bluuebunny/crossref_metadata_2025 huggingface dataset:
1434. Analysis of hand hygiene techniques using the artificial intelligence (AI)-based analysis tool SCORE!
Authors: Kakeya Hiroshi , Okada Yasuyo , Fujita Akiko , Nakaie Kiyotaka , Imoto Waki , Shibata Wataru , Yamada Koichi
Published: November 2023

Background

Hand hygiene is the most important technique for controlling nosocomial infections. While quantitative evaluations based on the amount of hand sanitizer used and qualitative evaluations such as compliance rates based on direct observation are commonly used to evaluate the effectiveness of this education, more objective evaluation indicators are needed. Here, we evaluated the effectiveness of hand hygiene education by scoring hand hygiene techniques using an artificial intelligence (AI)-based analysis tool.

Methods

Hand disinfection (proper spreading of fluorescent paint) and hand washing (proper rinsing of fluorescent paint) techniques were scored before and after a hand hygiene education video training using the AI-based analysis tool SCORE!Ⓡ(Moraine Corporation, Tokyo).

Images were taken with an iPhone before and after hand disinfection and washing. The image data were divided into 72 parts, including the wrists and the backs of the right and left palms. Hand hygiene techniques for each part were evaluated using AI. The effectiveness of the training was also evaluated by job categories.

Results

The pre- and post-education scores of 935 participants (128 physicians, 484 nurses, 56 nursing assistants, 93 other medical staff, and 174 administrative staff) increased for hand disinfection (P < 0.01) and decreased for hand washing (P < 0.01). The scores for hand disinfection increased for all occupations, while those for hand washing decreased for all occupations except nursing assistants, indicating that hand disinfection was highly effective in education but hand washing was less effective. In a comparison by job categories, there was a large difference in scores between the job categories in terms of the highest and lowest scores for both hand disinfection and hand washing. In the site-specific evaluation, the back of the hand scored higher in hand disinfection, with no significant difference between left and right hands. On the other hand, the palm and left hand scored higher in hand washing, differing from the hand disinfection results.

Conclusion

Evaluating hand disinfection scores using “SCORE!” allows for the assessment of even minor changes that may be difficult to detect visually and provides information on individual techniques that may require improvement.

Disclosures

Hiroshi Kakeya, MD, PhD, Asahi Kasei Pharma Corporation: Honoraria|Merck Sharp & Dohme: Honoraria|Sumitomo Pharma Co., Ltd.: Honoraria
1438. Hand Hygiene Compliance and Monitoring among Healthcare Workers at an Urban Hospital in the Caribbean.
Authors: Nwaogu Ezinne U M
Published: November 2023

Background

Hand hygiene is one of the most effective ways to prevent the spread of infections in the Hospital.

To promote quality care, simple procedures like hand hygiene are of paramount importance.

To prioritize clean hands in health facilities, people at all levels need to believe in the importance of hand hygiene by acting as key players in achieving appropriate behaviors and attitudes towards it.

Methods

A cross-sectional observational study was used, by direct observation technique. 'Secret shoppers' employees, were used to monitor colleagues' hand hygiene compliance each time they enter or exit a patient's room.

Role modeling, make it part of our rounding/just-in-time education, infection prevention, and control (IPC) monthly hand hygiene compliance updates/feedback, and incentives. We mention it in every huddle, especially Healthcare-Associated Infections (HAI) meetings, Electronic platforms, mandatory training and education for all Employees.

Results

The findings of this study showed that our hand hygiene compliance rates increased from 52% to 87% across most of the units - ICU, IMCU, Medical Surgical unit, Maternity, Emergency Room, OR and by all employees ranging from physicians to nurses, patient care technicians and others.

Healthcare workers, now aware they are being monitored, by secret shoppers, work in competition with other units to improve their compliance because they would be given the recognition " hand hygiene champions. "

Conclusion

In conclusion, using secret shoppers and positive recognition helped our Hospital to achieve a higher degree of compliance with hand hygiene.

More will still need to be done, to get our compliance closer to 100%

Clean Hands Save Lives! Together, we can achieve it.

Disclosures

All Authors: No reported disclosures
1440. Hand Hygiene in Nursing Homes During And After The Covid-19 Pandemic Outbreak
Authors: Sandbekken Ida H , Løyland Borghild , Hermansen Åsmund , Utne Inger , Grov Ellen Karine
Published: November 2023

Background

Residents in Norwegian nursing homes are vulnerable and fragile, and hand hygiene adherence is too low to prevent transmission of all infections. This study aimed to investigate hand hygiene in nursing homes during and after the COVID-19 pandemic, and if interventions targeting behavior change can improve adherence.

Methods

Observations of hand hygiene were collected in February and March 2021 and September and October 2022, using the WHO observation tool. The observations were carried out by trained nursing students and researchers. The first observations were during the pandemic when it was strict regulations in nursing homes, and the last observations were when there were no regulations related to COVID-19. Over 12 months, from August 2021 to August 2022, three of the 22 participating nursing home wards implemented interventions to improve hand hygiene. Multimodal interventions targeting behavior change, including education, UV-light box, and posters, were implemented.

