bluuebunny/crossref_metadata_2025 huggingface dataset:
1523. Impact of Antiretroviral Therapy (ART) on All-Cause Mortality in HIV from 1999 to 2020 in the United States
Authors: Prince Monique A , Tan Min-Choon , Tan Min-Xuan , Prince E’ebony , Nicholas Rick , Shaaban Hamid , Slim Jihad
Published: November 2023

Background

Over the last two decades, Antiretroviral Therapy (ART) has evolved dramatically in the United States (U.S.) from multi-tablet regimens (MTR) to single tablet regimens (STR) and from Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) and Protease Inhibitor (PI) based regimens to integrase inhibitor (INI) based ART. This study sought to determine the trends in all-cause mortality over time as ART trends changed.

Methods

We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database and performed serial cross-sectional analyses of national death certificate data for all-cause mortality with comorbid HIV from 1999 to 2020. HIV diseases (ICD-10 B20-B24, O98.7, R75) were listed as the contributing cause of death. We calculated age-adjusted mortality rates (AAMR) per 1,000,000 individuals. Additional analyses were performed to categorize the underlying causes of death by organ systems. The study period was further stratified into three groups when specific drug regimens were more prevalent: 1999-2007 (MTR), 2008-2014 (STR) and 2015-2020 (INI).

Results

In the 22-year study period, 251,759 all-cause mortalities with comorbid HIV in the United States were identified. The most common cause of death was infectious diseases (84.0%, N=211,438), followed by neoplasms (5.3%, N=13,264) and diseases of the cardiovascular system (3.9%, N=9,797). The AAMR in HIV was also highest in infectious diseases at 3.12 per 1,000,000 individuals, followed by neoplasms (0.18 per 1,000,000 individuals), diseases of cardiovascular system (0.12 per 1,000,000 individuals), diseases of respiratory system (0.05 per 1,000,000 individuals) and diseases of gastrointestinal system (0.04 per 1,000,000 individuals). Further analysis of infectious related causes showed significantly decreased mortality trends from 134,726 (MTR) to 69,450 (STR) and 47,583 (INI).Figure 1Demonstrates all-cause mortalities with comorbid HIV in the United States from 1999-2020

Conclusion

More than 80% of deaths in HIV occurred because of infectious disease over the past two decades. A decreasing trend was also seen in infectious related mortality in three different time periods. This reflects the improved tolerability and efficacy of ART over time.

Disclosures

Jihad Slim, MD, FACP, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
1527. Assessment of Human Immunodeficiency Virus Testing in Underinsured Persons
Authors: Skinner Andrew M
Published: November 2023

Background

Among those living with HIV, nearly 13% are unaware of their diagnosis and approximately 40% of new HIV infections are transmitted from those lacking a formal diagnosis. Thus, determination of populations at high risk of not having HIV testing completed are essential to reduce transmissions. A barrier to obtaining an HIV test within low-income individuals that do not qualify for Medicaid, or underinsured persons, is the rising cost of healthcare in the US. Thus, it is essential to determine if further resources should be dedicated to underinsured populations with the aim of increasing access to HIV testing.

Methods

This is a retrospective cross-sectional study utilizing the 2021 Behavior Risk Factor Surveillance System conducted by the US CDC to determine if individuals that do not qualify for Medicaid yet live in a household with an income of >138% but ≤200% of the US federal poverty line (FPL) had increased odds of not having an HIV test when compared to individuals that live in a household with an income of ≤138% of the FPL, and thus qualify for Medicaid. A multivariable logistic regression model was created to determine the adjusted odds ratio for not having an HIV test in those who did not qualify for Medicaid.

Results

This study analyzed data from 33,431 respondents that were age 18 – 64, living in a Medicaid expansion state, and had a household income of ≤200% the FPL. Among these persons, 65.1% of respondents qualified for Medicaid. Univariate analysis revealed that non-Medicaid eligible persons were more likely to not have an HIV test when compared to Medicaid eligible persons with 54% and 48.6% not having an HIV test, respectively. After adjusting for the confounding variables, persons who were not eligible for Medicaid had 1.26 (95% CI:1.21 - 1.32) times the odds of not having an HIV test compared to those who were eligible for Medicaid.(Table)

Conclusion

After adjusting for confounding variables, the odds that a person did not have an HIV test were higher among individuals that lived in a household with an income that was >138% but ≤200% of the FPL. These data reveal that underinsured persons are a potential group that may benefit from further resource allocation to bolster HIV screening.

Disclosures

Andrew M. Skinner, MD, Academy for Continued Healthcare Learning: Honoraria|American Society of Healthcare Pharmacists: Honoraria|Ferring Pharmaceuticals: Honoraria|MJH Life Sciences: Honoraria
1538. Is there value in performing yearly screening for latent tuberculosis infection by interferon-gamma release assay among patients living with HIV in non-endemic settings?
Authors: Palacios Carlo Foppiano , Achhra Amit , Barakat Lydia A , Virata Michael , Hao Richie , Baxter John D , Malinis Maricar F
Published: November 2023

Background

People with HIV (PWH) are at increased risk of reactivation of tuberculosis (TB) from latent tuberculosis infection (LTBI). Current guidelines recommend all PWH be initially screened for LTBI with either interferon-gamma release assays (IGRA) or tuberculin skin testing (TST). Also, repeat screening is recommended in either PWH with CD4 count < 200 cells/mm3 after initial negative screen or any PWH with new TB exposure risk. Despite such guideline, there are centers that continue to screen LTBI in all PWH with annual IGRA testing. Our study evaluated the utility of universal yearly LTBI screening by IGRA among PWH in non-endemic settings.

