerning the immunization of persons with HIV infection
  • Discuss cardiovascular risk reduction, including monitoring and management of hypertension and hyperlipidemia in persons with HIV infection
  • Describe special consideration of the management of diabetes mellitus in persons with HIV infection
  • Summarize management of hypertension in persons with HIV infection
  • Discuss causes of renal disease and management in persons with HIV infection
  • Describe screening indications and management of osteoporosis in persons with HIV infection
  • Diagnose and manage testosterone deficiency in persons with HIV infection
  • Discuss important non-infectious pulmonary disorders that may develop in persons with HIV infection
  • Summarize cancer screening recommendations in persons with HIV infection
  • Discuss family planning options for men and women living with HIV
  • Identify the role of social support and social services on the health care outcomes of persons with HIV infection
  • Summarize common screening tools for mental disorders, including screening tools for neurocognitive disorders
  • Discuss how to integrate screening tools for mental disorders into primary care HIV clinical practice
  • Identify the relationships between specific mental disorders and HIV acquisition and transmission risk
  • Explain the association between major depression and increased risk for mortality in persons with HIV infection and identify treatment options for depression
  • Describe models for integrating mental health care with HIV care, including through referral, consultation, co-located services and the use of embedded mental health providers
  • Describe the differential diagnosis of neurocognitive symptoms in persons with HIV infection, including opportunistic infections and neoplasms
  • Summarize screening for substance use disorder in persons with HIV infection
  • List options for treatment of tobacco dependence
  • Compare approaches of managing persons with alcohol use disorder
  • Describe the approach to management of persons with stimulant use disorder
  • Discuss strategies for the management of opioid use disorders
  • Identify factors associated with decreased retention in care and strategies to promote reengagement in care
  • Define methods of evaluating retention in care among persons with HIV infection
  • Summarize methods for improving HIV retention and reengagement in care
  • Describe strategies for optimizing the engagement and retention in care for persons with HIV infection who have a coexisting substance use disorder

Section 3. Antiretroviral Therapy

Section Core Competency
Apply Evidence-Based Antiretroviral Therapy for Persons with HIV
Topics
Learning Objective Performance Indicators
  • List the major classes of antiretroviral medications and describe the mechanism of action with each class of drugs
  • Discuss evidence supporting antiretroviral treatment of all persons with HIV infection
  • List recommended antiretroviral regimens for treatment-naïve individuals and discuss factors to consider when selecting an initial regimen
  • Summarize recommended laboratory studies to obtain at baseline and while monitoring response to therapy
  • Identify and address common barriers with antiretroviral therapy adherence
  • Identify clinically significant possible adverse effects associated with antiretroviral medications.
  • Discuss appropriate monitoring and management strategies for antiretroviral-related adverse effects.
  • Identify possible drug-drug interactions involving antiretroviral medications (with other antivirals as well as with commonly prescribed medications).
  • List important potential drug-drug interactions between antiretrovirals and non-prescription agents, including over-the-counter and herbal medications.
  • Compare and contrast regimen simplification approaches to optimize health, adherence and lessen pill burden. 
  • Summarize rationale and effective options for switching antiretroviral regimens.
  • Describe the management of intermittent and persistently detectable HIV RNA levels in persons receiving antiretroviral therapy.
  • Discuss the indications for and types of resistance testing for patients with virologic failure.
  • Utilize an HIV resistance database tool to assist in optimal selection of regimens in patients with resistance.
  • Explain key considerations when selecting a salvage antiretroviral regimen in patients with virologic failure.