Results

Hand hygiene adherence in total was 58.3% during the pandemic and decreased to 52.5% after the pandemic. The control wards experienced a decrease from 59.5% in 2021 to 51.3% in 2022, while the intervention wards experienced an increase from 54.7% to 60.9% (p-value: < 0.001). Hand hygiene adherence in total was lower when wearing gloves (32.8% vs. 61.7%), and inappropriate glove use was significantly higher after the pandemic. Hand hygiene adherence was 35.3% when using gloves in 2021, in 2022 the adherence had decreased to 27.7% (p-value: < 0.001).

Conclusion

This study shows that the implementation of interventions aimed at behavioral change increased hand hygiene adherence in nursing home wards. Despite hand hygiene adherence being lower, and inappropriate glove use higher than hoped for during the pandemic, we can see that attention and focus on hand hygiene during the pandemic probably had an increased effect on adherence. Attention to hand hygiene and activation of the motivation of healthcare workers is crucial, for receiving an effect of interventions. Hand hygiene adherence decreased after the pandemic when the focus on hand hygiene diminished. Behavior is likely to decline over time, and continuous reinforcement is needed to maintain a behavior change.

Disclosures

All Authors: No reported disclosures
1454. Descriptive Epidemiology of Candida auris Infections in African-American population in Tertiary Care Center in Greater Detroit Area
Authors: Pollock Erin , Sandhu Avnish , Keri Vishakh C , Maples Catherine , Salimnia Hossein , Chopra Teena
Published: November 2023

Background

The first reported Candida auris (C. auris) cases in United States, were associated with global travel. It has emerged as a nosocomial pathogen among critically ill patients with prolong hospital stay, patients in long-term-acute hospitals, and skilled nursing facilities. Given the increase in cases (59% in 2019 to 95% in 2021) and C. auris being multidrug-resistant, Centers for Disease Control and Prevention has declared it to be a pathogen of urgent public health threat. The purpose of this study is to describe the epidemiology of C. auris among patients in a tertiary care center in greater Detroit area.

Methods

A retrospective cohort study was conducted among patients who tested positive for C. auris between January 2021 to January 2023. See Figure 1 flow chart of screening and culture method used to identify C. auris. Patients were defined as infected or colonized based on review of medical documentation. Data on demographics, length of stay, source of admission, treatment and susceptibility report were collected.

Results

One hundred and eight patients tested positive for C. Auris with 10 infections and 98 colonizations. 90% of infected patients were in intensive care unit, 80% required a ventilator, 50% had fungemia and 40% died within 30 days of C. auris infection (Table1). Among the 4 patient that died, median age was 67.5, one patient had persistent C. auris fungemia due to endocarditis, one patient had decompensated cirrhosis with concomitant bacteremia and urinary tract infection with C. auris, one patient had C. auris mediastinitis with severe cardiac comorbidities, and one patient had abdominal aortic aneurysm repair developed ventilator associated pneumonia with C. auris and Aspergillus Niger complicated by severe acute respiratory distress syndrome. 80% of patients were treated with micafungin and one patient was treated with micafungin and amphotericin B given C. auris endocarditis (Table 1). Voriconazole was used for treatment in one patient due to concomitant Aspergillus infection (Table 1). See Table 2 for minimum inhibitory concentration for 8 of 10 isolates.

Conclusion

C. auris is an emerging pathogen that can colonize the skin and has a potential of causing invasive infections leading to high morbidity and mortality.

Disclosures

All Authors: No reported disclosures
1461. Risk Factor Evaluation and Performance Improvement for Surgical Site Infections in Patients Undergoing Abdominal Hysterectomy at a Large Academic Public Safety Net Hospital
Authors: Buford Anna , Anderson Tyler D , Jandarov Roman , Schaffer Joseph , Wells Jacqueline , Bartlett Marianne , Houston Latitia , White Calvin , Buford Laura , Sopirala Madhuri
Published: November 2023

Background

Incidence of deep and organ space surgical site infections (SSI) after abdominal hysterectomy ranges from 1.1% - 5.7%, with higher rates for women without private insurance. Parkland Hospital is one of the largest safety net hospitals in the United States, serving mostly uninsured and Medicaid-enrolled patients. In 2021, our deep and organ space SSI rate for abdominal hysterectomies was 1.39%, with a standardized infection ratio (SIR) of 1.456. We studied SSI risk factors and report performance improvement (PI) initiative that decreased SSI incidence.

Methods

This retrospective case-control study randomly matched 37 patients with deep and organ space abdominal hysterectomy SSI from 2019 to 2021 with controls undergoing the same procedure during the same calendar month. We evaluated 18 variables as potential risk factors (Tables 1&2). We conducted a multidisciplinary PI intervention focusing on a modifiable risk factor identified during our investigation to reduce SSI post-hysterectomy. Evaluation showed vaginal and enteric organisms causing SSI leading to observations indicating improper vaginal preparation even though it was being performed.Table 1.Risk factors for SSI after Abdominal Hysterectomy (Univariate Analysis)

Results

Univariate analysis found one variable to be associated with lower risk and eight variables to be associated with higher risk (Table 1). Diabetes (OR, 3.89; 95% CI,1.25-12.08; p=0.0188) was found to be a risk factor in multivariate analysis while being Hispanic seems to be protective (OR, 0.31; 95% CI,0.12-0.80; p=0.0160). After the intervention of educating nursing staff on the right way of doing vaginal preparation, and weekly OR observations, our deep and organ space SIR in 2022 decreased to 0.63. Vaginal preparation was found to be a risk factor in our univariate analysis, but the coefficient was not estimable in multivariate analysis.Table 2.Independent Risk Factors for SSI After Abdominal Hysterectomy (Multivariate Logistic Regression)

Conclusion

Multidisciplinary intervention significantly decreased deep and organ space SSI rates. Ensuring standardized pre-operative vaginal preparation also enhanced SSI risk reduction. We suspect that our intervention improved SSI rates by improving the accuracy of vaginal preparation. Performance of vaginal preparation was a risk factor in univariate analysis but was not significant on multivariate analysis.

