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Escalating usage and more drug choices are putting more people at risk.

Antimicrobial Stewardship Can Help Prevent Injection Drug Use–Related Infections

Along with a 1 reported case in Massachusetts, the

New Hampshire Department of Health and Human Services (DHHS) has confirmed a person infected with eastern equine encephalitis (EEE) has died. The public health agency said the person was hospitalized due to severe central nervous system disease. The last reported human EEEV infection in New Hampshire was in 2014, when DHHS identified 3 human infections, including 2 fatalities. In the same statement, DHHS mentions there has been 1 confirmed case in Vermont this summer.

On August 16, the Massachusetts Department of Public Health (MDPH) released a statement discussing the confirmation of the first human case of EEE in the state this year. The confirmed case was discovered in an 80 year old man who was exposed to the vector borne disease in Worcester County. As a result, the risk level in the local communities of Douglas, Oxford, Sutton, and Webster has been raised to critical, and in Dudley, Northbridge, and Uxbridge the risk is increased to high.

Additionally, the neighboring communities of Auburn, Charlton, Grafton, Leicester, Mendon, Millbury, Millville, Southbridge, and Upton are now considered at moderate risk according to MDPH.

“This is the first time we have seen a person infected with EEE in Massachusetts since 2020,” Public Health Commissioner Robbie Goldstein, MD, PhD, said in a statement. “EEE is a rare but serious disease and a public health concern. We want to remind residents of the need to protect themselves from mosquito bites, especially in areas of the state where we are seeing EEE activity.

Though very rare, EEE is serious and a potentially fatal disease that can affect people of all ages. EEE is generally spread to humans through the bite of an infected mosquito. There were 12 human cases of EEE in Massachusetts in 2019 with 6 deaths, and 5 human cases with 1 death in 2020. There were no human cases of EEE in Massachusetts in 2021, 2022, or 2023.

EEE has a fatality rate of 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.

In addition to a high mortality rate, long-term physical and mental complications, including permanent neurological deficits have been identified in many people who survive EEE.

Plymouth is approximately 40 miles south of Boston along the coast, and Worcester County is in the middle of the state, so the 2 areas are not in close proximity, but due to the elevated risk locally, the town of Plymouth decided to take action in response to outdoor parks. As of last Friday, all town public parks and fields are close daily from dusk until dawn.

“As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk to exposure to EEE. The health and safety of our community, residents, and visitors remain our priority,” Plymouth’s Commissioner of Health and Human Services, Michelle Bratti, said in a statement.

According to the Centers for Disease Control and Prevention (CDC) most people who are infected with the virus do not develop symptoms; however, for those that do, the date from the bite to the onset of the illness is 4 to 10 days. EEE can also result in fever or neurologic disease. The type of illness will depend on the age of the person and other factors. Those who are infected can develop meningitis.

There are no FDA-approved treatments for EEE and for patients who develop severe cases, they can be hospitalized to receive supportive treatment.

Over the weekend, MDPH detailed plans of spraying for mosquitos including aerially in areas of Plymouth County, and truck-mounted spraying in parts of Worcester County. As of Saturday, 10 communities in Massachusetts were raised to high or critical risk for EEE virus.

“The risk from EEE is high in parts of Plymouth County and critical in parts of Worcester County,” State Epidemiologist Catherine M. Brown, DVM, said in a statement. “In addition to recommending that people use mosquito repellent with an EPA-registered active ingredient and clothing to reduce exposed skin, we also recommend that evening outdoor events be rescheduled to avoid the hours between dusk and dawn. The mosquitoes most likely to spread EEE are most active during the dusk to dawn hours.”

There are preventative strategies to avoid EEE, and the MDPH has listed such measures 

For those who live in Massachusetts and want more information on EEE, it can be found 

 or by calling the DPH Division of Epidemiology at 617-983-6800.

