bluuebunny/crossref_metadata_2025 huggingface dataset:
2041. Impact of Coronavirus Disease 2019 pandemic on healthcare-associated infections at intensive care unit in South Korea: Data from Korean National Healthcare-associated Infections Surveillance System (KONIS)
Authors: Lee Yu-Mi , Kim Dong Youn , Kim Eun Jin , Park Ki-Ho , Lee Mi Suk
Published: December 2022

Background

Coronavirus Disease 2019 (COVID-19) pandemic has influenced hospital infection control practices. We evaluated the impact of the COVID-19 pandemic on healthcare-associated infections (HAIs) in the intensive care unit.

Methods

We conducted a retrospective analysis using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS has conducted nationwide prospective surveillance of HAIs in intensive care units. Comparisons of incidence rates of bloodstream infection (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) before (Jan 2018-Dec 2019) and during the COVID-19 pandemic (Jan 2020-Jun 2021) were performed according to hospital size. The microorganism distributions in BSI, urinary tract infection, and pneumonia were compared between the period before and during the COVID-19 pandemic.

Results

The incidence rate of BSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period (1.38 vs. 1.19 per 10,000 patient-days; P < 0.001) [Table 1]. Incidence rates of CLABSI (2.30 vs. 2.17 per 1,000 device-days; P = 0.03) and VAP (1.03 vs. 0.81 per 1,000 device-days; P < 0.001) decreased significantly during the COVID-19 pandemic than in the pre-COVID-19 period, whereas that rate of CAUTI was similar between the two periods. The annual trends of incidence rate of CLABSI and VAP also has decreased (Figure 1). According to the hospital size, the incidence rate per 1,000 device-days of CLABSI significantly decreased during the COVID-19 pandemic than in the pre-COVID-19 period in small to medium-sized hospitals (300-699 beds). The incidence rate per 1,000 device-days of VAP significantly decreased only in small-sized hospitals (200-449 beds). The microorganism distributions in HAIs did not change significantly.

Conclusion

The incidence rates of CLABSI and VAP decreased during the COVID-19 pandemic than in the pre-COVID-19 period, which was attributable to the changes in small to medium-sized hospitals.

Disclosures

All Authors: No reported disclosures.
2042. Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action
Authors: Gettler Erin , Kalu Ibukunoluwa , Advani Sonali D , Seidelman Jessica , Raj Krishnan Jay , Campbell Melissa , Lewis Sarah S , Smith Becky A , Anderson Deverick J
Published: December 2022

Background

Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI.

Methods

We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression.

Results

Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (< 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative to White patients in both study periods (pre-pandemic, 49% vs 38%; during pandemic, 47% vs 31%; respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30; 95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51; 95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3).

Conclusion

We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes.

Disclosures

Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.
2049. National Trends in Infections caused by Pseudomonas aeruginosa and Carbapenem Resistant Pseudomonas aeruginosa, 2017 – 2020
Authors: Rose Ashley , Baggs James , Wolford Hannah , Natalie McCarthy , Olubajo Babatunde , Reddy Sujan
Published: December 2022

Background

Pseudomonas aeruginosa is an opportunistic pathogen commonly found in the environment, including water and plumbing, which may serve as a reservoir of spread. We examined P. aeruginosa and carbapenem resistant P. aeruginosa (CRPA) rates and trends in recent years.

Methods

We assessed rates of P. aeruginosa using microbiology data from over 265 hospitals in the Premier Healthcare Database from January 2017 – December 2020. We identified a cohort of inpatients with any clinical culture yielding an isolate of P. aeruginosa with accompanying susceptibility testing results. Any isolate with at least 1 resistant result to imipenem, meropenem, or doripenem was considered CRPA. Cases were defined as community-onset (CO) when the culture was obtained immediately preceding admission or within the first 3 days of hospitalization, and hospital-onset (HO) when the culture was obtained on day 4 or later. Using monthly hospital level data we modeled cases per discharge, controlling for hospital characteristics, month of discharge, proportion of patients in specific age groups, and proportion of male patients. We developed weights using a raking procedure to match the American Hospital Association distribution for acute care hospitals to produce national estimates. Weighted multivariable logistic regression models were used to estimate national trends in rates per 10,000 discharges.

Results

Weighted rates of overall, HO, and CO P. aeruginosa and CRPA are shown in Figure 1. From 2019 – 2020, P. aeruginosa adjusted rates increased 7% (p=0.037) (Figure 2). HO P. aeruginosa rates declined 15% from 2017 – 2018 (p=0.014), however HO rates increased 29% in 2020 compared with 2019 (p< .0001). HO CRPA rates did not change during 2018 – 2019 compared with 2017, however HO rates increased 44% in 2020 compared with 2019 (p=0.001). Figure 1.Weighted Rates per 10,000 discharges, 2017 – 2020Figure 2.Pseudomonas aeruginosa and Carbapenem Resistant Pseudomonas aeruginosa Non-Linear Trend Comparisons, 2017 – 2020*Indicates statistical significance at p<0.05.

Conclusion

We observed an increase in the overall rate of P. aeruginosa in 2020 compared with 2019, driven by an increase in HO P. aeruginosa rates. HO CRPA rates also increased. Further evaluation of drivers of increasing HO P. aeruginosa infections is warranted, including exploration of the hypothesis that pandemic-associated changes in water use and management, such as intermittent closure and reopening of hospital units, may have increased exposure to water harboring P. aeruginosa.