Disclosures

All Authors: No reported disclosures
1465. Two- versus Three-Gram Cefazolin Dosing for Surgical Prophylaxis in Colorectal Surgery Procedures
Authors: Collins Curtis D , Hartsfield Eric , Cleary Robert K , Brockhaus Kara K
Published: November 2023

Background

International guidelines recommend an elevated dose of cefazolin 3 grams for surgical prophylaxis in patients weighing ≥ 120 kg. This recommendation was made based on limited pharmacokinetic data, low cost, and favorable safety profile of cefazolin. Since the release of these recommendations nearly a decade ago few analyses have investigated the impact of these elevated dosing recommendations on surgical outcomes.

Methods

A multi-center, retrospective cohort study was performed utilizing available data from a large, validated database of elective colorectal surgeries in Michigan. Adult patients weighing ≥ 120 kg who received cefazolin and metronidazole for surgical prophylaxis between July 2012 and June 2021 were included. Emergent or urgent surgeries, missing follow-up and antibiotic information, and patients who did not receive either 2 or 3-grams of cefazolin with 500 mg metronidazole were excluded. The primary objective was to evaluate the incidence of surgical site infections (SSIs) between patients receiving 2 grams versus 3 grams of cefazolin. Secondary objectives analyzed the incidence Clostridioides difficile infection (CDI) between cohorts. The impact of cefazolin dosing and confounders was tested through a multivariable logistic regression model.

Results

Six-hundred-fifty procedures were included. Four-hundred nine patients (62.9%) received 3-grams cefazolin prophylaxis and 241 (37.1%) received 2-grams. The cohorts were similar with a significant difference in median body mass index in the 3-gram cohort (41 vs. 41; p = 0.023). There was no difference between 2- and 3-gram cohorts in SSIs (8% vs. 9%, p = 0.745) or CDI (1.2% vs. 0.7%; p =0.510). A significant difference in compliance with recommended antibiotic timing (93.8% vs. 88%; p = 0.017) was noted. Multivariable logistic regression showed 3-gram prophylaxis was not associated with a change in SSIs (adjusted odds ratio (aOR) 1; 95% CI 0.54 to 1.85; p = 0.994).

Conclusion

Three-gram cefazolin dosing in combination with metronidazole in obese patients for surgical prophylaxis in elective colorectal surgery procedures was not associated with changes in SSIs or CDI.

Disclosures

Robert K. Cleary, MD, FASCRS, FACS, Intuitive Surgical Inc: Honoraria
1468. Antibiotic Prophylaxis Prior to Dental Procedures for Total Hip Arthroplasty and Total Knee Arthroplasty Patients.
Authors: Simon Samantha , Aziz Alya , Goden Gloria , Hollenbeck Brian L
Published: November 2023

Background

Guidelines no longer recommend use of prophylactic antibiotics for dental procedures after total hip and total knee arthroplasty (THA/TKA), yet many surgeons continue to routinely prescribe antibiotics for this purpose. In a setting where one must consider the cost of antibiotics and consequences of antibiotic resistance, there may be reason to rethink the practice of prescribing antibiotics prior to dental procedures.

Methods

We conducted a retrospective cohort study of 10,899 patients who underwent THA/TKA between 1/1/19 and 12/31/20 with one of the 13 surgeons at a single institution. Patients were excluded if they had prior infection in the same joint. The primary outcome was late-presenting PJI, defined as PJI diagnosis > 90 days after surgery. Patients were designated in the antibiotic group or non-antibiotic group based on their surgeon’s prophylaxis protocol. Dental-associated PJIs were considered if the patient had evidence of dental infection, poor dentition and/or a dental procedure within a few weeks prior to onset of PJI symptoms.

Results

There were 2,872 (26.4%) patients in the no antibiotics group and 8,027 (73.6%) patients in the antibiotics group (prescribed 2000mg of Amoxicillin 30 minutes prior to dental procedures) (Table 1). We identified 27 (0.3%) late presenting PJIs and 4 (0.03%) dental-associated PJIs (Table 2). 3 of the 4 dental-associated PJI were in people who had dental infections, rather than routine dental cleanings. In the multivariable analysis, BMI ≥ 30 (OR 2.7, CI 1.1-6.5) and revision surgery (OR 7.7, CI 3.1-19.4) were the only variables that increased late-presenting PJI risk (Table 3). Age, gender, American Society of Anesthesiology Score, occlusive silver dressing, and prescription of antibiotics were not shown to affect risk of late-presenting PJI.Table 1.Overview of Patient and Surgical Variables.Table 2.Description of dental-associated prosthetic joint infections.Table 3.Multivariable Analysis. Adjusted for sex, age, American Society of Anesthesiology Score, body mass index, revision vs primary surgery, and dressing type. Showing odds of developing a late presenting prosthetic joint infection.