Section 4. Co-Occurring Conditions

Coming Soon!
Section Core Competency
Apply Evidence-Based Recommendations for the Evaluation and Management of Co-Occurring Conditions in PLWH
Topics
Learning Objective Performance Indicators
  1. Latent Tuberculosis Infection
  • Describe and compare recommended screening tests for latent TB in persons with HIV infection
  • List recommended options for the treatment of latent TB in in persons with HIV infection
  • Summarize common drug-drug interactions between medications used to treat latent TB and common medications used for managing HIV infection.
  1. Opportunistic Infections: Prevention
  • Discuss recommendations for initiating and discontinuing primary prevention for opportunistic infections.
  • Summarize recommendations for initiating and discontinuing secondary prevention for opportunistic infections.
  • Recognize potential adverse effects and contraindications for medications used as opportunistic infection prevention.
  1. Opportunistic Infections: Treatment
  • Recognize the clinical manifestations of common serious opportunistic infections.
  • Discuss recommended treatment of common opportunistic infections.
  • Summarize common drug-drug interactions with TB medications and common medications used for managing HIV infection.
  • Summarize recommendations for initiating antiretroviral therapy in the setting of an active opportunistic infection.
  1. Sexually Transmitted Diseases
  • Describe the recommendations for sexually transmitted infection screening in persons with HIV infection.
  • List the CDC recommended treatments for the most common sexually transmitted infections in persons with HIV infection.
  • Describe recommendations for prevention of sexually transmitted diseases in persons with HIV infection.
  1. Hepatitis B Coinfection
  • Identify appropriate tests for evaluation of hepatitis B virus (HBV) infection and immunity.
  • Summarize immunization recommendations for persons with HIV infection who do not have documented serologic immunity or chronic HBV infection.
  • Discuss antiretroviral management of HIV and HBV coinfection.
  • List indications and methods for hepatocellular carcinoma surveillance in persons with chronic HBV and HIV coinfection.
  1. Hepatitis C Coinfection
  • Summarize recommendations for HCV screening in persons with HIV infection and describe the appropriate testing algorithm.
  • Discuss disease progression and monitoring of HCV infection in persons coinfected with HIV.
  • Summarize current guidelines for the treatment of chronic HCV in persons coinfected with HIV.
  • Describe and summarize important drug interactions associated with treating HCV in persons coinfected with HIV. 
  • List indications and method for hepatocellular carcinoma surveillance in persons with chronic HCV and HIV coinfection.

Section 5. Prevention of HIV

Section Core Competency
Apply Evidence-Based Recommendations for the Prevention of HIV Transmission 
Topics
Learning Objective Performance Indicators
  • Explain the mechanisms of perinatal HIV transmission and interventions to reduce the risks of perinatal HIV transmission.
  • Discuss interventions to reduce intrapartum perinatal HIV transmission.
  • Describe recommended antiretroviral prophylaxis for infants born to women living with HIV infection.
  • Summarize recommendations for initial management of HIV-exposed infants, including HIV diagnostic testing, monitoring, and Pneumocystis jirovecii pneumonia (PCP) prophylaxis.
  • Identify factors related to increased risk of HIV transmission
  • Discuss behavioral, biomedical, and structural prevention measures to reduce the transmission of HIV infection.
  • Describe impact of achieving undetectable HIV RNA levels on preventing transmission of HIV.
  • Identify strategies to reduce transmission of HIV, including partner testing and use of preexposure prophylaxis (PrEP) or postexposure prophylaxis (PEP) by HIV-uninfected sexual or injection drug use partner(s).
  • Describe current indications for the use of occupational PEP, including strategies for risk assessment following an occupational exposure.
  • Discuss recommended antiretroviral therapy regimens and duration of therapy for occupational PEP.
  • List recommended clinical and laboratory monitoring following occupational exposure to HIV.
  • Identify techniques for reducing the risk for occupational exposure to HIV.
  • Describe indications for the use of nonoccupational postexposure prophylaxis (PEP).
  • Summarize appropriate antiretroviral therapy regimens and duration of therapy for nonoccupational PEP.
  • List recommended clinical and laboratory monitoring following nonoccupational exposure to HIV.
  • Identify appropriate candidates for transition from nonoccupational PEP to PrEP
  • Describe approaches for non-judgmental, comprehensive sexual health and drug use discussions between patients and medical providers.
  • Identify indications for PrEP in men who have sex with men (MSM), heterosexual men and women, and persons who inject drugs.
  • Explain recommendations for testing and counseling prior to starting PrEP.
  • Discuss the recommended PrEP formulation and dosing schedule, including safety, efficacy, clinical eligibility, and adherence considerations.
  • Describe recommended clinical and laboratory monitoring for persons receiving PrEP.
  • Discuss the need for adherence in persons receiving PrEP.
  • Summarize initial management of persons who develop HIV infection while receiving PrEP.

