bluuebunny/crossref_metadata_2025 huggingface dataset:
P-405. A Case Against Universal Candida auris Screening
Authors: Patel Palak , Roessler Eric , Vasquez Nicole Perez , Steele Molly , Rezaeian Saba , Hill Kristy , Landon Emily , Zuccaro Patricia D
Published: January 2025

Background

Candida auris (C. auris) is an emerging multidrug resistant pathogen that is prevalent in congregate living facilities like skilled nursing facilities (SNFs) and long term acute care hospitals (LTACHs). CDC recommends that individuals who recently resided in SNFs or LTACHs undergo active surveillance for C. auris colonization on admission to an acute care hospital.

Methods

University of Chicago Medicine is an 800 bed tertiary academic medical center. To assess feasibility of C. auris screening, UCM piloted active surveillance for high risk patients in the 24 bed medical intensive care unit (MICU). During the study period, 6/26/2023 to 4/3/2024, charge nurses screened newly admitted patients each shift and notified provider teams to order a C. auris screening for anyone who had previously resided in a SNF or LTACH. The screening test, a combined axilla and groin swab, was collected from each eligible patient and sent for PCR assay to Mayo Clinic Laboratories (Rochester, MN). Patients known to be C. auris colonized were not retested. The infection prevention and control team audited MICU admissions to ensure patients were not missed.

Results

398 patients were admitted to the MICU and 94 were identified as high risk (previously in SNF or LTACH). Of these, 6 were already known to be C. auris colonized and were not tested. 88 total patients were swabbed for C. auris and 5 were positive, representing 5.7% of screened individuals. Turnaround time for this sendout lab was 4-5 days on average. During this time period, 4 patients in MICU developed a C. auris infection. Of those 4 patients only 1 was screened on admission and had a negative screen.

Conclusion

While the burden of swabbing high risk patients was low, the burden of screening all admissions to identify those who were high risk was not. This strain on our workforce, coupled with the unexpectedly low rate of colonization, has prevented expansion of the program. Additionally, the long turnaround time for the screen requires either isolating all high risk patients for a large part of their hospital stay or enduring significant transmission risk if forgoing isolation, while awaiting screening results.

Disclosures

All Authors: No reported disclosures
P-440. Shortened steroid regimen in people living with HIV/AIDS with associated moderate and severe P. jirovecii pneumonia
Authors: Peralta Prado Amy Bethel , Flores-Andrade Xavier A , León-Rodríguez María I , Ahumada-Topete Víctor H , Ávila-Ríos Santiago
Published: January 2025

Background

The 21-day steroid regimen in people with P. jirovecii pneumonia (PCP) showed positive clinical outcomes reducing mortality and immune reconstitution inflammatory syndrome (IRIS) incidence. However, steroids can perpetuate an immunocompromised state, having a negative impact on morbidity.

Respiratory Function test in PLWHIV with shortened vs conventional steroid regimen for PCP

Methods

This is an open-label, randomized non-inferiority controlled trial in adults living with HIV, to elucidate the effect of a shortened steroid regimen (sSR) of 8 days for moderate and 14 days for severe PCP compared to conventional 21-day steroid regimen (cSR) by mortality, IRIS incidence, and respiratory function. Herpesviruses and HIV viral loads, CD4 T cells (CD4), and respiratory function tests were performed at admission and at day 90.

Results

A total of 44 participants were randomized, 23 in sSR and 21 in cSR. Mechanical ventilation (MV) was equal between groups (13 participants each group (OR = 0.8, 95%CI = 0.24-2.67). HIV viral loads at admission and at day 90 were similar between groups (p = 0.34 and p = 0.33 respectively). Similarly, CD4 did not show differences at admission and day 90 (p = 0.82 and p = 0.73). Respiratory function tests were similar between both groups (Figure attached). The CMV, EBV, and HHV-8 viral loads did not show statistical differences. A total of 3 participants presented IRIS in sSR vs 2 in cSR (OR = 1.5, 95%CI = 0.23-9.96) and mortality was not statistically different (OR = 3, 95%CI = 0.29-31.35). The sSR group had a shorter hospital stay (12 vs 18 days; p = 0.37).

Conclusion

Preliminary analysis shows that reducing steroid duration may be safe, since a sSR achieved non-inferiority compared with a cSR, by presenting similarities in mortality, IRIS incidence, hospital-stay duration, MV requirements, herpesviruses and HIV viral loads, and in respiratory function tests; suggesting that at 90 days follow-up, the use of a sSR is not inferior compared to cSR in this preliminary analysis.

Disclosures

All Authors: No reported disclosures
P-461. Positive Aging Consultations: A Model for Expanding Geriatric HIV Care
Authors: Gorvetzian Sarah , Erlandson Kristine M , Iriarte Evelyn , Walker Jacob
Published: January 2025

Background

People living with HIV (PWH) experience geriatric syndromes commonly found in much older populations and may benefit from

geriatrician consultation. We aim to describe a referral-based model at the University of Colorado.

Methods

The Positive Aging Consultations, a referral-based model, sought to connect high-risk PWH ≥ 50 years old with geriatric care. High-risk patients (experiencing geriatric syndromes, polypharmacy, multimorbidity, or advance care planning needs) were referred for geriatric consultation at the UCHealth Seniors Clinic; those taking ≥ 10 medications were referred for clinical pharmacy consultation. Patients were screened for functional status, preventative care, socioenvironmental factors (living situation, food access, transportation, social support, and elder abuse), and cognitive/mental health concerns (depression, anxiety, and memory loss). Geriatricians placed orders or communicated recommendations to the patient’s primary HIV provider. HIV providers completed a survey about their experience with the program. Additional data was collected via chart review.