Conclusion

In this retrospective cohort study, we found a low rate of late-presenting PJI. Routine prescriptions of antibiotics prior to dental procedures did not alter the risk of late-presenting PJI. In addition, all 4 dental-associated PJIs occurred in patients prescribed antibiotics. These findings demonstrate that antibiotic prophylaxis before dental procedures may not be necessary, but good oral hygiene should be emphasized.

Disclosures

All Authors: No reported disclosures
1479. Analysis of Depression in People Living with Human Immunodeficiency Virus (HIV) During the Coronavirus Disease 2019 Pandemic in 4 African Countries
Authors: Adjei Paul , Dear Nicole , Esber Allahna , Kibuuka Hannah , Maswai Jonah , Owuoth John , Sing’oei Valentine , Bahemana Emmanuel , Crowell Trevor A , Ake Julie A
Published: November 2023

Background

We previously demonstrated higher odds of depression in PLWH during COVID-19 pandemic in our African Cohort Study (AFRICOS) between 07May2020 and 01Dec2021.1

This analysis updates the previous and estimates odds of depressive symptoms through 01Dec2022.

Hypothesis: If the pandemic was truly associated with depressive symptoms in PLWH then odds of depressive symptoms will continue the downward trend identified in later timepoints of our first analysis.

Methods

AFRICOS: Ongoing prospective cohort study enrolling PLWH at 12 clinics in Kenya, Uganda, Tanzania, Nigeria.2

Longitudinal evaluations every 6 months include physical evaluation, medical record abstraction, extensive questionnaires including CES-D; depression defined by score >16.3

We compared odds of depression in preCOVID-19 period (1 Jan 2019 to 19 Mar 2020) with five timepoints in COVID-19 era (7 May 2020 to 1 Dec 2022).

Logistic regression with generalized estimating equations for OR and 95% CI comparing depression before and during pandemic.

Models a priori adjusted for sex, age, and site.

Results

2,038 AFRICOS participants with complete cases and visits before and during COVID-19 periods included.

Median age at first visit included: 43 years (IQR 36-51)

1,181 (57.9%) were female

Depression varied significantly by: sex, participants by site, marital status, ART adherence at first timepoint included (Table 1).

60 (2.9%) participants had CES-D score suggestive of depression at first visit included.

Compared with pre-pandemic:

PLWH had higher odds of reporting depressive symptoms throughout pandemic. After adjusting for age, sex, and site, PLWH had higher odds of reporting depressive symptoms only in second, third, fourth parts of pandemic period, aORs: 1.62 (95% CI 1.13 – 2.31), 1.72 (95% CI 1.27-2.31), 1.41 (1.01 – 1.96) respectively (Table 2, Figure).

Conclusion

COVID-19 pandemic is associated with higher odds of depressive symptoms in PLWH in AFRICOS.

Odds of depression increased as pandemic progressed, peaking in third period and decreasing sequentially in fourth, fifth periods to confirm our hypothesis.

Given the strong association between depression and HIV outcomes, aggressive public health mental health response to pandemics may improve HIV clinical outcomes.

Disclosures

All Authors: No reported disclosures
1486. The Association of Aging-related Comorbidity Burden and Quality of Life Among Women with and without HIV in the U.S.
Authors: Collins Lauren F , Ofotokun Igho , Greene Quincy , Palella Frank J , Naggie Susanna , Topper Elizabeth F , Anastos Kathryn , French Audrey L , Kassaye Seble , Taylor Tonya , Fischl Margaret A , Adimora Adaora A , Kempf Mirjam-Colette , Tien Phyllis C , Sheth Anandi N , Mehta Cyra Christina
Published: November 2023

Background

Women with HIV (WWH) are at higher and earlier risk of developing aging-related non-AIDS comorbidities (NACM) compared to those without HIV; however, the impact on health-related quality of life (QoL) is largely unknown.

Methods

We analyzed data from the Women’s Interagency HIV Study to evaluate the effect of comorbidity burden (total NACM of 10 assessed) on nine QoL domains and a summary QoL index (QoLI; measured by the MOS-HIV instrument). We included women followed on/after 2009 (when >80% of WWH reported antiretroviral therapy use) and ascertained covariates, NACM, and QoL through the last study visit by 03/2018. Unadjusted (HIV, age, NACM burden or prevalence separately), partially adjusted (unadjusted + all possible interaction terms) and adjusted (partially adjusted + covariates) linear regression assessed impact on QoL.