Methods

A retrospective chart review of PWH in care from 2017-2021 at two urban academic medical centers. Demographics and annual IGRA results were collected. Patients were further stratified into three groups based on IGRA seroconversion: those with negative to positive (Group A), indeterminate to positive (Group B), and negative to indeterminate (Group C). Data for 3 groups, included risk factors for TB, chest imaging results, HIV data, and treatment. Descriptive statistics, chi-square, and Welch’s ANOVA were performed.

Results

A total of 2694 PWH were in care, comprised of 66% male, 50% Black, and 23% LatinX. Of the 2694, 2255 (84%) had a negative baseline IGRA. Seventy-two patients (2.7%) had IGRA seroconversion: 39 in Group A, 1 in Group B, and 32 in Group C (Table 1). Group A had lower CD4 counts (p=0.04) and higher HIV viral loads (p=0.03) than Group C.

Only 12 PWH (0.5%) with negative baseline IGRA developed new LTBI, with an incidence 1.1 cases/1000 patient-years. Of these, 8 PWH (67%) had ≥ 1 TB risk factor and none had CD4< 200. Travel to endemic region (33%) was most common risk factor. Among those with new LTBI, N=6/7 had confirmation of LTBI with repeat positive IGRA after initial seroconversion. Nine (75%) patients completed LTBI treatment and none developed tuberculosis.

Features of patients with conversion to a positive or indeterminate QuantiFERON

Conclusion

In two large diverse clinics in non-TB endemic settings, the true incidence of developing LTBI in PWH was rare among those with negative baseline IGRA. Due to low yield of cases with universal annual screening, our findings support the targeted approach recommended by current guidelines.

Disclosures

Michael Virata, MD, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant
2068. Progress in the Infection Prevention and Control Monitoring System for the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Programs and Supported Facilities
Authors: Gomes Danica J , Insua Maria , Desai Mitesh , Forno Rodriguez Diana , Goldstein Deborah A , Date Anand , Bancroft Elizabeth A , Godfrey Catherine , Zender Nicole
Published: November 2023

Background

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) prioritizes infection prevention and control (IPC) activities in its 40,000 supported facilities in over 50 countries. PEPFAR’s 2015 quality assurance tool included four IPC indicators (tuberculosis IPC [TBIPC], waste management [WM], injection safety [IS], laboratory biosafety [LB]). In 2022, four new IPC indicators were added (IPC program [IP], environmental cleaning [EC], availability of personal protective equipment [PPE], medical device reprocessing [MD]). As of October 2022, PEPFAR programs are required to assess IPC indicators in 10% of facilities over the course of one year. We report quarter one data results.

Methods

Indicator data from October 1 - December 31, 2022 were analyzed. Scores were calculated based on compliance with 2-4 criteria each: green, yellow, and red represented good, fair, and poor compliance, respectively. Percentages of yellow and red scores were combined, to represent the percent of facilities requiring improvement.

Results

A total of 272 sites were assessed across 15 countries; each PEPFAR program selects the indicators to assess in each site. For existing indicators (TBIPC, WM, IS, LB), 16%, 34%, 22%, and 57% of sites assessed scored red or yellow, respectively; for indicators added in 2022 (IP, EC, PPE, MD), 74%, 67%, 64%, and 61% scored red or yellow, respectively (Figure). Specific gaps include: 63% of facilities lack adequate IPC leadership; ∼50% lack adequate environmental cleaning staff, protocols, and methods; 41% lack respirators; 30% lack device reprocessing protocols.Figure:Infection Prevention and Control (IPC) Indicator Scores from PEPFAR Panorama for Quarter 1 (October 1 – December 31, 2022)

Conclusion

Unknown IPC weaknesses were identified in PEPFAR supported facilities. PEPFAR requires that facilities with fair or poor compliance be reassessed within six months to monitor improvements. Strengthening IPC leadership is a priority. Improvement activities will require collaboration between facilities, implementing partners, and Ministries of Health (MOH). Future plans include increasing compliance with conducting required IPC indicator assessments; timely, data driven identification of gaps and advancements towards IPC standards; and developing guidance and resources to facilitate improvements. MOHs can leverage data to inform priorities and design context-specific interventions.

Disclosures

All Authors: No reported disclosures
1557. The Real-World Impact of Pre-Exposure Prophylaxis (PrEP) Prescription Uptake and Dispensing Status on HIV Infection Risk in the US
Authors: Tao Li , Yang Juan , Zachry Woodie , Gruber Joshua , Mezzio Dylan
Published: November 2023

Background

Despite effective HIV prevention options, there are continued disparities in uptake and persistence on PrEP. We assessed access to PrEP, time to dispense, and their potential relationship with HIV.

Methods

Individuals receiving FTC/TDF or FTC/TAF for PrEP between Jan 2019–Feb 2023 were selected from a de-identified prescription claims database (IQVIA Longitudinal Access and Adjudication Dataset). Use of either regimen for HIV or HBV treatment or HIV PEP was excluded. Individuals were categorized into 3 groups: ≥1 PrEP claim dispensed (DISP); never had PrEP dispensed with ≥50% of claims rejected by payer (ND-R); and never had PrEP dispensed with ≥50% of claims abandoned (ND-A). A 12-month window from the index (first PrEP claim submitted) was used to assess risk of HIV infection. New HIV infection diagnoses per 100 population were calculated as no. of new HIV infections diagnosed, divided by total no. of individuals x100, in each cohort. Logistic regression was used to calculate odds ratios (OR) and 95% CIs of HIV infection by cohort and time to dispense.