Results

From January 2018 to July 2019, 11 patients underwent geriatric consultation. The average age was 69 years old (SD=7; range 59-80). Geriatricians most often made recommendations regarding referral to other health or community-based services (n=9), medication changes (n=8), osteoporosis screening (n=6), and memory loss management (n=5). Advance directives were discussed in all visits. All but one HIV provider (n=7) said they would refer patients to the program in the future.

Conclusion

The Positive Aging Consultations program improved access to geriatric care with minimal setup costs, but with limited uptake

over a one-year period. Limitations of the program included low utilization, lack of longitudinal geriatric care, geriatrician

shortage, and potential financial barriers.

Disclosures

Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant
P-484. Community Food Pantries Provide Unique Opportunities for Linkage to HIV Care in Newly Diagnosed Individuals
Authors: Pickard Marc , Rosmarin-DeStefano Corey , Mendez-Baez Christian , Landaverde Karina , Tirado Keven , Escalante Flavia , Vera Sonia , Caro Mauricio , Finkel Diana
Published: January 2025

Background

Food insecurity has been associated with sexual risk behavior that increases Human Immunodeficiency Virus (HIV) risk in cis women and sexual and gender minority (SGM) individuals such as transactional sex for money or food and multiple sexual partners. SGM people and cis women experiencing insecure immigration status also often face financial and housing instability, stigma, discrimination, lack of social support as well as food insecurity. North Jersey Community Research Initiative (NJCRI) is a non- profit organization in Newark, NJ that provides medical care and support services for highly vulnerable and hard to reach patient populations including unhoused individuals, people living with HIV/AIDS, LGBQTIA community members, people who use drugs and new immigrants. In 2023, NJCRI expanded food pantry status neutral services to the community and offered onsite HIV counselling and testing to pantry visitors.

Methods

From April 2023 to April 2024, NJCRI provided HIV testing for 3630 individuals with 1025 being tested at the pantry.

Results

There were 63 total positive tests with 13 diagnosed at the pantry. Of those diagnosed at the pantry, 2/3 (9) identified as SGM and 1/3 (4) as cis women. All the SGM individuals were Latinx. All reported to be new migrants. All diagnosed were linked to care and services and started on ART on the day of diagnosis.OrganizationTotal Test (Statewide)NJCRI Pantry TotalTotal (+) - StatewideNJCRI Pantry - (+)NJCRI363010256313Self-IdentificationSGMn/ax429Cis-Womenn/ax94EthnicityLatinxn/an/a4213Blackn/an/a170Othern/an/a40

Conclusion

Migrant individuals from known groups for higher HIV associated risk experiencing food insecurity benefit from HIV testing at nontraditional testing sites. Food pantries run by trusted community partners who provide integrated HIV care and prevention services can serve as entry points for HIV care for new immigrants. Community organizations serving this community should be aware of the opportunity to engage individuals in HIV care and prevention services and link to care.

Disclosures

All Authors: No reported disclosures
P-491. Advancing HIV Care: Implementing Comprehensive Screening and Linkage Services in Diverse Urban Settings
Authors: Owino Racquel , Gonzales Delana , Landin Steven , Mendez Tanya Khalfan , Lewis Roseanne , Espinoza Michelle , Bravo Juan , Krull Kimberlee , Johnston Kasandra , Hernandez Maria , Emanuel Tatiana , Riviello Ralph , Taranova Anna
Published: January 2025

Background

University Health is South Texas’ largest provider of specialty HIV/AIDS care to a 28-county region with an incidence rate of 21 per 100,000. San Antonio is designated as an HIV priority jurisdiction by the U.S. Department of Health and Human Services. University Health is suited to provide HIV services through its Emergency Department (ED), often the first point of care for indigent individuals, and screening at more than 19 primary care clinics and the Bexar County Adult Detention Center (BCADC).

Methods

University Health implemented opt out HIV screening at three sites; 11 outpatient clinics, the ED, and the BCADC for adults 18 years and over following Centers for Disease Control and Prevention guidelines. EMR system prompts providers to order the preferred HIV confirmatory test using a Care Gap flag alert in outpatient clinics and a Best Practice Advisory in the ED. An HIV screening prompt on BCADC’s EMR system alerts providers to order and conduct an HIV rapid OraQuick swab. Upon identification of all confirmed diagnosis by a provider, the navigation team facilitates linkage to care.

Results

From January 2023 to April 2024, 26,265 individuals were screened in the ED, identifying 205 as positive (0.8% seropositive). Among these, 34% were newly diagnosed, 64% were previously diagnosed, and 2% are pending diagnoses status. Among these, 57% of positive cases were linked to care. From January 2024 to April 2024, 2,415 individuals were screened in 11 ambulatory clinics, resulting in the identification of 3 positive cases (0.1 % seropositive), with 67% being new diagnoses and 33% being previously diagnosed. Of those with a positive result, 67% were linked to care. In the BCADC, spanning from February 2024 to April 2024, 2,473 individuals were screened, resulting in 20 positive cases (0.8% seropositive), with 70% being new diagnoses, 25% previous diagnoses, and 5% pending diagnoses status. Of those with positive diagnoses, 20% were linked to care.

Conclusion

Multi-site expansion of HIV screening and linkage to care services promotes early detection, increased accessibility, and targeted interventions within a HIV priority jurisdiction. Universal screening aligns with national and global goals to end the HIV/AIDS epidemic.