1.NH DHHS Identifies Person Infected with Eastern Equine Encephalitis Virus in New Hampshire.The New Hampshire Department of Health and Human Services. August 27, 2024. Accessed August 28, 2024.
https://www.dhhs.nh.gov/news-and-media/nh-dhhs-identifies-person-infected-eastern-equine-encephalitis-virus-new-hampshire
2. State health officials announce season’s first human case of Eastern Equine Encephalitis in Massachusetts. MDPH. August 16, 2024. Accessed August 27, 2024.
https://www.mass.gov/news/state-health-officials-announce-seasons-first-human-case-of-eastern-equine-encephalitis-in-massachusetts
3.Plymouth to Close all Public Parks and Fields from Dusk to Dawn. Town of Plymouth. August 23, 2024. Accessed August 27, 2024. PDF.
4. Eastern Equine Encephalitis: Symptoms, Diagnosis, and Treatment. CDC. May 15, 2024. Accessed August 27, 2024.
https://www.cdc.gov/eastern-equine-encephalitis/symptoms-diagnosis-treatment/index.html
5. State officials announce plans to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE. MDPH. August 24, 2024. Accessed August 27, 2024. 
https://www.mass.gov/news/state-officials-announce-plans-to-spray-for-mosquitoes-in-sections-of-worcester-and-plymouth-counties-due-to-eee



The town of Plymouth decided to prohibit people from using the parks from dusk to dawn due to concerns over eastern equine encephalitis after a man contracted the rare disease in the state.

Concerns Over Mosquito-Borne Illness Causes Massachusetts Town to Create Curfew for Parks, Spraying in Counties

Lead author Elizabeth Marlowe, PhD, D (ABMM), offers insights on her study looking at this ongoing issue including which states have the largest number of hepatitis D infections, the potential  implications for increased testing and the linkage to clinical care in a more efficient manner.  

Screening Study For Hepatitis B Shows Nearly One Third Also has Hepatitis D

Results from the first US study that looked at hepatitis B virus (HBV) and hepatitis D virus (HDV) prevalence concurrently found that 2.2% of HB surface antigen (HBsAg)

positive specimens were positive for HDV antibodies (Abs), and of those, 28%, or approximately one-third, were positive for HDV RNA or active infection.

The study’s results were published in the 

“We looked at over 5200 specimens across the US. About 2.2% of those were positive for hepatitis D antibodies,” said study first author Elizabeth Marlowe, PhD, D(ABMM), executive scientific director of infectious diseases for Quest Diagnostics. “Now the algorithm is if the antibody is positive, you then want to run a PCR [polymerase chain reaction] to look for RNA, which means you have active infection. And of those, about 28% of those were positive for RNA.”

The study investigators looked at deidentified remnant HBsAg-positive specimens submitted for routine clinical testing to Quest, representing all 10 US Department of Health and Human Services (HHS) regions. Female participants made up 45% of the participants, and the mean ages were 50.8 (male) and 49.4 (female) years. Reflex testing of HBsAg-positive specimens for HDV antibody testing and further testing of positive specimens for HDV RNA were conducted from July 2023 to June 2024.

As the study looked at prevalence by HHS region, one interesting finding was the highest absolute number of HDV Ab-positive specimens in HHS Region 9, which includes California, Nevada, and Arizona.

HDV is concerning because of its ability to progress to more serious complications, including cirrhosis and hepatocellular carcinoma. Wranke et al showed that having HDV leads to a faster progression to the aforementioned conditions and other liver-related end points.

“Given the serious nature of the disease, universal testing of HBsAg-positive specimens followed by reflex HDV RNA would increase our understanding of HDV prevalence, allow for earlier identification and linkage to care, and benefit patients with previously unrecognized HDV infection,” the 

Marlowe mentioned updated screening guidelines that are expected to come out soon and why HDV testing should be considered in testing for HBV. She referenced Robert Gish, MD, who is the medical director of the Hepatitis B Foundation and a fellow study author. 

“He'll always tell you, if you have a patient [with] hepatitis B surface antigen–positive [results], always screen for hepatitis D,” Marlowe said.

Traditionally, screening and receiving treatment for hepatitis can take 2 to 3 provider visits. However, there is a newer concept within hepatitis C care called “test and treat,” which looks to streamline the care process and may be applicable to patients with undetected chronic HBV and HDV. The concept simply has patients getting tested for the virus and leaving with medicine or a prescription for treatment all in the same appointment. The significance here is getting more people into the continuum of care.