Results

Among 522,273 individuals, 88% were DISP, 7% were ND-R, and 5% were ND-A. Individuals in the ND-R and ND-A cohorts had a 95% and 38% higher risk of new HIV diagnosis, respectively, compared to those in the DISP cohort (Figure). For individuals with R or A claims, delayed time to dispense was significantly associated with a higher risk of acquiring HIV of ∼20%. Subgroup analysis (Table) showed that new HIV diagnoses were lowest in cisgender men who received a dispensed claim (2.1%) and highest in transgender women and transgender men in the ND-A cohort (6.1% and 4.6%, respectively), and in individuals with STIs in the ND-R and ND-A cohorts (8.1% and 5.4%).

Conclusion

This study is the first to find that rejected claims for PrEP were linked to a 2-fold increase in new HIV diagnoses, emphasizing the impact of timely access to PrEP on HIV prevention in real-world settings. This underscores the urgent need to remove barriers to PrEP from a prescription perspective to end HIV transmission.

Disclosures

Li Tao, MD, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Juan Yang, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Woodie Zachry, RPh, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Joshua Gruber, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Dylan Mezzio, PharmD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds
2070. Outbreak of Crimean-Congo Hemorrhagic Fever in Kyzylorda region, Kazakhstan, March-July 2022
Authors: Gabdullina Malika , Gazezova Saya , Ayapova Gulzhan , Horth Roberta , Nabirova Dilyara
Published: November 2023

Background

Crimean-Congo Hemorrhagic Fever (CCHF) is a viral tick-borne disease with a high mortality rate. It is endemic in Kazakhstan. The Kyzylorda region reported higher-than-expected cases from March to July 2022 (15 compared to 10 in the previous year). We conducted an investigation to identify additional cases, determine risk factors, and assess CCHF knowledge and practices.

Methods

We conducted a case-control study in July 2022. We defined cases as PCR-confirmed or hospitalized with CCHF symptoms. The control group was made up of regional contacts including neighbors and household members at a 1:2 ratio. We reviewed medical records from April to July. We conducted face-to-face interviews using structured questionnaires. Blood collected from the control group was tested with PCR and ELISA for detection of IgM and IgG antibodies. We also collected ticks from domestic animals for PCR-testing. We used logistic regression to assess factors associated with CCHF.

Results

We identified 38 cases (n=15 confirmed, n=7 probable and n=16 suspected cases) and 71 controls. Cases were mostly male (74%) with mean age of 45 (range 17-81); 27% died. Top patient symptoms (n=38) were weakness (100%), headache (97%), fever (84%) and loss of appetite (55%). Risk factors for CCHF were being male (odds ratio and 95% confidence interval: 5.5, CI: 2.3-13.1), animal husbandry (3.1, 1.3-7.2), crop production (4.0, 1.5-10.5), tick contact (262.5, CI: 31.4-2192.2), tick bite (70.0, 8.8-556.9), contact with tick blood (18.7, 2.2-155.9), ticks on the body or clothing (77.8, 9.8-618.9) and having been in places with high tick risk (15.1, CI: 4.6-49.7). The control group were more likely to have awareness of CCHF, know that they can protect themselves from CCHF, refrained from visiting forests and rural areas, used repellents, and taken protective measures to reduce ticks in domestic animals. Of 55 controls tested: one was IgG positive. Of 163 ticks tested, one was PCR-positive.

Conclusion

Exposure to activities that are high risk for exposure to ticks increased odds of CCHF. Improved awareness of prevention to exposure from ticks, CCHF associated risk factors, and the importance of seeking early treatment is needed. This can be achieved by increasing population awareness and educating medical providers.

Disclosures

All Authors: No reported disclosures
1569. Antiretroviral Treatment (ART) Packaging Preferences and Their Impact on Adherence Among People With HIV (PWH): Findings From a Best–Worst Scaling Survey
Authors: Dunbar Megan , Gandhi-Patel Bhumi , Kopenhafer Lewis , Olsen Patrick , Mercadante Amanda R , Way Nate , Beusterien Kathleen Marie
Published: November 2023

Background

ART is highly effective when taken as prescribed, but adherence can be a challenge due to privacy concerns, convenience or stigmatization of HIV (especially among PWH facing health disparities). Blister packs (BPs) may improve medication adherence; however, ART packaging preferences have not been fully explored in PWH. We assessed preferred ART packaging and packaging features perceived to support daily adherence.

Methods

A cross-sectional, online survey was completed by PWH aged 18–65 years living in the US currently on a single-tablet ART regimen. Participants were recruited via patient databases/panels/associations, social media, physician referrals and community centers. The survey elicited preferences for a BP versus a pill bottle. Best–worst scaling (BWS) was used to quantify how PWH prioritized 14 packaging features based on how helpful they were perceived to be for taking daily ART.