Disclosures

All Authors: No reported disclosures.
2050. Proportion of hospital-onset infections expressing antibiotic resistant (AR) phenotypes in US Hospitals, 2018 – 2020
Authors: Olubajo Babatunde , Wolford Hannah , Rose Ashley , Natalie McCarthy , Reddy Sujan , Jernigan John A , Baggs James
Published: December 2022

Background

Reports suggest the COVID-19 pandemic in 2020 was associated with increases in hospital-onset AR infections, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp., carbapenem-resistant Enterobacterales (E. coli, Klebsiella spp., and Enterobacter spp.) (CRE) and Acinetobacter spp. (CRAsp), extended-spectrum cephalosporin resistance suggestive of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), and multidrug-resistant Pseudomonas aeruginosa (MDR-PA). To evaluate whether trends were similar for susceptible and resistant strains, we estimated the proportions of these resistant phenotypes in U.S. hospitals. Figure 1.Proportion of hospital-onset pathogens expressing resistant phenotypes, 2018 – 2020

Methods

We analyzed 2018–2020 hospital microbiology data in the Premier Healthcare and BD Insights Research Databases. Hospital-onset (HO) infections were those with positive cultures collected after hospital day 3. We used a raking procedure to produce weights to match national hospital characteristics, specifically: U.S. census division, bed size, teaching status, age, gender and urban/rural designation. We used a weighted means survey procedure for annual national estimates and generated annual comparisons with multivariable logistic regression adjusted by hospital characteristics.

Results

In 589 hospitals, the percentages of HO ESBL-E and CRAsp increased from 2019 to 2020 (Table). Among enterococci, the percentage with vancomycin resistance decreased. The percentages of MRSA, CRE, and MDR-PA did not change.

Conclusion

Our findings suggest pandemic-related factors, such as changes in antibiotic use or infection control, may have differentially affected susceptible and resistant phenotypes of hospital pathogens. Increases in the percentages of HO CRAsp and ESBL-E suggest these resistant phenotypes may have had a selective advantage over susceptible strains during the pandemic. In contrast, no changes in the percentages of HO MRSA or MDR-PA were observed, suggesting that infection rates increased similarly for resistant and susceptible strains. These findings underscore the importance of strategies to prevent hospital-associated infections and AR that are resilient to pandemic-related stresses on the healthcare system.

Disclosures

All Authors: No reported disclosures.
2052. Temporal and Geographical Prevalence of Carbapenem-Resistant Pseudomonas aeruginosa and the In Vitro Activity of Ceftolozane/Tazobactam and Comparators in Taiwan – SMART 2012-2020
Authors: Hsieh Tai-Chin , Chen Wei-Ting
Published: December 2022

Background

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is listed as a critical pathogen by World Health Organization (WHO). Using clinical isolates collected in Taiwan as part of the global SMART surveillance program, we evaluated the trend of CRPA prevalence in recent nine years (2012-2020) as well as in vitro activity of ceftolozane/tazobactam (C/T) and comparators against CRPA collected from ICU vs non-ICU wards from 2016 to 2020.

Methods

Between 2012-2020, Pseudomonas aeruginosa (PA) isolates were collected from nine sites in Taiwan (2 in Northern, 3 in Central and 4 in Southern Taiwan). MICs were determined and interpreted based on CLSI broth microdilution guidelines and 2021 CLSI breakpoints. PCR screening and β-lactamase gene sequencing were performed for isolates non-susceptible to imipenem or imipenem/relebactam or C/T.

Results

During the study period, a total of 2639 PA isolates were collected. Among these, 448 isolates were resistant to either imipenem or meropenem (17.0%). Yearly prevalence rate of CRPA increased from 12.3% in 2012 to 22.8% in 2020: 12.3% in 2012 (14/114), 11.5% in 2013 (16/139), 11.5% in 2014 (13/113), 12.2% in 2015 (41/336), 15.5% in 2016 (57/367), 15.9% in 2017 (68/428), 20.4% in 2018 (73/357), 19.4% in 2019 (75/386) and 22.8% (91/399) in 2020. Hospitals in Northern Taiwan had higher CRPA prevalence rate (22.8%, 131/574) compared to those in Central (15.7%, 126/802) and Southern Taiwan (15.1%, 191/1263). Percentage susceptibility of CRPA isolates to C/T from 2016 to 2020 showed 89.47% (51/57) in 2016, 79.41% (54/68) in 2017, 93.2% (68/73) in 2018, 90.7% (68/75) in 2019 and 98.9% (90/91) in 2020. For ICU vs. Non-ICU CRPA isolates, the susceptibility to C/T were 88.3% vs.93.8%, 77.8% vs. 82.5%, 92.3 % vs. 92.9%, 87.1% vs.93.2% and 100% vs. 98.26%, in 2016,2017, 2018, 2019 and 2020, respectively.

Conclusion

During the period of 2012-2020, the yearly prevalence of CRPA in Taiwan hospitals increased from 12.3% to 22.8%. The high prevalence and increasing trend of CRPA warrant continuous monitoring of evolving antibiotic resistance in Taiwan.