Disclosures

All Authors: No reported disclosures
P-492. Quantification of HIV Shedding in Viremic Patients
Authors: Linfield Rebecca , Zulli Alessandro , Jong Sehee , Wolfe Marlene , Boehm Alexandria , Parsonnet Julie
Published: January 2025

Background

Identifying pockets of undiagnosed HIV is a critical step in the U.S. Ending the HIV Epidemic (EHE). Wastewater-based epidemiology represents a novel way to build agnostic population-level data about disease distribution. We detected HIV virus in two sewersheds in Northern California. We are now conducting a study to measure how much HIV virus is shed into urine and stool, to better estimate cases represented by wastewater detection.

HIV-1 RNA Detected in Concentrated Urine

Methods

We are recruiting participants from HIV clinics in San Mateo and Santa Clara Counties. Patients must be 18 years or older with HIV-1 viral load of >10,000 copies/ml at the time of recruitment. Subjects are asked to provide 5 weekly self-collected blood (Tasso), urine, and stool samples. The plasma is analyzed by established HIV-1 RNA quantitative PCR techniques. Nucleic acids from urine, concentrated (centrifuged) urine, and stool are suspended in DNA/RNA Shield, then extracted using the ZymoBIOMICS DNA/RNA Miniprep Kit (ZymoBIOMICS #R2002). HIV genome-specific primers target the Long Terminal Repeat (LTR) region of the HIV-1 genome. Droplets for digital droplet PCR are generated using the AutoDG Automated Droplet Generator. Reverse transcriptase PCR, which quantifies RNA and DNA combined, and direct PCR, which quantifies DNA, is then carried out with the Mastercycler Pro. Thresholding is performed using QX Manager Software.

HIV-1 RNA Detected in Stool

Results

Two patients have been enrolled to date. Patient 1 was started on antiretroviral therapy after the first sample was obtained; Patient 2 was started on antiretroviral therapy 10 days before the first sample was collected. HIV-1 RNA was found in 87.5% (7/8) of concentrated urine samples, including 85.7% (6/7) of samples obtained while on ART (Table 1). Among stool samples, 25.0% (2/8) yielded HIV RNA, but only 14.3% (1/7) of those obtained on ART (Table 2). Nucleic acids were not detected in unconcentrated urine. Plasma viral load testing is pending, so only the initial clinical HIV-1 viral loads at enrollment are shown.

Conclusion

HIV-1 RNA is present in concentrated urine but also in stool samples of viremic patients, even up to five weeks after initiation of ART. When the study is complete, our results will bolster how to interpret HIV-1 detected in wastewater.

Disclosures

All Authors: No reported disclosures
P-494. The Silver Tsunami Is Upon Us: Over Half of Persons with HIV in the United States Are Aged ≥ 50 Years and Almost Half Have Been Living with Diagnosed HIV for ≥ 15 Years
Authors: O’Connor Siobhan M , Balaji Alexandra B , Grytdal Scott , Wu Baohua , Hu Xiaohong , Brooks John
Published: January 2025

Background

On average, persons with diagnosed HIV (PWH) are living longer, and PWH who are engaged in effective care can expect lifespans comparable to persons without HIV. Understanding changes in the age structure of PWH can help plan where to direct healthcare resources to match need, especially medical needs related to aging and to preventive care for AIDS- and non-AIDS-related comorbidities.

Methods

Using data from CDC’s National HIV Surveillance System (NHSS) for PWH aged ≥ 13 years in the United States, we compared changes in the number of PWH alive at each year-end over the period 2010-2021, examined changes in their age structure, and for 2021 calculated duration of HIV infection since diagnosis for all PWH aged ≥ 18 years.

Results

During 2010-2021, the overall number of PWH increased 29.9%, from 835,004 in 2010 to 1,084,351 in 2021 (Fig 1). The number of PWH aged ≥ 50 years increased 96.3%, from 295,464 to 580,011, and the number aged ≥ 65 years increased 335%, from 33,646 to 146,485 (Fig 2). At year-end 2021, overall median age was 51 years, 53.5% of all PWH were aged ≥ 50 years, and 13.5% were aged ≥ 65 years. Of all adult PWH, 45.8% (497,005) had lived with HIV over 15 years since diagnosis. Among the subset of 12,563 PWH living with perinatally acquired HIV, the median age at year-end 2021 was 26 years; 31.4% were infected at least 30 years, and 76.6% at least 20 years.

Conclusion

From 2010-2021, the number of PWH aged ≥ 50 years increased markedly and overall median age of PWH aged ≥ 13 years increased to exceed 50 years; 1 in 7 were aged ≥ 65 years. By year-end 2021, PWH aged ≥ 50 years totaled over one half million, among whom 1 in 4 was aged ≥ 65 years. Almost half of adult PWH had lived with diagnosed HIV for at least 15 years and three-quarters of young adults with perinatally acquired HIV had lived with HIV for 20 years or more. Our findings highlight the large and rapidly growing need not only for expertise treating older PWH but also integration of prevention strategies to minimize the impact of AIDS- and non-AIDS-related comorbidities of aging in PWH with long-standing HIV.