Results

The survey population had diverse race/ethnicity and socioeconomic status reflective of US PWH (Table). Of 208 PWH, 91% used pill bottles; 19% were dissatisfied with their current ART packaging and 26% were neither satisfied nor dissatisfied. Less than half (47%) of respondents reported never skipping/missing a medication dose; 25% skipped/missed a dose < 1× a month, and 28% ≥ 1× a month. Overall, 48% of PWH preferred pill bottle packaging, 38% preferred the BP and 15% had no preference. For Black PWH, 40% preferred a BP and 39% preferred a bottle, which differed from preferences in White PWH (35% preferred a BP, 59% preferred a bottle; P = 0.04). Among packaging features that PWH found helpful for taking medication as prescribed, the top four were ‘easy to open’, ‘convenient when traveling’, ‘easy to remove one pill at a time’ and ‘discreet’ packaging. PWH who preferred the BP prioritized ‘easy to remove one pill at a time’, ‘convenient when traveling’ and ‘easy to open’ features; those who preferred the bottle prioritized ‘easy to open’, ‘convenient when traveling’ and ‘discreet’ packaging (Figure).

Conclusion

PWH identified packaging features of a BP and/or a pill bottle for ART that may help them adhere to a once-daily treatment regimen. Offering a choice of ART in a BP or bottle may increase convenience and discreet use of HIV medication, helping to address stigma and support adherence.

Disclosures

Megan Dunbar, PhD, Gilead: Employment Bhumi Gandhi-Patel, PharmD, Gilead: Employment Kathleen Marie Beusterien, BS, MPH, Gilead: Employee of Cerner Enviza, which provides consulting services to Gilead
1575. Comparison of virologic suppression rates pre-, intra- and postpartum in women with HIV in an underserved US community
Authors: Gerdes Elise N , Suh Jin S , Kim Chloe , Jimenez Humberto R
Published: November 2023

Background

Antiretroviral therapy (ART) has significantly reduced mother-to-child transmission of HIV among pregnant women. Nonetheless, numerous factors can impede ART adherence and thus virologic suppression (HIV RNA < 200 copies/mL). Although there are limited data on current rates of virologic control in women with HIV around pregnancy, previous studies have highlighted lower rates at the start of pregnancy and 6 months postpartum. The objective of this study was to compare virologic suppression rates in women pre-pregnancy, intrapartum, and postpartum at a clinic serving a marginalized community and to identify factors associated with virologic control

Methods

This study was a single-center, retrospective chart review including pregnant patients receiving care at a hospital-based, NJ Ryan-White funded clinic between 2015-2022. The primary endpoint was to determine whether there is a difference in the proportion of patients with virologic suppression at the start of pregnancy, at delivery, and 6 months postpartum

Results

At the first visit, 64.4% of mothers were virologically suppressed. Our study found that the proportion of women remaining virologically suppressed was lower at 6 months postpartum compared to the time of delivery (82.2% versus 90.4%, p=0.017), regardless of virologic suppression at the first visit. Older age at pregnancy was associated with improved virologic suppression at 6 months postpartum (OR 1.13, 95% CI 1.01-1.27). However, perinatal HIV acquisition, as compared to heterosexual acquisition, was correlated with increased virologic failure at 6 months postpartum (OR 5.4, 95% CI 1.42-20.08).

Conclusion

Although a high percentage of patients were controlled at delivery, the drop in virologic suppression postpartum highlights the need for additional efforts to support the mother and child during that time. While further research is warranted to identify further confounders that may impact virologic control and other barriers to care, the healthcare team should work together holistically on frequent outreach and follow up during the entire pregnancy.

Disclosures

All Authors: No reported disclosures
1583. Optimal timing of antiretroviral therapy initiation in AIDS-associated Toxoplasma encephalitis: a prospective observational multicenter study in China
Authors: Chen yaokai , Li Yao
Published: November 2023

Background

Toxoplasma encephalitis (TE) is the most frequent cause of expansive brain lesions among acquired immunodeficiency syndrome (AIDS) patients; however, the optimal timing of antiretroviral therapy (ART) initiation in these patients remains controversial.

Methods

This was a multicenter prospective observational study, and eligible patients were recruited from eleven treatment centers in China.

Results

In total, 87 patients were included, and 38 of them were assigned to the Early ART group (initiating ART within 2 weeks after anti-Toxoplasma treatment initiation), while the remaining 49 patients were allocated to receive deferred ART (initiating ART at least 2 weeks after anti-Toxoplasma treatment initiation). Our results indicated that the incidence of immune reconstitution inflammatory syndrome (IRIS) (2.6% vs. 0, p=0.437) and the number of death events (1 vs. 5, p=0.225) were not significantly different between the two groups at Week 48. The timing of ART initiation was also found to not significantly contribute to human immunodeficiency virus (HIV) viral load control. The difference in the number of patients who maintained an undetectable HIV viral load of <50 copies/mL in each of the two groups of patients was calculated to not be statistically significant at Week 24 (8 vs. 3, p=0.142) and Week 48 (7 vs. 7, p=1.000). Meanwhile, median CD4+ T-cell counts were also observed not to reach statistical significance between the two groups, both at Week 24 (155 vs. 91, p=0.837) and Week 48 (181 vs. 96, p=0.219).

Conclusion

In our study, early ART initiation was observed to not confer statistically significant differences in the incidence of IRIS, mortality, and HIV virological and immunological outcomes, when compared to deferred ART initiation.