Disclosures

Tai-Chin Hsieh, MBBS, MSD Taiwan: Advisor/Consultant|MSD Taiwan: Employee of MSD Taiwan|MSD Taiwan: Stocks/Bonds.
2060. Evaluation of the real world incidence of integrase inhibitor resistance since adoption as guideline preferred therapy
Authors: Januszka Jenna , Drwiega Emily N , Drwiega Emily N , Burgos Rodrigo M , Michienzi Sarah M , Smith Renata , Badowski Melissa E
Published: December 2022

Background

There are limited data reporting real-world incidence of integrase inhibitor resistance (INSTI-R) since the approval and first-line treatment recommendation of INSTIs in the US. A recent analysis of the national surveillance data estimated INSTI-R to be 6.3%. The purpose of this study was to describe real-world incidence of INSTI-R in patients who used an INSTI-based single tablet regimen (STR) in a major metropolitan area and identify risk factors for resistance.

Methods

This was a retrospective study of adult patients living with human immunodeficiency virus (HIV) who were prescribed an INSTI-STR between September 2017 and September 2020 and followed for > 12 months at the University of Illinois Chicago Community Clinic Network (UCCN). The primary endpoint was the difference in INSTI-R in UCCN patients compared to the national prevalence of 6.3%. Other outcomes included development of virologic failure (VF), defined as 2 consecutive HIV-1 viral loads (VL) > 200 copies/mL after week 24, and documented INSTI-R mutations. Patient specific factors associated with medication nonadherence were also collected. All endpoints were analyzed using chi-square and Fisher’s exact tests.

Results

Of 948 patients screened, 248 patients were included. Baseline characteristics are summarized in Table 1. VF occurred in 17 subjects (6.8%). Two of the 17 (11.8%) received subsequent INSTI-R testing and nine eventually virally suppressed without regimen changes (52.9%). Patients without VF were assumed to have no INSTI-R.

No subjects developed INSTI-R, which was significantly less than the national prevalence of 6.3% (p=0.0029). Patients with a high VL at baseline were more likely to experience VF (p=0.001). The most common factors associated with nonadherence in patients with VF are summarized in Table 2.

Conclusion

The true rate of INSTI-R in UCCN patients is still unknown and factors associated with developing INSTI-R were unable to be assessed. Among patients at UCCN on INSTI-based STRs, INSTI-R rates were lower than the national average. Future analyses should also include patients on INSTI-based non-STR regimens as increased pill burden is a known risk factor for nonadherence leading to VF and drug resistance.

Disclosures

All Authors: No reported disclosures.
2066. Introduction of a Universal HIV Screening Electronic Health Record Alert at a Midwest Academic Health System
Authors: Allen Genevieve , Ahmed Mehwish , Coda John , Saravolatz Louis , McLane Michael , Heidemann Lauren , Cox Amanda
Published: December 2022

Background

Universal human immunodeficiency virus (HIV) testing is recommended for patients ages 13-64 at least once by the Centers for Disease Control and Prevention. Screening lags behind these recommendations.

Methods

We performed an analysis of the current state of HIV screening at three university-based internal medicine and one internal medicine/pediatrics clinics serving counties with HIV prevalence in 2020 from 51/100,000 to 176/100,000. We completed a chart review to examine current screening practices and conducted an electronic survey of primary care providers inquiring about awareness of universal screening recommendations and barriers to screening.

Based on this analysis, we implemented an automated electronic health record (EHR) reminder for HIV screening for patients aged 15-64 during health maintenance exams.

Our primary outcome was the number of patients screened for HIV pre-intervention (2017-July 2021) and post-intervention (August 2021-December 2021). We used odds ratio to compare the proportion of tests which were false positive and true positive pre- vs post-intervention. To evaluate the effect of the intervention on total HIV tests ordered across the institution, we used control chart methodology.

Results

Survey response rate was 59% for residents (n=97) and 18% for faculty (n=29). 93% were aware of the screening recommendation. The most common barrier to screening was forgetting to screen (Figure 1).

Pre-intervention, 25% of reviewed charts (n=4393) received recommended HIV screening. Post-intervention, HIV testing increased across the institution by 49% (Figure 2) and weekly testing was consistently three standard deviations above the mean compared to pre-intervention (Figure 3). The proportion of true positive tests decreased (p< 0.05). Figure 1.Common Reasons for Not Performing Universal HIV ScreeningFigure 2.Summary of HIV Testing 2017-2021Figure 3.Control Chart for HIV Testing by Week 2017-2021

Conclusion

Implementation of an automated HIV screening EHR reminder increased HIV screening. The proportion of true positive tests decreased, likely due to the low prevalence of HIV in our community

Disclosures

All Authors: No reported disclosures.
2071. HIV reservoir evaluation in GALT and PBMCs of virologically suppressed patients
Authors: Compagno Mirko , Scutari Rossana , Ferrari Ludovica , Teti Elisabetta , Piermatteo Lorenzo , Matteucci Claudia , D’Avolio Antonio , Malagnino Vincenzo , Grelli Sandri , Marco Iannetta , Silberstein Francesca Ceccherini , Perri Giovanni Di , Sarmati Loredana , Andreoni Massimo
Published: December 2022

Background

The extension of HIV reservoir in the rectal gut associated lymphoid tissue (GALT) and the ART influence on this compartment are still poorly studied. We aimed to evaluate the extent of HIV-DNA in GALT and peripheral blood of virologically suppressed patients (VS)