Disclosures

All Authors: No reported disclosures
P-495. Anal Cancer Screening and Referral Practices in an Academic Medical Center Affiliated HIV Clinic in Columbus, Ohio
Authors: Hassan Syeda F , Lipps Ashley , Patel Yesha , Sobhanie Mohammad Mahdee , Malvestutto Carlos , Koletar Susan L
Published: January 2025

Background

Rates of anal cancer (AC) in people living with HIV (PLWH) are higher than the general population. Screening for AC can be performed using cytology +/- high-risk human papillomavirus (hrHPV) testing. Until recently, there were no evidence-based consensus guidelines available regarding who should be screened for AC or management of abnormal cytology results. The International Anal Neoplasia Society (IANS) guidelines recommend AC screening in PLWH starting at age 35 for men and transgender women who have sex with men (MSM) and starting at age 45 for other PLWH. Guidelines recommend referrals for high resolution anoscopy (HRA) in those with cytology results of atypical squamous cells of unknown significance (ASCUS)/hrHPV+ or worse. The objective of this study is to evaluate existing AC screening and HRA referral practices in the Ohio State University Wexner Medical Center (OSUWMC) Infectious Diseases Clinic (IDC) to identify gaps in care based on the new IANS guidelines.

Methods

This was a single-center, retrospective study evaluating PLWH age >18 years old who underwent AC screening at the OSUWMC IDC between October 1, 2020 and September 30, 2023. Demographic and clinical outcomes were obtained.

Results

During the study period, 257 PLWH had anal cytology performed. Demographic information is shown in Table 1. Of 257 patients screened, median age was 49. 250 patients (97.3%) were men, including 241 (93.7%) MSM. 241 patients (93.8%) had HIV viral load < 40 copies/mL and 251 (97.7%) had CD4 counts >200 cells/mm3. Clinical outcomes, including cytology results, referrals to colorectal surgery (CRS) and results of HRA are shown in Table 2. Of patients with ASCUS/hrHPV+ or worse on cytology, 60/67 (90%) were referred to CRS and 31/67 (46%) underwent HRA.

Conclusion

Anal cancer screening was completed predominantly in MSM living with HIV. Further efforts are needed to promote anal cancer screening among other at-risk groups, such as women and MSW living with HIV. CRS referral practices based on cytology results were highly variable. Though most patients with ASCUS/hrHPV+ or worse were referred to CRS for HRA (consistent with new guidelines), less than half completed an HRA. Additional investigations are needed to determine individual and system level barriers to HRA in this patient population.

Disclosures

Carlos Malvestutto, MD MPH, Gilead Sciences: Advisor/Consultant|Viiv Healhcare: Advisor/Consultant
P-498. One Small Step for Man, One Giant Leap for Ending the HIV Epidemic
Authors: Mann Yasmeen , Hagerman Thomas , Malick Allison , Rao Sanjana , Harris Charlalynn , Santana-Garcés Maria , Manteuffel Jacob , Gudipati Smitha , Brar Indira
Published: January 2025

Background

To achieve the goal to “End the HIV Epidemic” by 2030, unique interventions are needed to increase testing and subsequently link people with HIV (PWH) to care for rapid start of antiretroviral therapy (ART). Extending testing to include emergency department (ED) based HIV screening initiatives are effective in new case identification, earlier detection, and are encouraged by Centers for Disease Control and Prevention guidelines. Collaborations of infectious diseases (ID) providers with ED providers provides improved linkage to care for HIV and rapid initiation of ART. We describe our combined ED and ID HIV testing and linkage to care program.

Methods

This is a retrospective analysis of newly diagnosed PWH at Henry Ford Health (HFH) via reactive HIV fourth generation test by an ED based opt-out HIV screening program from 7/16/2020 – 10/28/2023. A best practice alert (BPA) prompted providers to order an HIV screening test for patients ages 18-65 years old without a previously documented HIV fourth generation test. Patients were informed of the test when ordered and could opt-out of testing if desired. Follow up and linkage to care was provided by a team of ID providers.

Results

During the study period, a total of 48,725 fourth generation HIV screening tests were performed, of which 629 tests were reactive (1.24% of tests performed). Of the reactive tests, 86 patients (0.18% of all tests) were found to have a new diagnosis of HIV. Median CD4 cell count was 297 cells/mm3 (IQR: 98-614), 34 patients required hospitalization with 7 (8%) admitted with an opportunistic infection. Excluding the 34 patients hospitalized, the median time from positive result to first attended appointment was 5 days (IQR 2-13) and median time from screening test result to initiation of ART was 6.5 days (IQR: 4-16). At 3- or 6- months following HIV diagnosis, 40 (47%) had an HIV-1 follow-up viral load reported (see Table 1).

Conclusion

HIV testing and early linkage to care are two key pillars of the “End the HIV Epidemic” initiative. As shown by our study, collaboration between ED and ID providers ensures increased testing in the ED, improved linkage to care, and rapid start of ART which will help in achieving the goals of these two pillars.

Disclosures

Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Merck: Grant/Research Support|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Honoraria
P-524. Comparative Costs of Implementing an Evidence-Based Online HIV Prevention Program: Direct-to-Consumer Marketing vs. Community-Based Organization Recruitment
Authors: Munroe Sarah J , Schackman Bruce R , Madkins Krystal , Saber Rana , Macapagal Kathryn , Vititow Jocelyn , Sweeney Nicholas , Feder Noah , Benbow Nanette , Mustanski Brian , Linas Benjamin P
Published: January 2025

Background

Black/African American and Hispanic/Latino men who have sex with men face a disproportionate burden of new HIV diagnoses. The Keep It Up! (KIU) program, an evidence-based online intervention, is effective in reducing risk behaviors. The KIU 3.0 study, conducted between 2019-2022, compared two delivery strategies: centralized, national direct-to-consumer (DTC) recruitment, and decentralized recruitment via community-based organizations (CBO). Here, we report strategy costs.