Section 6. Special Populations

Coming Soon!
Section Core Competency
Apply Evidence-Based Care Recommendations for Subpopulations of PLWH
Topics
Learning Objective Performance Indicators
  1. HIV in Infants and Children
  • Explain the timing and types of diagnostic tests used to diagnose HIV in infants less than 1 year of age and in older children.
  • Describe symptoms and classification of HIV in children using the most recent CDC surveillance case definition for pediatric HIV infection.
  • Summarize antiretroviral therapy management in children, including initiation, adverse effects, and approach to virologic failure.
  • Discuss opportunistic infection prevention recommendations for infants and children and how these recommendations are influenced by a child’s age and stage of infection.
  1. HIV in Adolescents and Young Adults
  • Discuss developmental aspects of adolescents and young adults that enhance their risk of acquiring HIV infection and that impede testing and treatment efforts. 
  • Describe strategies for reducing acquisition and transmission of HIV infection among adolescents.
  • Describe strategies to improve linkage, engagement, and retention of care with adolescents and young adults. 
  • Summarize the approaches for successful transition of young adults with HIV infection into adult primary care HIV practice settings.
  1. Women and HIV
  • Summarize contraception options and recommendations for women living with HIV infection.
  • Discuss conception strategies for heterosexual HIV-serodiscordant couples desiring pregnancy.
  • List appropriate steps for evaluation and management of vaginal discharge.
  • Understand unique aspects and consequences of menopause in women living with HIV infection. 
  1. HIV in Older Patients
  • Recognize age-related and HIV-related changes to the immune systems of people ? 50 years old.Discuss cognitive and functional changes that may interfere with adherence to care in people ? 50 years old.
  • Identify and manage common co-morbidities of PLWH ? 50 years old. 
  1. HIV and Corrections
  • Compare HIV infection rates among the incarcerated population in the U.S. and the general population.
  • Describe issues related to HIV medication administration and adherence within correctional facilities. 
  • Summarize recommendations for linking PLWH to clinical care after release from a correctional facility.
  1. HIV in Racial and Ethnic Minority Populations
  • Discuss HIV infection rate disparities among different racial and ethnic minority populations in the U.S.
  • Identify factors associated with health inequities among racial and ethnic minority populations of PLWH and those at-risk compared to White populations.
  • Summarize strategies for prevention, testing, and care among racial and ethnic minority populations.
  1. HIV-2
  • Describe differences in the natural history and pathogenesis of HIV-2 as compared with HIV-1.
  • Summarize susceptibility of HIV-2 to antiretroviral medications.
  • Discuss antiretroviral treatment and monitoring recommendations for persons living with HIV-2 infection.

Progress Tracker

Section 1
This module is for any health care provider who would like to establish core competence in testing for HIV, recognizing acute HIV infection, and linking persons diagnosed with HIV to medical care.
Section 2
The Basic HIV Primary Care module is intended for any clinician who may interact with persons who have HIV infection in a clinical setting, with an emphasis on the primary care management issues related HIV.
Section 3
The Antiretroviral Therapy module is geared toward clinicians who provide antiretroviral therapy to persons with HIV infection, with an emphasis on initiating antiretroviral therapy and management of virologic failure.
Section 5
The Prevention of HIV module emphasizes new prevention strategies both for persons with HIV infection and for persons not infected with HIV. This module also addresses occupational and nonoccupational HIV postexposure prophylaxis. 
Topic 1 
Objectives:

  • Describe the contemporary epidemiology of HIV-1 in the United States
  • Discuss the impact of racial/ethnic disparities and social determinants on HIV epidemiology
  • Identify populations in the United States at risk for HIV-2 infection