Methods

40 HIV-1+ VS pts were enrolled. Blood and GALT HIV-DNA levels and residual plasma viremia (RV) were quantified by droplet digital-PCR. Rectal biopsies were collected during high resolution anoscopy. Lymphocyte (L) phenotype and antiretroviral drug concentrations were analysed in tissue and peripheral blood

Results

Pts median age (IQR) was 37 (32-45) yrs, 39 (97.5%) were males. At HIV-1 diagnosis, median (IQR) viremia and CD4+ were 4.7 (4.3-5) Log10cps/mL and 469 (299-627) cells/µL, respectively. 27 (67.5%) pts had HIV-1 B subtype. At the enrolment, median (IQR) CD4+ was 720 (583-1041) cells/µL and RV was 3 (2-6) cps/mL. All pts were on 2 NRTI-regimen with a 3rd drug (20 INSTI, 15 NNRTI, 5 PI). A positive correlation emerged among HIV-DNA levels in the GALT and PBMC (Rho= 0.432; p=0.005), CD8+ L counts (Rho=0.367; p=0.02), and a negative correlation emerged with blood CD3+ L percentage (Rho=-0.489; p=0.006). Peripheral blood HIV-DNA values were inversely correlated with the CD4+ nadir (Rho= -0.379; p=0.017) and blood CD4+/CD8+ ratio (Rho= -0.362; p=0.022), and directly correlated with GALT CD4+CD38+ (Rho= 0.414; p=0.028) and blood CD8+CD38+ L (%) (Rho= 0.400; p=0.026). A positive correlation among GALT and peripheral blood CD4+CD38+ (Rho= 0.555; p=0.005), CD8+CD38+ (Rho= 0.417; p=0.030), and CD19+CD38+ L (Rho= 0.498; p=0.007) was found. There was no difference in HIV-DNA levels in the GALT and PBMCs according to the ART 3rd drug. In a subgroup of 20 pts the analysis of rectal tissue and blood drug concentrations showed that tissue/plasma ratio was higher in pts on Elvitegravir (EVG) and Rilpivirine (RPV) (median ratio 2.8 and 1.7, respectively)

GALT and Blood HIV-DNA levels

Tissue-Plasma Drug concentration

Conclusion

HIV-DNA from rectal GALT is a valid marker to characterize viral reservoir. The correlation of higher GALT HIV-DNA levels, CD8+ T L counts and CD4 and CD8 activation levels suggests that a greater amount of virus in the anorectal reservoir can perpetuate the inflammatory state characteristic of HIV+ pts. EVG and RPV showed higher tissue exposure than other ART regimens

Disclosures

All Authors: No reported disclosures.
2075. Assessing HIV prevention knowledge and HIV stigma in an urban midwestern community
Authors: Uhlar Adrianna , Lewis Steven A , Bogorodskaya Milana , Avery Ann A
Published: December 2022

Background

Stigma and discrimination within communities remain major barriers to HIV prevention, diagnosis, and treatment. Prior studies have focused on HIV stigma as perceived by individuals with HIV and among HIV care providers. Our study aims to assess knowledge of HIV prevention, the prevalence of certain misconceptions about HIV, and internal and external HIV-associated stigma within our community.

Methods

We surveyed patients at three sexually transmitted infection clinics and employees at a community organization and the safety-net hospital in Cleveland, OH. The participants’ involvement was voluntary and anonymous. Participants were asked questions regarding demographics, sexual behavior, HIV prevention, and HIV stigma.

Results

Among 262 patients surveyed, 19.0% were ≤ 24 years old, 51.5% were male, 85.2% identified as Black, and 45.6% completed high school. Among 137 employees surveyed, 4.0% were ≤ 24 years old, 21.2% were male, 15.6% identified as Black, and 43.1% graduated college/university. Only 98 (38.7%) of patients knew of the concept “Undetectable equals Untransmissible” compared with 79 (59.0%) of employees (p< 0.001). Few patients and employees thought HIV was a punishment sent from God for sinful acts (3.2% vs. 2.0%, p=0.32) but many patients thought HIV was a man-made virus (26.0% vs. 5.3%, p< 0.001) and that there was a known cure for HIV (42.5% vs. 18.7%, p< 0.001). Almost half of participants in both groups endorsed that others talk badly about people with HIV (40.2% vs. 42.5%, p=0.66), and while only 8.4% and 3.7% of patients and employees, respectively, reported they would be ashamed if one of their family members had HIV, 42.4% and 60.9% (p=0.009) of patients and employees, respectively, reported that they would not want their neighbors/coworkers to know that they had HIV.

Conclusion

While internal stigma related to HIV appears to be low, expected external stigma remains high. Suspicions that HIV is a man-made virus and that a cure exists but withheld from certain communities were prevalent among the community. Further studies can help elucidate the underlying reasons that lead to persistent expected external stigma and suspicions associated with HIV.

Disclosures

All Authors: No reported disclosures.
2077. Assessing the Association Between Parent-Child Relationships and HIV Testing in the Asian American Population: A Longitudinal Study
Authors: Kaul Christina
Published: December 2022

Background

Asian Americans (AAs) make up approximately 2% of new HIV diagnoses, 1.5% of all diagnoses, and are the only ethnic group noted to have a continuous increase in infection rate from 2011 to 2016. AAs also report the lowest rates of HIV testing (33.5%). Barriers to HIV testing in Asian Americans continue to exist; however, the predictors of HIV testing among Asians in the United States are not well studied.