Methods

We conducted interviews to identify and quantify start-up (e.g. equipment, training), time-dependent (e.g. advertisements, payroll), and variable (e.g. incentives, medical materials) costs for both delivery models. We report costs in 2021 USD. We analyzed cost variation among CBOs and present a hypothetical scenario where all CBOs match the efficiency of the two with the lowest cost per participant.

Results

The DTC arm enrolled 1,468 participants. Start-up costs totaled $398,384 of which $376,393 was content design and development. Ongoing costs per participant totaled $501 (66.8% variable, 29.8% time-dependent, and 3.4% overhead, Table 1). The CBO arm enrolled 656 participants across 22 sites. Start-up costs totaled $511,528 of which $401,141 was content design and development. Ongoing costs per participant totaled $4,239 (9.2% variable, 69.3% time-dependent, and 21.4% overhead, Table 1). Site-specific costs ranged from $467 - $26,950 per participant with no correlation to the number of participants (Table 2, Figure 1, Spearman’s Rho = 0.007). In a hypothetical optimized CBO scenario, we estimated that 1,991 participants would enroll, start-up costs would be $470,653 and ongoing costs per participant would be $573, demonstrating that CBO delivery has the potential for similar costs to DTC delivery.

Conclusion

DTC implementation demonstrated lower costs per participant than CBO distribution. CBO costs were highly variable with no correlation to enrollment. It is important to note the challenges related to the COVID-19 pandemic (clinic closures and restrictions, material shortages, and price increases) when contextualizing these costing outcomes. Efficient implementation models are crucial for scaling evidence-based interventions.

Disclosures

Brian Mustanski, PhD, Hologic: Grant/Research Support
P-535. Implementation of Injectable Cabotegravir/Rilpivirine for Treatment of HIV in Patients with Substance Use Disorders at a Syringe Exchange Clinic
Authors: Perez Amanda E , Nieves Shane , Meisner Jessica
Published: January 2025

Background

Injectable Cabotegravir + Rilpivirine (CAB+RPV-LA) is a long-acting anti-retroviral therapy (ART) that has the potential to be utilized for people living with HIV (PLWH) who face significant barriers to daily ART. A key population that can benefit is PLWH with concomitant opioid use disorder (OUD) and housing instability. In this case series, we describe the implementation of a program that provides low-barrier access to CAB+RPV-LA for PLWH and OUD.

Methods

The electronic medical record (EMR) was reviewed to identify individuals aged 18 years or older with a documented HIV diagnosis and a history of intravenous drug use (IVDU) who were initiated on CAB+RPV-LA between June 2022 - January 2024 at the Sana Clinic at Prevention Point Philadelphia (PPP). Fifteen patients were identified as having initiated CAB+RPV-LA during this time period. Descriptive statistics were used to summarize demographics, clinical characteristics, and outcomes of the study population.

Results

A review of the patients started on CAB+RPV-LA found that 100% of patients (n =12) with follow-up labs after initiation had HIV viral load suppression and CD4 counts > 200. Three patients did not yet have follow-up labs since initiation due to their recent start on CAB+RPV-LA. Viral load on initiation ranged from undetectable to 1440. There were no missed doses during the two-year period. All patients had OUD and 67% had housing instability.

Conclusion

Overall, CAB+RPV-LA was effective in maintaining and obtaining viral suppression in PLWH and OUD. To our knowledge, there is currently no literature on the implementation of long-acting ART for HIV maintenance in patients with OUD at a syringe exchange. Our findings support that long-acting ART is a key tool in ending the HIV epidemic especially at clinics serving patients with comorbid substance use and housing instability.

Disclosures

All Authors: No reported disclosures
P-553. The Impact of Six-Months Antiretroviral Drug Dispensing on Viral Load Suppression in 18 Health Facilities in Mozambique From 2019 to 2023
Authors: Namburete Bauaze Evangelina Inacio , Macul Helder , Nhaguiombe Herminio , Bila Erica , Gaspar Irenio , Tiberi Orrin , da Cunha Morais
Published: January 2025

Background

In 2019, Mozambique adopted the six-months antiretroviral drug dispensing (6MMD) for all eligible People Living with HIV (PLHIV) subgroups. Patients on 6MMD, pick up their antiretroviral drugs at the clinics every six months. As of June 2023, the model was rolled out to 85 health facilities (HFs) and overall viral load suppression was 93%. We analyzed United States President’s Plan for AIDS Relief (PEPFAR) program monitoring and evaluation data to understand the impact of six-months drug dispensing on viral load suppression.

Methods

At the end of June 2023, we analyzed Viral Load data obtained from electronic patients tracking system (EPTS) an OpenMRS used by PEPFAR to report HIV data nationally in all PEPFAR supported sites in Mozambique. Based on the volume of clients served ( >1000 PLHIV) by each health facility, we selected 9 out of 85 health facilities that implemented six-months antiretroviral drug dispensing and 9 that were not implementing, and we compared the overall percentage of viral load suppression at each HF in June 2019 and June 2023.Viral load was considered suppressed if < 1000 copies/ml in the last consultation for patient enrolled on 6MMD and in the last 6 months for patient not enrolled on 6MMD. All the 18 HFs were PEPFAR supported sites.