“I think it's an exciting area," Marlowe said of test and treat. "I think it goes back to implementation science…and we want to improve screening rates, so if you have a patient in the office, you can screen them, and you're not going to lose them to follow-up—that's the goal, right?”


References
1. Marlowe EM, Swanson BE, Realegeno SE, Meyer WA 3rd, Gish R, Kagan RM. Epidemiological burden of hepatitis delta virus in the United States. 

. 2025;32(6):e70029. doi:10.1111/jvh.70029
2. Wranke A, Heidrich B, Deterding K, et al. Clinical long-term outcome of hepatitis D compared to hepatitis B monoinfection. 

. 2023;17(6):1359-1367. doi:10.1007/s12072-023-10575-0



In our latest podcast, first author Elizabeth Marlowe, PhD, D(ABMM), offers insights on her study looking at this ongoing issue, including the need for increased testing and admitting patients into the continuum of care in a more efficient manner.  

Screening Study for Hepatitis B and Hepatitis D Demonstrates Need for Follow-Up Testing

Carl Schmid on the Supreme Court ruling, proposed CDC cuts, and why equitable PrEP access—including new long-acting options—depends on more than insurance.

Carl Schmid on the Supreme Court ruling, proposed CDC cuts, and why equitable PrEP access—including new long-acting options—depends on more than insurance. stigma

Although the US Supreme Court’s recent decision in 

 preserved access to preventive services under the Affordable Care Act (ACA), public health advocates warn that proposed funding cuts to the Centers for Disease Control and Prevention (CDC) threaten to undermine HIV and hepatitis prevention efforts nationwide, particularly among uninsured and underserved populations.

“We're gonna fight those cuts that have been included in the president's budget because...private insurers may cover something, but you need all that outreach,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in the last part of our interview. “You need all the education. And what about all the people who don't have health insurance? They need help as well with HIV testing, hepatitis testing, and people turn to their health departments.”

Schmid emphasized that although the ACA's preventive coverage mandate supports many privately insured Americans, CDC funding remains a cornerstone of the public health infrastructure. “Yes, it's CDC funding. But like in the case of HIV, I know 88% of that funding goes out in the field and mostly to health departments and community-based organizations,” he said. “To have the coverage will be extremely important. If we lost it...and we're also facing budget cuts, then we'd really be in trouble. But we still need that federal government funding.”

Pointing to the infectious nature of both HIV and hepatitis, Schmid stressed the importance of continued federal investment. “These are both infectious diseases. These are public health issues, and...there is a role for the federal government and state and local health departments,” he said. “For people who have health insurance, the government doesn't have to pay for those.”

Beyond funding concerns, Schmid highlighted the ongoing role of the US Preventive Services Task Force in guiding clinical practice and combating stigma. “Just to get included on the US Preventive Services Task Force recommended list of preventive services is really a map for providers to review,” he explained. “There's around 40 of them right now, and depending on who the patient is, then a provider should offer these preventive services.”

That list includes routine testing for HIV and hepatitis as well as offering preexposure prophylaxis (PrEP) for those at risk. “In the case of HIV and hepatitis, everyone should be tested at least once in their life. And if they have other risk factors, they should be tested more frequently,” Schmid said. “And if they are at risk for HIV, they should be offered PrEP.”

Stigma and provider discomfort remain persistent obstacles, particularly in underserved regions. “We still have a lot of stigma with HIV, and people don't talk about their sexual practices with their providers always, and especially if someone is gay and particularly in the South as well,” Schmid noted. “But I hope this is a road map for providers in the South to talk about PrEP to their patients.... I hope it will reduce stigma as well. People should be applauded for wanting to get on PrEP and taking the steps to protect themselves and others from HIV.”

Asked whether the Trump administration’s support for ACA preventive services reflects a broader shift in national HIV policy, Schmid described a mixed record. “It's been a mixed bag since day 1 with the administration—grants being canceled, staff being cut at the CDC,” he said. “The president's budget that came out in a leak said that they would end the HIV epidemic initiative.”

Although some core programs were preserved, others were gutted. “They're not cutting the Ryan White Program that provides care and treatment to low-income people. That's great news,” Schmid said. “And they also brought back almost all of the CDC HIV division staff except communications.”