Prior studies have shown that the parent-child relationship may play a role in increasing the likelihood of HIV testing. One study found that father-child communication in the Black population was positively associated with HIV testing. No such study has been performed in the AA population.

This study examined the association between parent-child relationships and HIV testing in AAs to understand what factors can contribute to increased HIV testing uptake.

Methods

We used data from Waves I and III of the National Longitudinal Study of Adolescent Health, a nationally representative, longitudinal study. Parent-child relationships were categorized as authoritarian (low warmth, high control), permissive (high warmth, low control), neglectful (low warmth, low control) and compared to an authoritative reference group (high warmth, high control. Based on prior studies as well as theory, age, gender, and parental education were included as covariates. Analyses were performed using Stata 17.0. We used multivariate logistic regression, controlling for covariates. Analyses were weighted to account for the complex survey design.

Results

302 respondents self-reported as Asian. 147 (48.68%) identified as female. 42 respondents (13.91%) reported having been tested for HIV, while 259 (85.76%) did not. Compared to the authoritative reference group, both authoritarian and neglectful parenting were significantly associated with having a lower likelihood of obtaining an HIV test (authoritarian OR 0.27, p=0.026; neglectful OR 0.08, p=0.026), after adjusting for covariates.

Conclusion

Authoritative parenting style is most supportive of HIV testing in Asian American adolescents and young adults, while authoritarian and neglectful parenting predicted decreased HIV testing. Parenting style likely plays a role in HIV testing uptake in the Asian American population.

Disclosures

All Authors: No reported disclosures.
2078. Barriers and Facilitators to the HIV (PrEP) Care Continuum: Perspectives of Key Stakeholders and Formerly Incarcerated Individuals.
Authors: Arant Elizabeth C , Walker Abbey , Knittel Andrea K , Ashkin Evan A , Lauren Brinkley-Rubenstein , White Becky L
Published: December 2022

Background

Recently incarcerated individuals are at increased risk for HIV acquisition during community re-entry but have poor access to HIV pre-exposure prophylaxis (PrEP). There is an opportunity to integrate PrEP into an existing Formerly Incarcerated Transition (FIT) program in North Carolina (NC). We aimed to explore potential barriers and facilitators to post release PrEP implementation within the existing FIT program from the perspectives of formerly incarcerated individuals (FIT clients) and community stakeholders (community health clinicians, community health workers).

Methods

We conducted 28 semi-structured in-depth interviews (14 FIT clients and 14 community stakeholders). We used a rapid assessment method to summarize interview transcripts based on the domains of the semi-structured interview guide and to characterize the contents of the summaries as potential barriers or facilitators to steps of the PrEP cascade.

Results

HIV stigma was mentioned as a potential barrier at each step of the PrEP cascade among both FIT clients and stakeholders. Both groups emphasized the importance of PrEP education for FIT clients, stakeholders, and the community to facilitate awareness and HIV risk perception. Stakeholders and FIT clients believed that competing priorities would be a significant barrier to PrEP uptake post-release. Linking incarcerated individuals to PrEP services during incarceration was mentioned as a facilitator to increase PrEP uptake. A lack of ongoing social support was seen as a critical barrier by FIT clients to achieve the necessary adherence to PrEP and retention to PrEP appointments. Both groups cited financial and logistical challenges such as the cost of PrEP services and transportation as potential barriers to PrEP adherence and retention.

Conclusion

Community stakeholders and FIT clients recommended several strategies that can be implemented to increase PrEP knowledge, uptake, and retention upon release. However, they also identified critical structural barriers that must be overcome before PrEP can be adopted among formerly incarcerated individuals in a non-Medicaid expansion state.

Disclosures

All Authors: No reported disclosures.
2081. Failing to PrEPare is PrEParing to Fail: Advocating for PWID PrEP Inclusion
Authors: Barner Amanda , Shipton Linda , Jackson Ebony
Published: December 2022

Background

The CDC recommends that PrEP be offered to anyone with a history of injection drug use, with a particular focus on those that have injected in the past 6 months, shared injection equipment, or have sexual risk factors. Yet, PrEP remains underutilized. The SARS-CoV2 pandemic introduced additional barriers to HIV testing and substance use treatment. We sought to develop a specialty pharmacy-driven program to minimize barriers and increase education surrounding PrEP in PWID in patients admitted to the hospital with IV drug use related complications. Patients identified by the ID consultant or stewardship team were offered enrollment in the program as part of a comprehensive harm reduction strategy. Upon referral, specialty pharmacists provided phone counseling, prescribed TDF/FTC, and conducted laboratory monitoring.

Methods

From November 2020 through March 2022, we collected data on our accepted referrals including number of refills, laboratory appointments, reason for discharge, duration of retention in the program, and injection-related emergency department visits and hospital admissions for 90 days after program discharge.

Results

During the eighteen month period, 23 patients accepted referral into the program. The median age was 42 years and 47.8% were male. Despite accepting the initial referral while inpatient, 87% (n=20) of patients did not remain in the program to receive the first month's supply of TDF/FTC once discharged. Sixteen (69.6%) were not able to be contacted on the phone number provided despite multiple attempts. Four (17.4%) declined ongoing IV drug use. Eight patients (35%) had an injection related ED visit or hospitalization within 90 days of program discharge.