 
Objectives:

  • Describe the goals and components of the initial evaluation of persons with HIV infection who are entering, reentering, or transferring care
  • Categorize the different stages of HIV disease and the criteria used to define each stage
  • List recommendations for the initial monitoring visit and baseline laboratory tests

 
Objectives:

  • List the major classes of antiretroviral medications and describe the mechanism of action with each class of drugs
  • Discuss evidence supporting antiretroviral treatment of all persons with HIV infection
  • List recommended antiretroviral regimens for treatment-naïve individuals and discuss factors to consider when selecting an initial regimen
  • Summarize recommended laboratory studies to obtain at baseline and while monitoring response to therapy
  • Identify and address common barriers with antiretroviral therapy adherence

 
Objectives:

  • Explain the mechanisms of perinatal HIV transmission and interventions to reduce the risks of perinatal HIV transmission.
  • Discuss interventions to reduce intrapartum perinatal HIV transmission.
  • Describe recommended antiretroviral prophylaxis for infants born to women living with HIV infection.
  • Summarize recommendations for initial management of HIV-exposed infants, including HIV diagnostic testing, monitoring, and Pneumocystis jirovecii pneumonia (PCP) prophylaxis.

Topic 2 
Objectives:

  • Explain the rationale for routine HIV screening and identify strategies to overcome potential barriers to routine screening.
  • Discuss current Centers for Disease Control and Prevention (CDC) and United States Preventive Services Task Force (USPSTF) screening recommendations for HIV-1 and HIV-2 infection in the U.S.

 
Objectives:

  • Recognize common oral manifestations in persons with HIV infection and list appropriate diagnostic procedures when indicated
  • Construct a differential diagnosis for oral lesions of unknown cause and list appropriate diagnostic procedures, when indicated
  • Define appropriate treatment for common oral manifestations

 
Objectives:

  • Identify clinically significant possible adverse effects associated with antiretroviral medications.
  • Discuss appropriate monitoring and management strategies for antiretroviral-related adverse effects.

 
Objectives:

  • Identify factors related to increased risk of HIV transmission
  • Discuss behavioral, biomedical, and structural prevention measures to reduce the transmission of HIV infection.
  • Describe impact of achieving undetectable HIV RNA levels on preventing transmission of HIV.
  • Identify strategies to reduce transmission of HIV, including partner testing and use of preexposure prophylaxis (PrEP) or postexposure prophylaxis (PEP) by HIV-uninfected sexual or injection drug use partner(s).

Topic 3 
Objectives:

  • Compare different types of HIV diagnostic tests and when to use them
  • Summarize the 2014 CDC recommended HIV testing algorithm
  • Discuss interpretation of HIV diagnostic tests and delivery of test results to clients
  • Summarize partner notification and reporting requirements for persons diagnosed with HIV infection

 
Objectives:

  • Recognize common HIV-related cutaneous manifestations and list appropriate diagnostic procedures when indicated
  • Describe the etiologies of cutaneous findings in persons with HIV infection, including adverse drug reaction, immune dysregulation, infection, or immune reconstitution syndrome.
  • Define appropriate treatment for common dermatological manifestations

 
Objectives:

  • Identify possible drug-drug interactions involving antiretroviral medications (with other antivirals as well as with commonly prescribed medications).
  • List important potential drug-drug interactions between antiretrovirals and non-prescription agents, including over-the-counter and herbal medications.

 
Objectives:

  • Describe current indications for the use of occupational PEP, including strategies for risk assessment following an occupational exposure.
  • Discuss recommended antiretroviral therapy regimens and duration of therapy for occupational PEP.
  • List recommended clinical and laboratory monitoring following occupational exposure to HIV.
  • Identify techniques for reducing the risk for occupational exposure to HIV.