That absence of communications capacity has had ripple effects, he argued. “I think they have a conception that communications is like working with the media, but communications does the outreach not only to the community, the public, but [to] the providers as well. And that's all gone, and all the grants are canceled. We're working on trying to get that back.”

Recent events have made the gap in federal engagement especially visible. “We just had National HIV Testing Day on June 27, and there were absolutely no campaigns from the federal government, which is really sad,” Schmid said. “The Ending the HIV Epidemic Initiative was in the president's formal budget, but the bad news was they completely eliminated the $800 million for CDC HIV prevention nationwide.”

As new HIV prevention tools become available, Schmid stressed the need for both policy support and insurance coverage. “There's a new drug for HIV prevention called 

, which was just approved by the FDA a couple of weeks ago, and that will revolutionize PrEP uptake,” he said. “It's only twice a year. It's an injection. It was approved just before the Supreme Court decision, which is great.”

But approval alone is not enough. “We want to make sure that insurers now cover that drug as well,” he said. “Because as people ask for it, they expect it to be covered and expect no cost sharing. So that's something we're gonna be definitely watching and asking people who are on PrEP to speak up and make sure their insurers are covering that.”

Supreme Court upholds preventive services coverage requirements. Press release. HIV+HEP Policy Institute. June 27, 2025. Accessed July 9, 2025. https://hivhep.org/press-releases/supreme-court-upholds-preventive-services-coverage-requirements/

Carl Schmid on the US Supreme Court ruling, proposed Centers for Disease Control and Prevention cuts, stigma, and why equitable PrEP access, including new long-acting options, depends on more than insurance.

A Win for Coverage, but Can People Still Access HIV Prevention?

TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discusses dihydrofolate reductase inhibitors (DHFRIs) as a novel approach to combat multidrug-resistant neisseria gonorrhoeae. 

A Group of Antimicrobial Compounds Show Novelty Action Against Gonorrhea 

Back in May, TAXIS Pharmaceuticals announced it had received a $2.9 million grant, to be awarded over 3 years, from the National Institute of Allergy and Infectious Diseases. This grant allows the company to further advance research and development for its dihydrofolate reductase inhibitors (DHFRIs) as a novel approach to combat multidrug-resistant gonorrhea (commonly referred to as supergonorrhea), a rapidly spreading, deadly, and highly resistant strain of 

TAXIS is a clinical-stage company developing new classes of therapies to treat multidrug-resistant bacterial infections. Their investigational drug candidates include efflux pump inhibitors, DHFRIs, and FtsZ inhibitors and aim to combat antimicrobial resistance.

One of their investigational compounds, TXA 15054, is in the very early stages of development, and TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discussed its novelty.

“TXA 15054 is from a compound series that targets bacterial DHFR…. Although DHFR is not a new target, it is important to remind the audience that trimethoprim, which is the only drug that targets DHFR, has absolutely no activity against gonorrhea. So our TXA 15054 and other compounds from that series target bacterial DHFR in a unique way, which is totally different from trimethoprim,” said Parhi in an interview with 

 at the recent American Society for Microbiology Microbe conference.

In terms of safety and tolerability, there are some benefits associated with this group of compounds. “TXA 15054 and other compounds found in this series do not actually bind to human DHFR, so it can have a very big implication in the adverse effects or toxicity for patients,” Parhi said.

This newer strain of this sexually transmitted infection (STI), also known as supergonorrhea, poses a public health challenge due to its resistance to the last line of an effective antibiotic, ceftriaxone. And the overall incidence rates of this STI are escalating worldwide. The World Health Organization (WHO) reports that in 2020, there were an estimated 82.4 million (range, 47.7 million-130.4 million) new gonorrhea cases among people aged 15 to 49 years worldwide, with a global incidence rate of 19 (range, 11-29) per 1000 women and 23 (range, 10-43) per 1000 men. Most cases were in the WHO African Region and Western Pacific Region.

Although this strain has been seen mostly outside the US, in 2023, 2 cases of this pathogen were confirmed in the US and identified by the Massachusetts Department of Public Health.

Massachusetts officials reported that clinicians were able to treat the patients successfully with ceftriaxone. However, this strain of the STI had reduced susceptibility to 5 antibiotic classes, including cephalosporins.