Results

As by June 2023, the 18 HFs selected had 126,719 PLHIV on treatment, representing 6% of PLHIV on treatment in the country. Overall Viral load suppression in June 2019 & June 2023 in the 9 HFs with 6MMD ranged from 69 – 72% & 91 – 94% while in the 9 HFs that were not implementing 6MMD ranged from 69 – 74% & 78 – 89%.

Conclusion

In the sites we assessed, six-months antiretroviral drug dispensing contributed to reduce HIV transmission by improving viral load suppression rates in Mozambique.

Disclosures

All Authors: No reported disclosures
P-575. Evaluation of Weight Gain on Incident Hypertension among People Living with HIV-1 Receiving Dolutegravir (DTG)-Based Regimens or Comparator Antiretroviral Therapy (cART) in Randomized Clinical Trials through 96 Weeks
Authors: Jones Clifford B , Pozsonyiova Sofia , Grove Richard , McKenna Michael , Patel Parul
Published: January 2025

Background

Weight gain has been observed with integrase strand transfer inhibitor (INSTI)-based treatment with an association between INSTI use and hypertension (HTN) in some studies. We observed no difference in odds of incident HTN and minimal weight increase in participants receiving DTG-based or comparator antiretroviral therapy (cART) through Week (W)96. Here, we evaluated the relationship between ART use, weight gain, and HTN risk among participants without baseline (BL) HTN receiving DTG or cART in pooled phase 2/3 studies.

Methods

Data from ART-naive participants randomized to either DTG-based ART (+ ABC/3TC or TDF/FTC), or cART (EFV/TDF/FTC, RAL + 2 NRTIs, or DRV/r + 2 NRTIs), were pooled from the SPRING-1 and -2, SINGLE, and FLAMINGO trials. HTN at BL, W24, W48, and W96 was defined as a single systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, HTN history or HTN adverse event, and/or antihypertensive use. Mixed-models repeated-measures (MMRM) analyses evaluated adjusted change from BL in weight. Bayesian Joint Models (JM) evaluated the associations between treatment, weight change, and treatment and weight change interaction with HTN risk. Models were adjusted for key BL variables and pooled treatment.

Results

Among 2345 participants, 23% (n=530) were excluded for BL HTN; of the remaining, 927 received DTG-based ART and 888 received cART. At W96, adjusted mean (SE) change in weight was 1.98 (0.242) kg for DTG-based ART vs 1.59 (0.212) kg for cART (treatment difference: 0.39 kg; 95% CI: −0.25, 1.04; P=0.230). From JM, treatment (DTG-based ART vs cART) was not independently associated with HTN risk through W96 (mean, M [hazard ratio, HR]: 1.099; 95% credible interval [CrI]: 0.876, 1.370). On average, a 1-kg increase in weight was estimated to increase HTN risk (HR) by 1.012 (CrI: 1.004, 1.020). No evidence of treatment separation was observed through the treatment-weight interaction (DTG-based ART HR: 1.013 [1.003, 1.022]; cART HR: 1.009 [0.998, 1.020]).

Conclusion

Weight gain was moderately associated with HTN risk through W96. ART was not an independent risk factor for HTN. Weight gain attributed to treatment effect impacted HTN risk similarly.

Disclosures

Clifford B. Jones, BSc MSc MB ChB, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Sofia Pozsonyiova, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Richard Grove, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company) Michael McKenna, MBChB, GSK: Employee|GSK: Stocks/Bonds (Public Company) Parul Patel, MSW, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee
P-583. Admission Diagnoses and Outcomes among Hospitalized People Living with HIV during Pre-COVID-19, COVID-19 and Post-COVID-19 Pandemic Periods
Authors: Khawcharoenporn Thana , Panutat Pattarapoom
Published: January 2025

Background

Coronavirus disease 2019 (COVID-19) has affected human immunodeficiency virus (HIV) care in many ways. However, impacts on admission diagnoses and outcomes among hospitalized people living with HIV (PLHIV) have not been evaluated.

Methods

A retrospective cohort study was conducted among hospitalized PLHIV at a Thai tertiary care center during the 3 periods, Period 1: Pre-COVID-19 (September 2017-March 2020), Period 2: COVID-19 (April 2020-September 2022, and Period 3: Post-COVID-19 (October 2022-October 2023). Characteristics, admission diagnoses and outcomes were compared between PLHIV admitted during these 3 periods. Factors associated with hospital mortality were determined.

Results

Of the 310 PLHIV included, 117, 125 and 68 were admitted during Period 1, 2 and 3, respectively and 115 (37%) were newly diagnosed HIV on admission. Median CD4 cell counts and proportions of those with antiretroviral therapy (ART) adherence rates of ≥95% at admission were different between the periods [(206, 97 and 138 cells/mm3 and 97%, 89% and 100% in Period 1, 2, and 3 (P=0.02 and P=0.06)]. Of the 310 PLHIV, admission diagnoses were non-AIDS-related (62%) and AIDS-related (38%). Most of the non-AIDS-related diagnoses were infections (40%) while opportunistic infections were the most common for AIDS-related diagnoses (88%). The types of admission diagnoses were not different between the 3 periods. Among 62 PLHIV who developed in-hospital complications, 47% and 39% had nosocomial infections and drug-related complications, respectively. Hospital mortality rates were 10%, 13% and 16% during Period 1, 2, and 3 (P=0.80). By multivariable analysis, intensive care unit admission, underlying malignancy, monthly income less than $USD 400, and admission CD4 count less than 50 cells/mm3 were independently associated with hospital mortality.