Results

Among 3036 women (2173 HIV+, 863 HIV-), median age was 50 (Q1-Q3 43-56) yrs, 66% were Black, 51% had annual income < $12K, and mean (sd) NACM burden was 3.4 (2.2). In unadjusted models, each additional NACM decreased the mean QoLI by -4.4 (95%CI -4.7,-4.1; p< 0.0001). Mean QoLI did not differ in WWH vs without HIV (68 vs 69, p=0.40) but decreased with older age (< 40, 40-49, 50-59, 60-69 yrs): 75 (95%CI 73,77), 71 (70,73), 65 (63,66), 63 (61,65), respectively (p< 0.0001). Unadjusted QoLI was negatively associated with each prevalent NACM (Table). NACM burden was associated with all nine QoL domains in unadjusted models: physical function, role function, energy/fatigue, social function, cognitive function, emotional well-being, health perception, pain, and perceived health index. In the partially adjusted model, the impact of NACM burden on QoLI was modified by age (p=0.02) but not HIV serostatus (p=0.40) (Figure). In covariate-adjusted models (race, BMI, cigarette, alcohol or crack use, menopausal status, socioeconomic status), NACM burden was associated with QoLI (p< 0.0001) but age and HIV did not modify this effect (age*HIV*NACM burden, p=0.83).

Summary quality of life index and aging-related comorbidity burden by HIV serostatus and age

Conclusion

Among women with a high prevalence of multimorbidity, HIV, and health disparities, total comorbidity burden was associated with QoL, independent of age or HIV serostatus. Research is needed to optimize multimorbidity screening and prevention strategies in this population.

Disclosures

Lauren F. Collins, MD, MSc, Curio Science: Honoraria Igho Ofotokun, MD, MSc, FIDSA, Merck: Grant/Research Support Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support
1496. Utility of Urinary Lipoarabinomannan (LAM) for Diagnosis of Tuberculosis in HIV-infected Hospitalized Patients – A Prospective Observational Study.
Authors: Kumar Deepak , Sharma Shivang , Bohra Gopal Krishana , Garg M K , Midha Naresh Kumar , Meena Durga Shankar
Published: November 2023

Background

Lipoarabinomannan (LAM) is an essential component of the cell wall of mycobacterium tuberculosis. LAM causes anti-inflammatory effects on the human immune system by reducing innate and acquired cellular activity and increasing IL-10 production. Increased LAM in body fluid is a marker of active infection, with maximum concentration in sputum followed by urine. WHO has endorsed the urine LAM for diagnosis of tuberculosis in HIV infection. The study aimed to find the utility of urinary LAM assay in diagnosing tuberculosis in hospitalized patients with HIV Infection.

Methods

All Adult (≥18-year-old) patients with HIV infection and hospitalised and regardless of their presenting symptoms or CD4 count, were included for urinary LAM assay (Alere) for diagnosis of tuberculosis. Patients who had taken antituberculosis drugs (first or second line) the month prior were excluded. With molecular and culture methods, best practices were done to find opportunistic infections, including tuberculosis.

Results

A total of 60 patients were enrolled, and urinary LAM was positive in 18 (30%) cases. Among culture or GeneXpert-confirmed tuberculosis, urinary LAM was positive in 55.6% of cases. None of the patients who were not eligible for the LAM test as per 2019 WHO guidelines were found positive (Table 1). The sensitivity, specificity, and negative and positive predictive values of urinary LAM were 62.5%, 91.8%, 76.3% and 85.1%, respectively. In-hospital mortality was significantly high in LAM-positive cases (38.8% vs 16.7%; p-value=0.03).

Conclusion

Urinary LAM may greatly help diagnose tuberculosis in Patients with HIV-TB co-infection with critically ill, with low CD4, or presented by multiple system affection with high specificity. LAM positivity was also associated with increased mortality in HIV infection.

Disclosures

All Authors: No reported disclosures
1501. Characterizing Engagement in Care and STI Screenings among DC Cohort Participants with HIV and Mpox
Authors: O’Connor Lauren , Byrne Morgan , Anderson Elisabeth , Benator Debra A , Lucar Jose , Horberg Michael A , Denyer Rachel V , Lee Rachel , Castel Amanda Derryck , Monroe Anne K
Published: November 2023

Background

A high proportion of people with HIV (PWH) in the 2022-2023 mpox outbreak (approx. 40% of US cases) has raised questions about the association between HIV and mpox. Increased encounters with the healthcare system may be contributing to this association. This study sought to elucidate whether detection bias drives the relationship between mpox and HIV by determining whether engagement in care and STI screening are associated with having an mpox diagnosis.

Methods

We conducted a 5:1 matched case-control study among DC Cohort participants, a longitudinal cohort of PWH receiving care in Washington, DC. Cases were matched on age (+/-5 years), gender, race/ethnicity, HIV transmission risk factor, time since HIV diagnosis (+/-5 years), years enrolled (+/-3 years), and HIV care site (community or hospital) with up to 5 controls. Engagement in care was defined as two or more CD4 or HIV RNA tests at least 90 days apart during the last year. STI screening was any test for gonorrhea, chlamydia, or syphilis in the past year. Cases were participants with an mpox diagnosis identified by providers or an ICD10 code in the EHR. We used unadjusted conditional logistic regression to assess the relationship between engagement in care, STI screening, and mpox diagnosis.

Results

We identified 68 cases of mpox in the DC Cohort and 65 could be matched to 300 controls (n = 365). Participants were majority male (98.9%), Black (70.7%), MSM (89.3%), and 51.5% of participants had an STI diagnosis since cohort enrollment. Cases were significantly more likely to be engaged in care (50.8% vs. 26.3%; OR: 3.24), receive an STI screening (69.2% vs. 41.3%; OR: 3.45), have a historical STI (72.3% vs. 47.0%; OR: 3.58), and have a CD4 count < 500 (40.4% vs. 21.9%; OR: 2.51).