Parhi is optimistic his company will identify a specific agent to bring to the clinic. “I hope by the end of 2025 or mid-2026 we will be able to identify a preclinical candidate, and then within 6 months or so, we can identify a clinical candidate.... We are excited about this series of compounds,” he said.



References

1. TAXIS Pharmaceuticals announces $2.9 million NIH grant for its novel investigational therapeutic to combat antibiotic-resistant gonorrhea. Press release. TAXIS Pharmaceuticals. May 27, 2025. Accessed July 14, 2025.
https://www.prweb.com/releases/taxis-pharmaceuticals-receives-2-9-million-nih-grant-for-its-novel-investigational-therapeutic-to-combat-antibiotic-resistant-gonorrhea-302464710.html
2. Multi-drug resistant gonorrhea. World Health Organization. July 11, 2023. Accessed July 14, 2025. 

https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea


3. Landhuis EW. Multidrug-resistant “super gonorrhea” rallies multipronged effort. 

 2024;331(20):1695-1697. doi:10.1001/jama.2023.15355



TAXIS Pharmaceuticals Chief Scientific Officer Ajit Parhi, PhD, discusses dihydrofolate reductase inhibitors as a novel approach to combat resistant Neisseria gonorrhoeae. 

Conferences

A Group of Antimicrobial Compounds Shows Novelty Action Against Multidrug-Resistant Gonorrhea

Johns Hopkins is offering its Pamela Tucker transplant and oncology infectious diseases course, and its director, Shmuel Shoham, MD, offers more information about this learning opportunity. 

An Education Opportunity for Transplant and Oncology Infections 

Shmuel Shoham, MD, professor of clinical medicine in the Division of Infectious Diseases at Johns Hopkins University School of Medicine, was looking for a course for transplant and oncology infectious diseases. When he couldn’t locate one, he and his team developed one.

Specifically, Johns Hopkins Medicine is offering its new course, 

the Pamela Tucker Course in Transplant & Oncology Infectious Diseases

, on infectious complications in patients undergoing transplant (solid organ and stem cell) and patients with cancer.

“We worked together to create one that starts from the bottom in terms of what patients, doctors, and clinicians can expect in terms of transplantation, in terms of oncology, from the oncologists and the surgeons and the physicians' side and then what can be expected from the infectious disease side,” Shoham said. 

This will be a 2-day, in-person educational activity held from September 8 to 9 at the 

Johns Hopkins University Bloomberg Center

, which is located at 555 Pennsylvania Avenue NW in Washington, DC.

The course will expand expertise on infectious complications in patients undergoing transplant (solid organ and stem cell) and patients with cancer. It will feature lectures from experts in the ﬁeld and provide attendees with the knowledge and skills to provide infectious diseases care to patients undergoing transplant and those with cancer.

“We'll be talking about how organisms get to the places where they don't belong, the impact of resistance, antibacterial and antifungal resistance on those infections, and then have people really know what infections to expect,” Shoham said. “Also, viral infections are huge. So we'll have world experts in CMV [cytomegalovirus], other herpes virus infections, and respiratory viral infections talking about how those infections happen, how to prevent them, how to manage them—cutting-edge approaches to diagnosis and treatment.”  

Shoham also said they are going to be covering xenotransplantation infections.

AMA PRA Category 1 Credits. For those who are interested in learning more or signing up for the course, clinicians can go 

Johns Hopkins is offering its Pamela Tucker transplant and oncology infectious diseases course. Its director, Shmuel Shoham, MD, offers more information about this continuing education opportunity. 

VOLITION and OPERA study data presented at IAS 2025 show patient preference and real-world use of injectable CAB + RPV LA, informing the treatment strategy of ViiV CMO Jean van Wyk.     Ask ChatGPT

Nearly 90% of treatment-naïve people with HIV chose to switch to long-acting injectable therapy after achieving viral suppression, according to findings from the Phase IIIb VOLITION study presented by ViiV Healthcare at IAS 2025. The study enrolled 145 newly diagnosed individuals who began treatment with the daily oral regimen dolutegravir/lamivudine (DTG/3TC). Once they achieved viral suppression, typically in just over four weeks, participants were given a choice: remain on daily oral medication or switch to the long-acting injectable regimen, cabotegravir plus rilpivirine (CAB + RPV LA), administered every two months. An overwhelming 89% (n=129) opted for the long-acting option at their next study visit.