Conclusion

In conclusion, high risk PWID admitted to the hospital who agreed to PrEP with daily TDF/FTC had a low retention rate after discharge. PWID need to be included in future research studies, especially studies involving novel PrEP treatments.

Disclosures

All Authors: No reported disclosures.
2082. HIV Pre-Exposure Prophylaxis Practices and Beliefs in Four African Countries
Authors: Shah Neha , Dear Nicole , Cavanaugh Joseph S , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswaii Jonah , Sing'oei Valentine , Crowell Trevor A , Parikh Ajay , Esber Allahna , Polyak Christina , Ake Julie A
Published: December 2022

Background

Pre-exposure prophylaxis (PrEP) is an essential component to stopping the HIV epidemic. Recent breakthroughs in PrEP including the vaginal ring and long-acting preparations provide more options for individuals. However, PrEP uptake continues to be a challenge. We evaluated PrEP awareness and barriers to PrEP uptake among individuals in four sub-Saharan African countries.

Methods

Individuals aged 16 years or older without HIV were referred to the African Cohort Study (AFRICOS) at 12 PEPFAR-supported clinics in Uganda, Kenya, Tanzania and Nigeria through their sexual partners, social media outlets or outreach to communities and schools. Starting in 2020, participants were administered a survey regarding PrEP knowledge, practices, and beliefs every six months. We conducted descriptive analyses from a participant’s first study visit after PrEP-related questions had been introduced.

Results

From February 2020 to November 2021, the PrEP survey was completed by 372 participants, of whom 204 (55%) were female; their median age was 37.5 (interquartile range (IQR): 26.6-46.5) years old; 228 (61%) were married; 64 (17%) consumed alcohol and 6 (2%) used recreational drugs. Of the 314 (92%) who reported ever having sex, the median age at sexual debut was 18 (IQR: 16-19); 241 (77%) reported 1 regular partner; 295 (94%) had no casual partners in the past six months, 97 (31%) had an HIV+ partner and 26 (10%) had a partner with an unknown HIV status. Results from the PrEP survey are in the Figure. When asked about PrEP, 44 (29%) had discussed PrEP with their provider and 73 (20%) stated they would feel ashamed or embarrassed taking PrEP. Those who had heard of PrEP were more likely to be unmarried (p=0.046) and more likely not to have used a condom during the last sexual encounter with their regular partner (p< 0.05).

PrEP knowledge and practices

Conclusion

In our cohort, few participants had heard of or were taking PrEP. While our cohort may not represent a high-risk population, PrEP awareness was limited among those who were either unaware of their partner’s status or who had a partner infected with HIV. The lack of PrEP awareness highlights the need for increased provider education and outreach especially as new, and potentially less stigmatizing, PrEP options come to market.

Disclosures

All Authors: No reported disclosures.
2085. PrEP Interest and Preferences Among US Black and Hispanic Men – A National Survey
Authors: Poteat Tonia , Sarkar Supriya , Ragone Leigh , Rawlings Keith , Rinehart Alex R , Hill Jennifer N , Gallington Kyli , Coyne Karin S , Vannappagari Vani
Published: December 2022

Background

Use of daily oral HIV pre-exposure prophylaxis (DO PrEP) has increased steadily in the past several years, but patterns of racial disparities have emerged in PrEP uptake. Although Black and Hispanic people are disproportionately affected by HIV in the US, they constitute a minority among those accessing DO PrEP. Newly available prevention options, such as long-acting injectable (LA) PrEP may help close the gap in unmet need for PrEP; however, interest in LA PrEP has not been evaluated specifically among racial/ethnic minority groups. Awareness, willingness, and usage of PrEP as well as HIV prevention preferences were assessed among sexually active adult men in the US.

Methods

Participants were recruited through a geographically targeted social media campaign and completed a self-administered, cross-sectional, online survey on demographics, sexual health and behavior, healthcare access, PrEP awareness and usage, and PrEP intention and preferences. Eligible participants met the following criteria: cisgender men, self-identified Black race and/or Hispanic ethnicity, 18 years or older, reporting unknown or HIV-negative status, currently residing in the US, and reporting anal or vaginal sex in the past six months. Descriptive statistics were calculated using SAS v9.4.

Results

From November to December 2021, 1365 men completed the survey (median age: 29.0 years; Black non-Hispanic: 43.1%, Black Hispanic: 40.3%, White Hispanic: 10.2%, Other Hispanic: 6.4%). A majority had heard of DO PrEP (66.6%) and LA PrEP (47.5%) as a way to prevent HIV; however, a smaller proportion had spoken to a healthcare provider (HCP) about PrEP (42.1%), had ever used PrEP (24.7%), or were currently taking PrEP (16.3%) (Figure 1). A large majority (74.0%) reported interest in using LA PrEP. When asked about their preferred PrEP option, 60.2% chose LA PrEP and 7.4% chose DO PrEP, while 27.5% stated that they preferred neither PrEP option. Figure 1.PrEP Awareness, Discussion with HCP, and Usage Among US Black and Hispanic Men, Overall and by Race/Ethnicity

Conclusion

Most participants demonstrated high awareness of PrEP and a strong interest in LA PrEP. The availability of and interest in LA PrEP may serve as an opportunity to help increase overall PrEP uptake among Black and Hispanic men in the US.