Conclusion

Among a cohort of PWH, those with an mpox diagnosis were significantly more likely to be engaged in care and received an STI screening in the year prior, suggesting increased encounters for HIV care may account for a higher rate of PWH among mpox cases. The high proportion of CD4 < 500 among mpox cases suggests more clinically evident manifestations in this population. Future analyses should examine unmeasured behavioral factors to explain the association between mpox diagnosis, increased engagement in care and STI screening.

Disclosures

All Authors: No reported disclosures
1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs
Authors: Soria Jaime , Collins Jana , Thacker James R , Thornton Alice C , Hoven Ardis , Van Sickels Nicholas
Published: November 2023

Background

Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites.

Methods

We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results

In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID.

Conclusion

SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount.

Disclosures

All Authors: No reported disclosures
1553. Cost Effectiveness of Cabotegravir versus Continuous and Event-Driven PrEP: A Systematic Review and Cost-Analysis
Authors: Sharma Ishani , Hill Andrew
Published: November 2023

Background

The HIV epidemic continues to grow with 1.5 million new infections globally in 2021. In 2019, 62% of new infections were amongst key at-risk populations. HPTN 083 and 084 trials showed up to 88% increased efficacy of long-acting cabotegravir (CAB-LA) compared to continuous oral tenofovir/emtricitabine (TDF/FTC). However, the expense of CAB-LA ($22,200 per person per year (pppy)) limits its availability to populations who need it most. In most countries, HIV prevention budgets are highly limited, with TDF/FTC available as a low-cost generic.

Methods

We conducted a systematic review of studies on global HIV incidence in at-risk populations. The weighted incidence was calculated for each population, blood donors, and the general population. We evaluated potential HIV infection rates for 4 prevention strategies: no PrEP, continuous CAB-LA (annual cost $22,200 per person (pp)), continuous TDF/FTC (annual cost $48pp), and event-driven TDF/FTC (annual cost $12pp). For each PrEP strategy we assumed an additional $4 pppy for HIV testing, and $14 pppy for education and service access. Assumed efficacy was 90% for continuous CAB-LA, 60% for continuous TDF/FTC, and 30% for event-driven TDF/FTC. Using weighted HIV incidence rates and an assumed $1million fixed budget for HIV prevention, annual HIV infection rates for each target population were calculated for each PrEP strategy.

Results

The database searches identified 98 studies in 5,230,189 individuals. Incidence per 100 person-years (pys) ranged from 0.03 in blood donors to 3.82 in people who inject drugs (Table 1). Within the fixed $1 million budget, annual HIV infections in commercial sex workers (incidence of 3.1/100pys) would be 1,033 for no PrEP, 1,032 for continuous CAB-LA, 752 for continuous TDF/FTC, and 723 for event-driven TDF/FTC. The same trends were seen across all populations: use of event-driven PrEP prevented the largest number of HIV infections for fixed budgets.

Table 1

A table showing the number of studies, total sample size, and average incidence of HIV infection in key populations, blood donors and the general population.

Conclusion

CAB-LA is the most efficacious form of PrEP, but high prices limit numbers who can be treated. More HIV infections can be prevented using low-cost event-driven TDF/FTC as PrEP: far more people can be treated for fixed budgets. This result is consistent across a range of at-risk populations in different countries.

Disclosures

All Authors: No reported disclosures
2069. Exploring the Barriers and Enablers of Safe Oral Sexual Practices among Transgender Women of Malaysia: A Qualitative Study on STI Transmission
Authors: Ajay Telang Lahari , Shaik Daud Hezreen , Cotter Aoife , Rashid Abdul
Published: November 2023

Background

Transgender women (TGW) in Malaysia experience unique social and interpersonal challenges that contribute to their risk of acquiring HIV and sexually transmitted infections (STIs). (Fig 1)The study aimed to understand the experiences of this vulnerable population, barriers and enablers of safe sexual practices relating to oral transmission of STIs.Fig 1Challenges faced by Transgender women in Malaysia

Methods

Participants were recruited through a snow-balling method of sampling with the help of TGW community advocates. Theories of Health Belief Model and Andersen’s Behaviour Model of health services use were used to devise the interview guide. Semi-structured in-depth interviews and Focus group discussion with participants gave insights into the needs of the community. (Fig 2) The data obtained was transcribed, coded and subjected to thematic analysis using the constructs of the Information, Motivation and Behavioural skills (IMB) theory. Results are presented as n (%) or median (interquartile range, unless otherwise stated).Fig 2:Methodology Flowchart -Qualitative analysis

Results

Participant characteristics are outlined in table 1. The major themes that emerged through qualitative analysis are highlighted (Fig 3). The results identified gaps in awareness of oral transmission of STIs among TGW and lack of condom use during oral sex. Self-medication / non-professional treatments and lack of utilization of dental services was a concern.Table 1:Participant characteristicsFig 3:Thematic analysis map of In-depth Interviews with Major themes and Minor themes indicating Barriers and Enablers

Conclusion

The importance of social support in positively influencing health promotion as well as improving health care and dental care utilization was highlighted. The areas of concern identified through this qualitative research will inform the design and development of an educational intervention aimed at addressing these concerns and providing support. Developing a customised, culturally sensitive, peer reviewed educational intervention that will be delivered through a widely popular social media platform is proposed.