Disclosures

All Authors: No reported disclosures
2072. Clinical Evaluation of the BioFire® Global Fever Special Pathogens Panel
Authors: Collins Brittany , Rabiger David S , Gurling Mark , Helm Jared R , Smith Wendy , Belgique Pascal , Jackson Olivia , Johnson Michael , Kelley Alex J , VanHollebeke Hannah , Webster Sidney , Wiltsie Ashley , Kim Marianne , Phillips Cynthia L
Published: November 2023

Background

BioFire Defense has developed the BioFire® Global Fever Special Pathogens Panel, in collaboration with the U.S. Department of Defense and NIAID (contract Nos. W911QY-13-D-0080 and HHSN272201600002C), as an in vitro diagnostic test for the simultaneous identification of viral, bacterial, and protozoan pathogens directly from whole blood in under an hour using the BioFire® FilmArray® platform. The BioFire Global Fever Special Pathogens Panel has been cleared by the U.S. FDA for the detection of chikungunya virus, Crimean-Congo hemorrhagic fever virus (CCHFV), dengue virus, (serotypes 1-4), Ebolavirus spp., Lassa virus, Marburg virus, West Nile virus (WNV), yellow fever virus (YFV), Bacillus anthracis, Francisella tularensis, Leptospira spp., Yersinia pestis, Leishmania spp., and Plasmodium spp. from individuals with signs and/or symptoms of acute febrile illness (AFI) and known or suspected exposure to target pathogens.

Methods

BioFire Defense performed a prospective clinical evaluation for the Global Fever Special Pathogens Panel at eleven geographically distinct sites across the globe. A total of 2139 prospective whole blood specimens were tested between March 2018 and March 2021.

Results

The Global Fever Special Pathogens Panel detected at least one analyte in 33.9% of specimens (725/2139). The most prevalent analyte was Plasmodium (29.0%, 118/407), followed by dengue virus (36.4%, 266/730). Chikungunya virus, Leptospira spp., Leishmania spp., CCHFV, and WNV were detected in fewer than 5% of specimens. Two or more analytes were detected in 4.3% (31/725) of positive specimens. All other analytes were not detected by the Global Fever Special Pathogens Panel. Positive percent agreement between the Global Fever Special Pathogens Panel and comparator testing ranged between 92.7-100%, and the negative percent agreement ranged between 99.2-100%.

Conclusion

The results show that the BioFire Global Fever Special Pathogens Panel could aid in rapid and actionable AFI diagnosis caused by multiple, sometimes co-occurring, pathogens. The Global Fever Special Pathogens Panel will be a valuable diagnostic tool to aid in national preparedness for disease outbreaks.

Disclosures

All Authors: No reported disclosures
1605. Dual Therapy VS Triple Therapy in Experienced PLWH: a Multicentre One-Year Long Observational Study
Authors: Russotto Ylenia , Saia Antonino Gaspare , Rullo Emmanuele Venanzi , Pellicanò Giovanni Francesco , Nunnari Giuseppe
Published: November 2023

Background

The introduction of new antiretroviral drugs with increased viral potency, as integrase inhibitors (INI), has changed the history of HIV. The higher potency has brought to light the necessity to reduce drug adverse effects, drug-drug interaction and costs. We conducted a multicentre observational study and we observed a group of people living with HIV (PLWH) who had switched to a two drugs regimen (2DR) for a year, comparing it with a group of PLWH who maintained the 3DR regimen, focusing on inflammation markers.

Methods

We did a multicentre parallel-group, observational study, from four Sicilian hospitals: “Gaetano Martino” hospital of Messina, “Cutroni-Zodda” hospital of Barcellona Pozzo di Gotto, “Papardo” hospital of Messina, “Cannizzaro” hospital of Catania. First group comprehends PLWH aged 18 years or older, who switched from a 3 or more drugs antiretroviral therapy (ART), of any class, to a 2DR ART, of any class excluded long acting treatment with cabotegravir + rilpivirine, between 2020 and 2022. Second group comprehends PLWH aged 18 or older, who maintained their 3DR, of any class. We performed blood analyses at three time-points (time 0, 6 months and 12 months).We considered the following items: HIV viral load, CD4+, CD4+/CD8+, platelets (PLT) count, C reactive protein (CRP) and lactate dehydrogenase (LDH). We performed a statistical analysis using the student T test.

Results

Group one comprehends 81 individuals, 69 males, mean age of 54 ± 8 years old. Group two comprehends 97 individuals, 55 males and 43 females, mean age of 49 ± 11 years old. No statistically significant difference between 2DR group and 3DR group was found in terms of HIV viral load (p-value 0.203), CD4+ count (p-value 0.238), CD4+/CD8+ (p-value 0.556), PLT count (p-value 0.631), LDH (p-value 0.295) and CRP (p-value 0.558). No adverse effects to the therapy were reported.

Conclusion

The major concern in switching to 2DR is the diminished pressure on HIV and increase of inflammation factors. Recent studies have reported no changes in inflammation markers in HIV-suppressed people who switch to 2DR, compared to those who maintain the 3DR. Considering the brief time of observation, we did not observe statistically significant changes in inflammation markers nor viral load, similarly to other studies.

Disclosures

All Authors: No reported disclosures
1633. Willingness to receive maternal RSV vaccine and infant monoclonal RSV antibody
Authors: Gidengil Courtney , Jones Jefferson M , Fleming-Dutra Katherine E , Pike Jamison , Prill Mila , Wodi Patricia , Lindley Megan , Gedlinske Amber , Parker Andrew , Scherer Aaron
Published: November 2023

Background

RSV results in substantial morbidity among young infants. Maternal RSV vaccines and monoclonal antibodies against RSV for infants have been developed, but little is known about acceptance of these products.