Disclosures

TONIA POTEAT, PhD, MPH, PA-C, ViiV Healthcare: Advisor/Consultant Supriya Sarkar, PhD, MPH, ViiV Healthcare: Salary|ViiV Healthcare: Stocks/Bonds Leigh Ragone, MS, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Keith Rawlings, MD, ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Stocks/Bonds Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.
2096. Associations with Pneumocystis Pneumonia in Solid Organ Transplant Recipients: Impact of Posttransplant Lymphoproliferative Disorder
Authors: Yetmar Zachary A , Duffy Dustin , Smith Byron , Vikram Holenarasipur R , Brumble Lisa M , Limper Andrew H , Beam Elena
Published: December 2022

Background

Pneumocystis jirovecii pneumonia (PCP) is a potentially deadly infection afflicting the immunocompromised population, including solid organ transplant recipients. Several risk factors have been described, including acute rejection, lymphopenia, and cytomegalovirus (CMV) infection. However, little is known regarding the risk imparted by posttransplant lymphoproliferative disorder (PTLD).

Methods

We performed a nested case-control study of solid organ transplant recipients diagnosed with PCP from 2000-2020. PCP was defined as positive smear or polymerase chain reaction testing with compatible clinical symptoms and radiographic findings. Two control were matched to each case by year of first transplant, first transplanted organ, and sex. Each control had at least as much follow-up from their transplant date to their matched case’s PCP diagnosis date. Multivariable conditional logistic regression was performed to analyze theorized risk factors.

Results

Sixty-seven cases met inclusion criteria and were matched to 134 controls (Table 1). Median age was 60.9 years, and the most common transplant type was kidney (52.2%). Fourteen patients had a history of PTLD, 12 of which developed PCP. All cases of PTLD were monomorphic, 6 were EBV-positive, 9 were receiving chemotherapy at the index date, and only 1 control patient was receiving PCP prophylaxis. The cases with PTLD developed PCP a median of 85 days after PTLD diagnosis, while the two controls were diagnosed more than 1 year earlier. After adjusting for age, acute rejection requiring treatment within the last 6 months, CMV infection within 6 months, current PCP prophylaxis, and lymphopenia (lymphocyte count < 0.5 x109/L) within 6 months, PTLD had a significant association with PCP (OR 14.0, 95% CI 1.7-114.5; p = .014). Lymphopenia was also associated with PCP (OR 8.2, 95% CI 3.2-20.7; p < .001), while the other factors were not. Table 1:Characteristics of 67 Solid Organ Transplant Recipients with Pneumocystis Pneumonia and 134 Matched Controls

Conclusion

Diagnosis of PTLD is independently associated with subsequent PCP after adjustment for recognized risk factors. This association is likely influenced by PTLD-directed chemotherapy, particularly regimens containing rituximab. PCP prophylaxis should be initiated in solid organ transplant recipients with PTLD, particularly those undergoing active therapy, and those with severe lymphopenia.

Disclosures

All Authors: No reported disclosures.
2366. Impact of the Febrile Podcast and Learning Resource as an Infectious Diseases Education Platform
Authors: Dong Sara W , Stead Wendy
Published: December 2022

Background

Febrile is a digital infectious diseases (ID) learning platform with the aim of providing high quality and accessible ID content. We describe utilization of Febrile as a resource for learning and teaching ID, learner satisfaction, and the perceived impact on clinical practice.

Methods

Febrile was launched in December 2020 as a trainee-focused resource as shown in Figure 1. Content is also promoted on social media. Podcast analytics are available from the media host, Captivate, which is Interactive Advertising Bureau certified. Website and Twitter engagement was obtained from Google and Twitter Analytics, respectively. An online anonymous survey was conducted to assess educational impact using Likert scales and open answer questions.

Results

As of April 26 2022, Febrile has produced 39 episodes and has been downloaded > 107,000 times in all 50 United States (US) and 140 countries. Majority of the audience (62%) listens from within the US, see Fig. 2 for geographic distribution. The website has received > 60,000 views, and the Twitter account has garnered > 8,100 followers.

A total of 224 participants from 30 countries and 37 US states completed the survey, of whom 78 (35%) were ID fellows in training and 71 (32%) were ID faculty physicians. Breakdown of other respondents is in Fig. 3.

Most had listened to either ≥ 21 episodes (57, 25%) or 11–20 episodes (86, 38%). In addition, 72% reported visiting the website and 82% had seen a Febrile infographic. There was a high level of satisfaction with the resources, and 83% of respondents have already recommended Febrile to a colleague (Fig. 3).

Enhancing core ID knowledge was the primary driver for listening among other reasons noted in Fig. 4. Two-thirds of respondents indicated that information they learned from Febrile has changed their practice, and 50% have used Febrile as a way to teach others (Fig. 4). Of note, for those considering ID as a career, Febrile had a favorable impact on perception of the specialty (30/34, 88%). Many respondents also indicated Febrile as a source of community (50%, Fig. 4 and 5).

Conclusion

Febrile is a novel and impactful tool for ID medical education. In addition to providing educational resources, this innovative digital platform holds the potential for meaningful community building and attracting trainees to the field of ID.