Disclosures

All Authors: No reported disclosures
1566. Determinants associated with weight gain among persons with HIV who switch to integrase strand transfer inhibitors (INSTI)
Authors: Cutshaw Melissa Klein , Harding Mahmoud , Davenport Clemontina A , Okeke Nwora Lance
Published: November 2023

Background

Weight gain associated with integrase strand transfer inhibitors (INSTI) has been well documented among patients with HIV. However, recent reports suggest that the observed weight gain among patients who switch to INSTIs may be associated in part with their pre-switch regimen.

Methods

We conducted retrospective analyses of a 50% sample of all treatment-experienced patients who switched to second-generation INSTI containing regimen (bictegravir/dolutegravir) at the Duke Adult Infectious Diseases Clinic (Durham, NC, USA) between 1 January 2014 and 31 December 2021. Covariates included sex at birth, age, race, ethnicity, pre-switch regimen, body mass index (BMI), CD4 count and HIV-1 viral load. All weights documented within 24 months from regimen switch were included. Outcomes of interest were percent change in weight and absolute weight change. Ordinary least squares was used to obtain average percent weight change from baseline, adjusted for covariates.

Results

Overall, 339 persons were included in the analyses. Cohort demographics were: median age 51.2 (interquartile range 44.4, 57.6), 73% male sex at birth, 56% Black, 4% Hispanic ethnicity. At regimen switch, median CD4 count was 671 (IQR 460-935), and 78% had a viral load < 200 copies/cc. Mean weight at regimen switch was 87.8 kg (standard deviation [SD] 22.1kg), and mean total weight change over 24 months post-switch was +1.3 kg (SD 7.1 kg). Overall, 28% of cohort members gained >5% of baseline body weight within 24 months of switch. Hispanic ethnicity (5.9% [95% CI 1.0, 10.7]) and BMI < 20 (3.7% [95% CI -0.3, 7.7]) were associated with post-switch weight gain. Only efavirenz-containing pre-switch regimens were significantly associated with weight gain over 24 months post-switch; EFV/FTC/TDF (3.1% [95% CI 0.2, 6.1]), all other EFV-containing regimens (6.3% [95% 0.1-12.4]).

Conclusion

Pre-switch regimens containing efavirenz were significantly associated with weight gain after switch to second-generation INSTI-based regimens, consistent with findings from non-US based cohorts.

Disclosures

Nwora Lance Okeke, MD MPH, Gilead Sciences: Advisor/Consultant
1572. Impact of an Educational Initiative to Close Gaps in Knowledge, Confidence and Engagement in HIV Care
Authors: Okulicz Jason F , Fallon Stephen J , SAWYER J E W E L , Carter Jeffrey D , Rodriguez Melissa , Herbin Shelbye , Simone Laura , Molloy Leah
Published: November 2023

Background

Ongoing engagement in HIV care is crucial to optimizing outcomes while addressing changing needs. This project aimed to identify and address gaps in HIV education, counseling and engagement.

Methods

Between 12/2021 and 5/2022, 20 education sessions for people with HIV (PWH) were held in 5 US HIV clinics as a 4-part series emphasizing (1) benefits of viral suppression, (2) talking about sexual health, (3) HIV treatment options, and (4) aging well with HIV. Surveys were administered to participating PWH and healthcare professionals (HCP). Content was extended for nationwide use through an online toolkit for HCPs, and a peer mentorship video for PWH.

Results

Surveys were completed by 312 PWH and 68 HCPs who participated in the live sessions. At baseline, 32% of HCPs were confident in counseling PWH about improving ART switching and 41% about adherence, which improved to 47% (p< 0.001) and 55% (p< 0.001), respectively, after accessing the online toolkit. Most PWH demonstrated greater knowledge about “undetectable = untransmittable” (96%) and the need for ART for all PWH regardless of viral load (86%) after the sessions than before (69%; p< 0.05 and 46%; p< 0.05, respectively). Compared to baseline, more HCPs reported high confidence in counseling PWH about achieving and maintaining viral suppression (96% vs 64%; p< 0.05) after the sessions. While not meeting the level of statistical significance, some increases in HCP confidence were identified in counseling PWH about coping with mental health challenges (90% vs 69%; p=0.34), and managing HIV with comorbidities (80% vs 58%; p=0.41). When asked about medication adherence, HCPs commonly identified health insurance (55%) as a barrier, while most PWH reported no barriers (61%). All participants identified top goals. Most PWH indicated a goal to educate themselves about HIV treatment and prevention while HCPs prioritized education and conversations about sexual wellness. As of August 2022, the online toolkit extension was accessed by 3,320 HCPs, and the peer mentorship video by 4,331 PWH.

Conclusion

PWH knowledge and HCP confidence in counseling PWH improved following live collaborative educational sessions. Post-program goals were aligned amongst PWH and providers who prioritized improving PWH understanding of HIV management.