Methods

We conducted an online survey of U.S. adults who were pregnant (50%) or < 12 months postpartum (50%) between December 21, 2022 and January 2, 2023. Primary outcomes in two logistic regression models were willingness to receive RSV vaccine during pregnancy (definitely or probably would) and willingness to give their infant RSV monoclonal antibody. Covariates included prior vaccinations, vaccine attitudes, RSV risk perceptions, and RSV knowledge.

Results

Among respondents (N=523), mean age was 32 years (SD + 8 years); 48% had a high school education or less. In the last 12 months, 56% had received a COVID-19 vaccine and 58% an influenza vaccine; 66% had received Tdap during the pregnancy or intended to. A third of respondents thought their infant would get RSV in the first year of life; 14% thought severe illness would result. Sixty-one percent were willing to receive maternal RSV vaccine and 70% were willing for their infant to receive monoclonal antibody; 74% expressed willingness for at least one of these products. Predictors of maternal RSV vaccine willingness were Tdap during pregnancy (adjusted Odds Ratio [aOR] 2.83; 95% CI 1.75, 4.59), influenza vaccine in last 12 months (aOR 1.63; 95% CI 1.01, 2.63), positive feelings towards vaccines (aOR 4.15; 95% CI 2.49, 6.91), and higher perceived likelihood of their infant getting RSV illness (aOR 2.42; 95% CI 1.43, 4.09). Predictors of infant monoclonal antibody willingness were Tdap during pregnancy (aOR 2.50; 95% CI 1.52, 4.11), positive feelings towards vaccines (aOR 2.52; 95% CI 1.49, 4.26), and higher perceived likelihood of RSV illness (aOR 3.57; 95% CI 1.95, 6.53); living in the South versus Northeast was associated with lower willingness (aOR 0.41; 95% CI 0.20, 0.84).

Conclusion

Most respondents (74%) were willing to receive RSV vaccine and/or give their infant RSV monoclonal antibody. Receiving Tdap during pregnancy, favorable attitudes to vaccines, and higher perceived likelihood of RSV illness were associated with willingness for these products, which may inform future roll-out.

Disclosures

All Authors: No reported disclosures
1643. Journey Mapping Penicillin Allergies in Children: Parental Experiences, Care Gaps, and Suggestions Offered by Parents to Address Unmet Needs
Authors: Carter Eileen J , Baron Kate , Davies Ellen , Pogorzelska-Maziarz Monika , Monsees Elizabeth , Manning Mary Lou , Pagoto Sherry
Published: November 2023

Background

Penicillin allergies are commonly reported in children but rarely true and perpetuate the use of alternative antibiotics. Leading allergy societies recommend a proactive approach to penicillin allergy delabeling. We use patient journey mapping to identify opportunities to improve the delabeling of penicillin allergies in children before, during, and after a child’s initial reaction to penicillin.

Methods

Mapping was conducted via a secondary analysis of a qualitative study consisting of 18 interviews with parents recruited via social media reporting a penicillin allergy in their child. Two researchers coded interviews using a directed content analysis to capture parent’s experiences before, during, and after their child’s penicillin reaction. We describe the common experiences of parents ( >9 participants).

Results

Pre-reaction, parents reported a lack of awareness regarding potential reactions children may experience when taking penicillin. Intra-reaction, parents reported their child’s provider suspected their child’s reaction was due to a penicillin allergy, wrote the child’s reaction in the medical record, and suggested or advised that penicillin be avoided in the future without mention of the availability of penicillin allergy testing. Post-reaction, parents remained unaware of the availability of penicillin allergy testing and uninformed of the implications of penicillin allergies on their child’s care. To better engage parents in penicillin allergy testing, participants suggested that providers inform parents of: 1) potential reactions their child may experience at the time of penicillin prescription (pre-reaction); 2) the availability of penicillin allergy testing to confirm the presence of true allergy (intra-reaction); and 3) penicillin allergy testing procedures and the benefits of penicillin allergy testing for their child’s health (post-reaction), see Table 1.

Conclusion

Using patient journey mapping, we describe the common experiences of parents concerning their child’s penicillin allergy, gaps in care parents experienced, and suggestions offered by parents to address their unmet care needs. These findings may inform future efforts to improve the delabeling of penicillin allergies in children.

Disclosures

Sherry Pagoto, PhD, Astellas Pharmaceuticals: Scientific Advisor|Weight Watchers, International,: Scientific Advisor
1646. Optimizing Antibiotic Durations of Therapy in Pediatric Community-acquired Pneumonia
Authors: Cook Gregory , Sarkar Shubho
Published: November 2023

Background

Several recent high-quality studies have shown similar efficacy for a shorter, 5-day duration of antibiotics instead of the prior standard, 10 days, in pediatric community-acquired pneumonia (CAP). Despite high-quality literature support, implementing short courses into routine clinical practice remains challenging. This study aimed to assess the impact on the duration of antibiotics for CAP of a pilot clinical pharmacist discharge antibiotic prescription review and departmental education supporting short-course antibiotics for CAP.