Jean van Wyk, MBChB, MFPM, chief medical officer at ViiV Healthcare, explained, “This study was specifically designed to see how quickly we can get treatment-naive individuals to get to a point where they can potentially choose long-acting injectable therapy."

“They were started on a medication called Dovato, which is a combination of dolutegravir and lamivudine... the moment they became undetectable—which means that they have no virus replicating in their blood—they were immediately given the choice: do they want to stay on the daily oral medication, or do they want to switch to long-acting injectable therapy?”

Participants reached viral suppression with a median time of 4.14 weeks, and data showed that convenience was a key driver in their decision-making.“About 80% of them said it’s because they don’t want to worry about forgetting to take a tablet every day, and about two-thirds of them said it removed the worry about traveling with medication,” van Wyk added.

This strong preference aligns with outcomes from other studies and real-world experiences.“We’ve seen this in studies and in real-world evidence, and it’s just a testament to the power of choice—giving people the choice of a medication that might be best suited to them,” said van Wyk.

OPERA Real-World Data Reinforces Effectiveness in Treatment-Experienced Populations

While VOLITION focused on newly diagnosed individuals, real-world data from the OPERA cohort broadened the picture to include treatment-experienced people living with HIV, especially those with viremia at baseline.

Among 3,304 participants in OPERA, 11% (n=368) had viral loads above 50 copies/mL at initiation of CAB + RPV LA. Remarkably, 88% of these viremic individuals achieved suppression to <50 copies/mL, showing the potential of long-acting treatment even for those with complicated treatment histories.“This time, specifically, we looked at people who are treatment-experienced… but for whatever reason, it wasn't working for them and they became viremic again,” van Wyk explained.

“We had well over 300—nearly 400—people included in this analysis, and they had viremia… what we found was that, over time, they had really good responses—very good effectiveness rates from this OPERA analysis—with around 88% of individuals having an undetectable viral load.”

A separate sub-analysis of viremic women in the OPERA cohort demonstrated even more impressive results, with 92% achieving viral suppression after switching to long-acting therapy.“Again, we saw very similar and good treatment outcomes—just over 90%, 92% of women—having an undetectable viral load after they’d gone on to long-acting injectable therapy,” van Wyk said.

In addition to VOLITION and OPERA, ViiV is building a growing portfolio of real-world effectiveness data. Supporting studies such as CARLOS (Germany), COMBINE-2 (Europe), and BEYOND (U.S.) continue to confirm low virologic failure, strong adherence, and high patient satisfaction across diverse populations—including both virally suppressed and viremic individuals at the time of switch.

“That includes viremic and suppressed populations at the time of switch—again, showing really good effectiveness rates, low rates of virologic failure, and persistence on treatment over time,” noted van Wyk. As the HIV treatment landscape shifts toward personalization and patient-centric care, Jean van Wyk’s leadership at ViiV is shaping a strategy rooted in flexibility, access, and real-world insight.“It’s just a testament to the power of choice,” he said. “Giving people the choice of a medication that might be best suited to them.”

Stay tuned for part two, where we explore how long-acting regimens like CAB + RPV LA are helping to reduce stigma, improve adherence, and expand access, and how these findings are shaping Wyk’s vision for the future of HIV prevention and treatment.

ViiV Healthcare data show 89% of treatment-naïve people with HIV choose to switch to long-acting injectable 

 from daily pills after achieving rapid viral suppression. 

. June 14, 2025. Accessed June 14, 2-25. https://www.businesswire.com/news/home/20250714839509/en/ViiV-Healthcare-data-show-89-of-treatment-nave-people-with-HIV-choose-to-switch-to-long-acting-injectable-Vocabria-Rekambys-from-daily-pills-after-achieving-rapid-viral-suppression

At IAS 2025, the VOLITION and OPERA study data presented at IAS 2025 show patient preference and real-world use of injectable CAB + RPV LA, informing the treatment strategy of ViiV CMO Jean van Wyk.


Alyssa M. Peckham, PharmD, BCPP; and Michael G. Chan, PharmD, BCCCP, CACP

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