Topic 4 
Objectives:

  • Explain the immunopathogenesis, clinical manifestations, and diagnosis of acute HIV infection
  • List the potential public health benefits of diagnosing a patient with acute and recent HIV infection
  • Summarize the rationale for immediate treatment of persons with acute or recent HIV infection

 
Objectives:

  • Summarize recommended immunizations for persons living with HIV infection
  • Explain the principles of safety and efficacy concerning the immunization of persons with HIV infection

 
Objectives:

  • Compare and contrast regimen simplification approaches to optimize health, adherence and lessen pill burden. 
  • Summarize rationale and effective options for switching antiretroviral regimens.

 
Objectives:

  • Describe indications for the use of nonoccupational postexposure prophylaxis (PEP).
  • Summarize appropriate antiretroviral therapy regimens and duration of therapy for nonoccupational PEP.
  • List recommended clinical and laboratory monitoring following nonoccupational exposure to HIV.
  • Identify appropriate candidates for transition from nonoccupational PEP to PrEP

Topic 5 
Objectives:

  • Describe strategies for optimizing linkage to care for persons newly diagnosed with HIV in the United States
  • Identify barriers for persons newly diagnosed with HIV infection linking to care
  • List the metrics used to estimate and monitor linkages to care
  • Discuss strategies for linking HIV-negative individuals for preexposure prophylaxis (PrEP), as clinically indicated

 
Objectives:

  • Discuss cardiovascular risk reduction, including monitoring and management of hypertension and hyperlipidemia in persons with HIV infection
  • Describe special consideration of the management of diabetes mellitus in persons with HIV infection
  • Summarize management of hypertension in persons with HIV infection
  • Discuss causes of renal disease and management in persons with HIV infection
  • Describe screening indications and management of osteoporosis in persons with HIV infection
  • Diagnose and manage testosterone deficiency in persons with HIV infection
  • Discuss important non-infectious pulmonary disorders that may develop in persons with HIV infection
  • Summarize cancer screening recommendations in persons with HIV infection
  • Discuss family planning options for men and women living with HIV
  • Identify the role of social support and social services on the health care outcomes of persons with HIV infection

 
Objectives:

  • Describe the management of intermittent and persistently detectable HIV RNA levels in persons receiving antiretroviral therapy.
  • Discuss the indications for and types of resistance testing for patients with virologic failure.
  • Utilize an HIV resistance database tool to assist in optimal selection of regimens in patients with resistance.
  • Explain key considerations when selecting a salvage antiretroviral regimen in patients with virologic failure.

 
Objectives:

  • Describe approaches for non-judgmental, comprehensive sexual health and drug use discussions between patients and medical providers.
  • Identify indications for PrEP in men who have sex with men (MSM), heterosexual men and women, and persons who inject drugs.
  • Explain recommendations for testing and counseling prior to starting PrEP.
  • Discuss the recommended PrEP formulation and dosing schedule, including safety, efficacy, clinical eligibility, and adherence considerations.
  • Describe recommended clinical and laboratory monitoring for persons receiving PrEP.
  • Discuss the need for adherence in persons receiving PrEP.
  • Summarize initial management of persons who develop HIV infection while receiving PrEP.

Topic 6 
Objectives:

  • Summarize common screening tools for mental disorders, including screening tools for neurocognitive disorders
  • Discuss how to integrate screening tools for mental disorders into primary care HIV clinical practice
  • Identify the relationships between specific mental disorders and HIV acquisition and transmission risk
  • Explain the association between major depression and increased risk for mortality in persons with HIV infection and identify treatment options for depression
  • Describe models for integrating mental health care with HIV care, including through referral, consultation, co-located services and the use of embedded mental health providers
  • Describe the differential diagnosis of neurocognitive symptoms in persons with HIV infection, including opportunistic infections and neoplasms

Topic 7 
Objectives:

  • Summarize screening for substance use disorder in persons with HIV infection
  • List options for treatment of tobacco dependence
  • Compare approaches of managing persons with alcohol use disorder
  • Describe the approach to management of persons with stimulant use disorder
  • Discuss strategies for the management of opioid use disorders

Topic 8 
Self-Assessment

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