Methods

This was a single-center retrospective cohort study for patients admitted with an order for any antimicrobial for CAP. Patients were excluded if they were admitted to the pediatric intensive care unit or transferred during their course of care. The pre-intervention period was from June 2021 to June 2022, and the postintervention group was from August to October 2022. A one-time education session was hosted with the Pediatric Hospital Medicine department summarizing the literature supporting short courses. Statistical analysis included ANOVA, Fisher’s Exact, and Mann-Whitney U test as appropriate.

Results

One hundred twenty-four patients were included, 85 in the pre-intervention and 39 in the post-intervention groups. The median age was two years old in both groups (p=0.2). No differences were present in the median length of stay, penicillin-allergy status, or vaccination status. Patients had a positive viral test 56% and 59%, respectively (p=0.8). Discharge attendings did differ and impact the total length of therapy (p< 0.001). Overall median antibiotic duration for CAP decreased from 8 to 5 days (p< 0.01). Inpatient median durations remained the same at 2 days (p=0.5), while outpatient durations fell from 6 to 4 days (p< 0.01). Patients that received over seven days for CAP decreased from 62% to 10% (p< 0.01). Treatment failure at 30 days occurred in 2 and 8% (p=0.16), respectively.

Conclusion

A pilot discharge prescription review by clinical pharmacists and education supporting short courses for CAP effectively reduced the duration of antibiotic therapy. Consideration should be given to discharge antibiotic prescription reviews when adopting short courses for common pediatric infections.

Disclosures

Shubho Sarkar, MD, Abbott Laboratories: Stocks/Bonds|Abbvie INC: Stocks/Bonds|Bristol-Myers Squibb: Stocks/Bonds|CVS Health Corp: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds
1653. Cost effectiveness of Levofloxacin Vs Amoxicillin/Clavulanate And Ciprofloxacin In The Outpatient Management Of Low-Risk Febrile Neutropaenia In Children With Cancer: A Randomised Control Study.
Authors: Khedr Reham , Abdelaziz Ebtihal , mahellawy hadir Al , El-Deen Nashwa Ezz
Published: November 2023

Background

outpatient management of low-risk fever and neutropenia should be implemented if close monitoring is accessible and patient compliance is feasible.In this study, we aimed to assess the efficacy and safety of single-agent Levofloxacin versus the Augmentin /ciprofloxacin regimen used in our institute.

Methods

This is a randomized prospective interventional 2 arm study of low-risk febrile neutropenia patients presenting to the emergency department at the National Cancer Institute, Cairo University starting from December 2021 to July 2022. Eligible patients were children< 18 years with Low-risk febrile neutropenia without an aetiological diagnosis.Patients were randomized to double-agent ciprofloxacin and amoxicillin-clavulanic acid in comparison to single-agent levofloxacin. Follow up of the outpatient cases on; Day 1, Day 3, and Day 7 for Resolution of infection and stopping of antibiotics regardless of neutropenia. Drug-related side effects encountered in both arms of the study were reported. A decision analytic model was created to compare the two different treatment strategies Outcome measures were quality-adjusted FN episodes, costs, and incremental cost-effectiveness ratios (ICER). The clinical parameters of the model were derived mainly from data collected at National Cancer Institute. Health effects were expressed in terms of QALY gain.One-way sensitivity analysis (DSA) was conducted.

Results

200 patients (100 in each group) were enrolled. 100% of patients achieved marrow recovery in both arms by D7. Fever subsided in 100% on the Levofloxacin arm compared to 60% in the other group. only 1 patient on the double agent arm was upgraded to HR.Levofloxacin was tolerable in all patients with no significant side effects, while patients in the double agent arm; 4 had diarrhea, 2 nausea, and 2 complained of a bad drug taste. Levofloxacin is the dominant strategy versus Augmentin/ciprofloxacin with incremental QALY 0.0001and lower cost 62.4996 L.E in the treatment of home-based care of febrile neutropenia with a willingness to pay threshold of 77,520 LE per QALY (1 GDP/CAPITA)

Figure 1

Conclusion

Levofloxacin is cost effective and can be administered safely in children with low-risk FN, however close follow-up for long-term side effects and emerging bacterial resistance is warranted.

Disclosures

All Authors: No reported disclosures
1660. Harnessing Handshake Rounds for Infection Prevention: Interventions and Great Catches in the First Year
Authors: Martinez Kathleen , Weber Matthew J , MacBrayne Christine , Parker Sarah K , Nyquist Ann-Christine
Published: November 2023

Background

There are national calls to engage Infection Preventionists (IPs) as antimicrobial stewards (AS), but it is unknown how this is translated into action and measurable outcomes. The Association of Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) 2012 joint position paper states that IPs can benefit ASPs. The paper summarizes key actions for IPs as promoting compliance with standard and transmission-based precautions, care bundle, hand hygiene, and educating staff, patients, and visitors. However, an initial review of the literature did not find any publications outlining IP actions or outcomes as participants in AS.

Methods

In August 2022 an IP was added as available to the existing handshake stewardship rounding team. During rounds the IP observed units for safe infection control practices, asked staff if there were any questions about IC policies or practices, and shared information about circulating illness and COVID-19 policy updates.

Results

Between August 2022 and March 2023, there were 201 interventions. The largest categories included environmental, education, and expired product. 42 (21%) were categorized as a “great catch”, defined as likely to have system-wide impact. Secure chat data was also collected as a baseline to assess change over time.