Disclosures

All Authors: No reported disclosures.
2110. Immunocompromised Adults Hospitalized with Community-Acquired Pneumonia in the United States: Incidence and Clinical Outcomes
Authors: Ramirez Julio A , Chandler Thomas R , Furmanek Stephen , Carrico Ruth , Wilde Ashley M , Sheikh Daniya , Ambadapoodi Raghava Sekhar , Salunkhe Vidyulata , Tahboub Mohommad T , Arnold Forest W , Bordon Jose , Cavallazzi Rodrigo
Published: December 2022

Background

Community-acquired pneumonia (CAP) is an important complication in immunocompromised adults (ICAs). In hospitalized patients, the burden of CAP in ICAs is not well defined. The primary objective of this study was to define incidence, epidemiology, and outcomes of ICAs hospitalized with CAP in the city of Louisville. The secondary objective of this study was to estimate the burden of CAP in ICAs in the US.

Methods

This was a prospective population-based cohort study of consecutive hospitalized adult Louisville residents with CAP at all adult hospitals in Louisville from 1 June 2014 to 31 May 2016. An ICA was defined as a patient with any of the following medical conditions or treatments: (1) primary immunodeficiency disease; (2) advanced-stage cancer (stage III or IV cancer or hematologic cancer); (3) advanced HIV infection (CD4 T-lymphocyte count < 200 cells/mL or < 14%); (4) solid organ transplantation; (5) hematopoietic stem cell transplantation; (6) receiving cancer chemotherapy; (7) receiving biological immune modulators; (8) receiving corticosteroid therapy with a dose ≥ 20 mg prednisone or equivalent daily for at least 14 days prior to hospitalization; or (9) receiving disease-modifying antirheumatic drugs (DMARDs). The annual population-based CAP incidence among ICAs was calculated. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization.

Results

A total of 7449 unique patients were included, with 854 (11%) ICAs identified. Figure 1 depicts the immunocompromising conditions. Per 100,000 adults in Louisville, each year 75 ICAs are hospitalized with CAP (95% CI: 68-78), corresponding to an estimated 190,106 ICAs hospitalized with CAP in the US. Mortality during hospitalization was 8% in ICAs vs 6% in non-ICAs; at 30 days 23% in ICAs vs 11% in non-ICAs, at 6 months 42% in ICAs vs 20% in non-ICAs, and at 1 year 52% in ICAs vs 27% in non-ICAs. Figure 1:Frequency of Immunocompromising Conditions and TreatmentsImmunocompromising conditions and treatments among 7449 patients hospitalized for community-acquired pneumonia sorted by frequency. Abbreviations: DMARDs: Disease-modifying antirheumatic drugs; HIV: Human immunodeficiency virus.

Conclusion

This study indicates that nearly one out of nine hospitalized CAP patients are immunocompromised, and 190,000 ICAs may be hospitalized due to CAP each year in the US. We found a twofold increase in mortality at every time point after discharge for ICAs compared to non-ICAs hospitalized due to CAP. Further strategies to prevent CAP and improve outcomes in ICAs hospitalized with CAP are necessary.

Disclosures

Forest W. Arnold, DO, MSc, Gilead Sciences, Inc.: Grant/Research Support.
2124. Active surveillance for Congenital Cytomegalovirus infections as part of institutional protocol for newborns with failed hearing screening
Authors: Reto Patricia Pichilingue , Manzar Shabih , Mankekar Gauri
Published: December 2022

Background

Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss in newborns. Universal screening for cCMV is not recommended in the United States. It is important to establish effective strategies for early detection of newborns with cCMV, as most of them are asymptomatic at birth.

Methods

As per institutional protocol at Louisiana State University Health Sciences Center in Shreveport, every newborn who fails auditory brainstem response (ABR) hearing screen is referred to Audiology and is evaluated with CMV polymerase chain reaction (PCR) from urine samples to rule out cCMV before they are discharged home. We intended to evaluate the proportion of newborns failing hearing screening during a two-year period that are positive for CMV by urine PCR and that are referred to Pediatric Infectious Diseases for cCMV treatment.

Results

From January 1st, 2020, to March 6th, 2022, 4,010 newborns had ABR based hearing screening at birth, with 125 (3%) failing on two attempts. Subsequently, 85 of them, corresponding to 68%, passed repeat testing at Audiology clinic, while 25 did not show up for their appointments. Out of the 67 infants that passed repeat hearing test and were tested for cCMV, none had positive urine CMV PCR results. Among the 15 newborns who failed repeat hearing test in Audiology clinic, 2 (13%) had positive urine CMV PCR results, 9 had negative results and 2 infants did not have tests done (Figure 1). Both infants diagnosed with cCMV showed severe to profound sensorineural hearing loss and are being followed by Otorhinolaryngology. They are also receiving oral valganciclovir for cCMV infection with a plan to receive treatment for 6 months, being followed periodically by Pediatric Infectious Diseases.

Evaluations with urine CMV PCR in newborns with repeat hearing screening showed that all 67 that passed were negative; and out of the 15 infants that failed repeat testing, 2 had positive CMV PCR results.

Conclusion

Our institutional protocol recommends sending urine samples for CMV PCR in every baby that fails newborn ABR hearing screen, and this has helped identified neonates with cCMV infections in the setting of severe to profound sensorineural hearing loss. These patients diagnosed with cCMV are planned to receive treatment for 6 months. Our future goals involve evaluating if early treatment of cCMV for 6 months can prevent progression of hearing loss and help achieving improved audiological outcomes at 2 years of age.

Disclosures

All Authors: No reported disclosures.