Disclosures

Jason F. Okulicz, MD, Gilead Sciences: Advisor/Consultant JEWEL SAWYER, PA-C, MSHS, AAHIVS, Janssen: Speakers Bureau|Prime Education: Speakers Bureau
1574. Co-Utilization of HIV, Substance Use, and Mental Health Services Among Women with Current Substance Use
Authors: Fujita Ayako W , Ramakrishnan Aditi , Mehta Cyra Christina , Yusuf Oyindamola , Wilson Tracey , Shoptaw Steven , Carrico Adam , Adimora Adaora A , Eaton Ellen , Cohen Mardge H , Cohen Jennifer , adedimeji Adebola , Plankey Michael , Chandran Aruna , Weiss Deborah Jones , Colasanti Jonathan , Sheth Anandi N
Published: November 2023

Background

Integrated HIV, mental health, and substance use (SU) treatment strategies to improve health outcomes among women living with HIV (WWH) are limited. We described co-utilization of HIV, SU, and mental health treatment services among women enrolled in the Women’s Interagency HIV Study (WIHS) who report current SU.

Methods

We included data from participants enrolled in 10 WIHS sites during their last study visit from 2013-2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. We described utilization of each treatment service (SU treatment, HIV care, mental health care, alcohol use treatment, tobacco cessation treatment) by subgroups of participants with current SU and either HIV, depressive symptoms (Center for Epidemiologic Studies–Depression score ≥ 16), heavy alcohol use ( > 7 drinks/week), or current tobacco use. We then compared utilization of services by those who did or did not utilize SU treatment using Chi-square/Fisher exact tests.

Results

Among women with current SU (n=377), 41.9% reported utilizing SU treatment (Table) and 82.7% receiving any health care. Among women with current SU+HIV (n=233), 86.3% had an HIV healthcare provider visit since last study visit; among current SU+depressive symptoms (n=204), 39.2% had a mental health provider visit since last visit; among current SU+heavy alcohol use (n=87), 23.0% utilized alcohol treatment in the past year; and among current SU+current tobacco use (n=296), 10.1% utilized tobacco cessation treatment in the past year. Among subgroups of women with current SU who were eligible for another service, utilization of other services was significantly higher among those who utilized SU treatment for alcohol and tobacco cessation treatment, but not for any healthcare provider, HIV care, or mental health care provider (Figure).

Conclusion

Among this sample of WWH with current SU, we found 1) high engagement in SU treatment, and high engagement in health care and HIV care regardless of SU treatment, but 2) low engagement in alcohol and tobacco cessation treatments. Integrated drug, alcohol, and tobacco treatment programs should not be missed opportunities for WWH with concurrent SU, alcohol or tobacco use.

Disclosures

Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support Ellen Eaton, MD, MPH, Gilead: Grant/Research Support|Gilead: Honoraria
1576. Implementation of a Pharmacist-Driven Initiation of Antiretroviral Therapy in Patients Newly Diagnosed with Human Immunodeficiency Virus
Authors: Griffith Kamron Amir , Wallace Katie L , Stoner Bobbi Jo , Burgess Donna R , Jeter Sarah B
Published: November 2023

Background

Human Immunodeficiency Virus (HIV) infects over one million people annually. A major barrier to ending this pandemic is access to care. Prompt antiretroviral therapy (ART) initiation after diagnosis reduces time to viral suppression, decreases rates of opportunistic infections, and increases patient retention. At University of Kentucky HealthCare, there was a significant wait time from intake appointment to ART initiation with a provider. Beginning in November 2019, the HIV clinical pharmacist developed a program to initiate ART at intake appointments to curb this delay.This study was conducted to evaluate the impact of this initiative.

Methods

We conducted a retrospective, quasi-experimental study assessing newly diagnosed HIV ART-naïve adult patients pre- and post-implementation of the pharmacist-driven ART initiation. Exclusion criteria included initial HIV-1 RNA < 40 copies/mL (undetectable) and patients transferring care. Those enrolled between November 2017 to October 2019 were included in the pre-group and those enrolled from November 2019 to November 2021 in the post-group. The primary outcome was time to undetectable from ART prescribing. Secondary outcomes included time to HIV-1 RNA < 200 copies/mL from ART prescribing, and time to undetectable from HIV-1 diagnosis.

Results

Overall, we included 185 patients (pre-group=104 and post group=81). Undetectable was achieved in 95.5% of patients. Demographics were similar between the groups (Table 1). Median days to undetectable (63.0 vs 56.5; p=0.518) and HIV-1 RNA < 200 copies/mL (49 vs 43; p=0.388) from ART prescribing were similar between the two groups. Median days to undetectable from diagnosis (122 vs 85; p=0.004) and days to ART prescribing from initial visit (31 vs 0; p=0.001) were significantly shorter in the post-group. Median days to initial visit from HIV-1 diagnosis were shorter in the pre-group (13.5 vs 18.0; p=0.015). One-year retention was similar (93.2% vs 90.0%; p=0.433).

Conclusion

Our study showed a significantly shorter time to undetectable from HIV-1 diagnosis with ART initiation by a clinical pharmacist at intake visits. Additionally, retention of care remained similar despite ART initiation prior to provider visit. This initiative improved timely access to care at our institution.

Disclosures

All Authors: No reported disclosures