IP interventions during ASP Handshake Rounds

EHR Secure Chats to on call Infection Preventionists

Conclusion

The impact of including an IP during handshake stewardship was great. Impact includes environmental interventions: cleaning and disinfection processes, laundry, waste, damaged structures, construction, and ventilation issues. Educational impact: teaching providers how to access policies, answering questions about isolation and PPE, and the importance of standard precautions and policy changes surrounding COVID-19. Identifying and disposing of expired products and guidance on isolation precautions and PPE. Examples of a great catch included upgrading isolation status, identifying multiple expired products, correcting incorrect PPE or IC in real time, and educating large groups of staff members on critical IC topics. Health care teams and leadership expressed appreciation of education and support provided by the IP during rounds. Integration of IP into Handshake Stewardship will improve IC practices and Joint Commission readiness.

Disclosures

All Authors: No reported disclosures
1661. Incorporating Infection Prevention and Nursing into Antimicrobial Stewardship Handshake Rounds
Authors: Martinez Kathleen , Weber Matthew J , Nyquist Ann-Christine , Parker Sarah K , Ziniel Sonja I
Published: November 2023

Background

Antimicrobial Stewardship Programs’ (ASP) “handshake stewardship” rounds are used in many hospitals to review patient antibiotic prescribing and use in real time. Historically, handshake rounds at our organization have consisted of Infectious Disease providers and pharmacists but have not included infection prevention (IP) and nursing. While recent literature suggests the value of including infection prevention and nurses in ASPs, information is lacking on practical implementation and assessment of such inclusion. The objective of this study was to understand the perceived value of adding IP and nursing to existing “handshake stewardship” rounds lay the groundwork for sustained implementation to improve both antimicrobial stewardship and infection prevention practices hospital wide.

Methods

Surveys to assess provider and nursing perceptions were developed with infection control, nursing, stewardship, and survey specialist input. Data was collected in REDcap from 1,030 physicians and advanced practice providers (APP) and 170 nurses on units where “handshake stewardship” rounds occur daily.

Results

276 respondents completed the 12-question survey (response rate: 23%). 52% of physicians and nurses rated the potential inclusion of an IP as “very useful” or “pretty useful”. 52% of physicians and 48% of nurses responded that including nurses in ASP rounds would be “very useful” or “pretty useful”. Free responses were analyzed for themes.Table 1Survey Results

Survey Question: Would it be useful to include Infection Prevention and Control an ASP Rounds?

Table 2 Survey Results

Survey Question: Would it be useful to include RNs in ASP rounds?

Conclusion

Our results demonstrate a mismatch between literature recommendations and survey participants’ perceptions. Despite mixed perceptions of value, nurses’ free text comments reflect interest in learning more about this nursing role. While the usefulness of including IPs was viewed positively in only over 50% of respondents, opportunities for improvement were reflected in the high number of nurses and providers who lacked confidence in knowing IP policies. Results suggest the opportunity for education on the potential contributions of nursing in antimicrobial stewardship and infection prevention, facilitated by IP presence on Handshake Stewardship rounds. The ASP rounding tool can be harnessed to ensure successful integration of nurse and IP specific processes. Tools to assess the success of this initiative are in progress.

Disclosures

All Authors: No reported disclosures
1665. Assessment of Documentation of Adverse Effects of Oral Antibiotics for Pediatric Acne Vulgaris
Authors: Scardina Tonya , Brady Kai , Sun Shan , Vivar Karina , Parzen-Johnson Simon , Li Caitlin , Patel Sameer
Published: November 2023

Background

Oral antibiotics (OA) are frequently prescribed for acne vulgaris (AV). However, adverse effects (AE) associated with OA are likely underappreciated. We investigated the assessment of documentation of AE and prescribing trends of OA for AV among pediatric patients in the outpatient setting.

Methods

A random sample of patients prescribed OA for AV with at least one follow-up dermatology clinic visit between 1/1/19 and 1/1/22 were selected. Patients were excluded for non-compliance to OA therapy. Patients with multiple follow-up visits were included once. Data collected included prescriber type (OA initiated by dermatologist at our institution or outside provider), severity of AV, prescribed OA agent, duration of OA, documentation of assessment of AEs, and reported AEs. Chi-square, Kruskal Wallis, or Wilcoxon rank-sum tests were used to analyze non-parametric data. General linear regression model was conducted to examine multivariate impact on the duration.

Results

Two-hundred and forty-eight patients met inclusion criteria. Median age was 16 years (range: 11 -21). Most patients were White (49.6%), non-Hispanic/Latinx (68%) and female (57%). 99% of patients had OA initiated by a dermatologist at our institution. Doxycycline was prescribed for 71% of patients. Each one month increase in age was associated with a one day increase in duration of OA (p=0.005). There was no correlation between duration of OA and severity of AV (p=0.16). There was no documentation of assessment of AEs for 48% of patients. Severity of AV and duration of OA were not associated with the incidence of assessment of an AE (p=0.18 and 0.84, respectively). After adjusting for the severity of AV, age, and documentation of assessment of AEs, doxycycline and sulfamethoxazole-trimethoprim were found to be prescribed for a longer duration than minocycline and cephalexin (p=0.02).

Conclusion

Nearly half of pediatric patients prescribed an OA for AV did not have documentation of assessment of AE. Severity of AV and duration of OA did not impact assessment of AE. Given AEs and duration of OAs prescribed for AV, antibiotic stewardship opportunities exist to improve documentation of tolerance.

Disclosures

Tonya Scardina, PharmD, American Society of Health-System Pharmacists: Advisor/Consultant