Conclusion

Although admission during COVID-19 pandemic period was not associated with increased mortality, we observed the impact of the pandemic on the lower CD4 cell count and ART adherence at admission among hospitalized PLHIV. Interventions to improve early care engagement, ART adherence, and close monitoring for those with identified mortality risks are needed for better HIV care, especially during pandemics.

Disclosures

All Authors: No reported disclosures
P-584. Tailored telehealth behavioral health coaching demonstrates feasibility and potential in overcoming barriers to HIV treatment outcomes
Authors: Labisi Titilola , Furl Renae , Hansen Deanna M , Burwell Lance L , Carr Rachelle , Fadul Nada
Published: January 2025

Background

People with HIV (PWH) face challenges, including behavioral health, stigma, financial constraints, homelessness and homophobia that negatively impact their HIV care. Unfortunately, limited, tailored programs exist to address these problems. Additionally, transportation and time constraints may hinder participation in available programs. Thus, Nebraska’s Specialty Care Center implemented the Intervention to Telehealth and Text to Improve Engagement in Care (i2TEC), a Health Resources and Services Administration (HRSA) HIV/AIDS Bureau-funded evidence-informed intervention aimed to address the intersection of mental health, substance use, and HIV. Here, we describe i2TEC program and its early impact on viral suppression (VS) among PWH in Nebraska.

Methods

Delivered by a licensed behavioral health therapist (BHT), participants receive 12 weekly behavioral health virtual coaching sessions. Participants could choose from various topics such as HIV care, mental health, relationships, sexuality, housing, and lifestyle. Then, they collaboratively work with the BHT to identify barriers to their HIV care and establish goals to overcome them. Participation in i2TEC requires being an HIV diagnosed adult not fully engaged in HIV care.

Results

Of the 50 participants enrolled in i2TEC, 84% were males, and 50% were non-Hispanic Whites. At baseline, 64% had a positive screen for substance use, 54% had a positive screen for depression or anxiety, and 71% did not have durable VS. Sixty percent had follow-up viral load labs, of which 97% had achieved VS within one-year post-enrollment. Participants' most identified discussion topics were lifestyle/health and socioeconomic needs (housing, food, and transportation). Overall, 95% would recommend the program, 86% agreed that i2TEC helped improve their mental health, and 76% reported that the program improved their medication adherence.

Conclusion

Preliminary findings from this tailored telehealth behavioral health program demonstrate feasibility and potential for improving HIV outcomes and overcoming individual barriers to VS. Through the delivery of i2TEC, we identified priority coaching needs among PWH. Future studies focusing on the topics identified by participants and the long-term impact of such programs are recommended.

Disclosures

Nada Fadul, MD, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
P-622. Diurnal Rhythms in Varicella Vaccine Effectiveness
Authors: Danino Dana , Kalron Yoav , Hazan Guy
Published: January 2025

Background

Immune processes are influenced by circadian rhythms. A previous study evaluating the relationship between vaccination time-of-day and vaccine efficacy was conducted during a pandemic mass vaccination campaign. We evaluate this association with the varicella vaccine in a setting of a childhood immunization program.

Methods

A national cohort study was conducted: All patients under 6 years old who received one dose of the varicella vaccine between January 2002 and December 2023 were enrolled. The main outcome was defined as a varicella breakthrough infection according to ICD-9 codes. We compared children vaccinated during morning hours (7:00-10:59), late-morning to afternoon (11:00-15:59), or evening hours (16:00-19:59). A Cox proportional-hazards regression model was used to adjust for differences in ethnicity, sex, and comorbidities, estimating the association between varicella vaccine administration time-of-day and varicella breakthrough infection.

Results

Of 238,432 children vaccinated against varicella, 1.8%) 311,4) experienced breakthrough infections. Breakthrough infection rates differed based on vaccination time, with the lowest rates associated with late-morning to afternoon (11:00-15:59), HR 0.88, 95% CI 0.82-0.95, P< 0.001, and the highest rates with evening vaccination (16:00-19:59), HR 1.44, 95% CI 1.33-1.55, P< 0.001. Vaccination timing remained significant after adjustment for patient ethnicity, sex, and comorbidities (Figure 1A,B). The association between varicella immunization time and infection risk followed a sinusoidal pattern, consistent with a diurnal rhythm in vaccine effectiveness (Figure 2).

Conclusion

We report a significant association between the time of varicella vaccination and its clinical effectiveness, similar to the association observed with the COVID-19 vaccine, providing proof of concept consistent with a diurnal rhythm in vaccine effectiveness.

Disclosures

Dana Danino, Dr. MD, Pfizer: Grant/Research Support
P-624. Changes in Pneumoccocal serotypes in adults and children after 2 years of introduction of PCV13 in National Inmunization Plan in Colombia
Authors: Escobar Franco Omar Huang , Giraldo Erika Alejandra
Published: January 2025

Background

Pneumococcal disease remains a significant public health concern globally, particularly affecting vulnerable populations such as children and adults. The introduction of pneumococcal conjugate vaccine 13 (PCV13) into national immunization plans has aimed to reduce the burden of pneumococcal disease by targeting specific serotypes. However, monitoring changes in pneumococcal serotypes following vaccine introduction is crucial for understanding vaccine effectiveness and potential serotype replacement.

Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia 2023

Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia by age group, INS data as of December 2023.

Methods

In this study, data were extracted from the National Institute of Health for the Surveillance of Pneumococcus in Colombia. We conducted a comparison of proportions to analyze changes in pneumococcal serotypes among both adults and children after two years of PCV13 introduction. Serotype distribution was examined pre- and post-vaccine introduction to identify shifts in prevalence.

Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age, Colombia 2023

Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age in Colombia by age group, INS data as of December 2023.

Results

Our analysis revealed a notable decrease in vaccine serotypes among both adults and children following the introduction of PCV13. However, an increase in non-vaccine serotypes was observed during the same period. Of particular significance, isolates of serotypes 19A, 3, and 6C continued to predominate, suggesting a persistent challenge in combating these serotypes despite vaccination efforts.

Distribution of Streptococcus pneumoniae serotype isolates in persons over 60 years old, Colombia 2023

Conclusion

The findings of this study underscore the complex dynamics of pneumococcal serotype distribution following the introduction of PCV13. While the vaccine has led to a reduction in vaccine-targeted serotypes, the emergence of non-vaccine serotypes presents a new challenge for pneumococcal disease prevention and control efforts. Continued surveillance and research are essential to monitor serotype trends and inform vaccine strategies to effectively combat pneumococcal disease in both children and adults.

Disclosures

Omar Huang Escobar Franco, MD, MSc, PhD., Pfizer: Honoraria
P-627. Modeling the Clinical and Economic Impact of Increasing Varicella Vaccination Coverage in Panama
Authors: Burgess Colleen , Samant Salome , Hirata Luciana , Parellada Cintia I , Estripeaut Dora , Pawaskar Manjiri D , Lang John C
Published: January 2025

Background

Panama implemented two-dose universal varicella vaccination (UVV) in 2018. First-dose vaccination coverage rates (VCRs) declined from 91% (2018) to 70% (2021) during the COVID-19 pandemic. We quantified the clinical and economic impact of increasing UVV VCRs over a 10-year time horizon.

Methods

A previously published age-structured dynamic transmission model was adapted to Panama using country-specific demographic, healthcare resource use, cost, and epidemiological data or comparable proxy. Four UVV strategies (1st dose: 15 months; 2nd dose: 4 years) were evaluated, with 1st dose VCR assumed to be (A) 70% (status quo), (B) 80%, (C) 90%, and (D) 95% for the strategies A-D (Table 1). Second dose VCR was assumed to be 50% of first dose VCR. Outcomes were evaluated over a 10-year time horizon (2022-2031) and included cumulative varicella cases, outpatient cases, hospitalizations, deaths, payer (direct) costs, and societal (direct and indirect) costs. Costs were reported in 2023 USD with 3% annual discounting.

Results

Under the status quo (strategy A), we estimated 232,381 cumulative varicella cases, 159,123 outpatient cases, and 7,320 hospitalizations over 10 years, resulting in total payer and societal costs of $29,335,329 and $36,893,235, respectively. Increasing 1st dose/2nd dose VCR from 70%/35% (Strategy A) to 80%/40% (Strategy B) will avert approximately 3.6% of varicella cases, 4% of hospitalizations, and 1.8% of deaths. Increasing VCR to 90%/45% (Strategy C) will avert 6.8% of all cases, 7.7% of hospitalizations, and 3.5% of deaths compared to reference Strategy A. The impact of increasing VCRs to 95%/47.5% (Strategy D) resulted in a further reduction in varicella cases by about 20% more than Strategy C. Strategies B-D increased payer costs by 2%-6% ($0.02-$0.04 per person per year [PPPY]) and societal costs by 1%-4% ($0.01-$0.03 PPPY) over the 10-year time horizon versus reference strategy A (Figure 1).

Conclusion

Increasing UVV VCRs compared to the status quo will result in improved clinical outcomes with marginal increases in payer and societal costs.

Disclosures

Colleen Burgess, MS, Merck & Co., Inc., Rahway, NJ, USA: Contractor Salome Samant, MBBS, MPH, Merck & Co., Inc., Rahway, NJ, USA: Employee- earned salary and own stock|Merck & Co., Inc., Rahway, NJ, USA: Stocks/Bonds (Public Company) Luciana Hirata, PhD, Merck & Co., Inc., Rahway, NJ, USA.: I am an employee of MSD subsidiary of Merck & Co., Inc., Rahway, NJ, USA. and may hold stock or stock options in Merck & Co., Inc. Cintia I. Parellada, MD, PhD, Merck & Co., Inc: Employee|Merck & Co., Inc: Stocks/Bonds (Private Company) Manjiri D. Pawaskar, PhD, merck: employee|merck: Stocks/Bonds (Public Company) John C. Lang, PhD, MSc, MSc, BSc, Merck & Co., Inc.: Stocks/Bonds (Private Company)|Merck Canada Inc.: Employee
P-640. Vancomycin vs Ceftaroline for Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia: A Multicenter Retrospective Study
Authors: Auyeung Austin , Thomas Sanil
Published: January 2025

Background

Vancomycin (V) is considered first-line treatment for MRSA infections, assuming bacterial susceptibility and patient tolerability. Ceftaroline (C) has been used off-label to treat MRSA blood stream infections, osteomyelitis, ventilator-associated pneumonia, hospital-acquired pneumonia and endocarditis. However, the efficacy of C vs V for treatment of MRSA pneumonia has not been studied.Figure 1.Summary of Exclusions for Patient Population

Methods

Data was extracted from a centralized database for 184 HCA Healthcare hospitals from January 1st, 2016 – June 30th, 2023. Patient encounters with a diagnostic code of MRSA pneumonia and received V and/or C were included for further analysis. In-hospital mortality and length of stay (LOS) were the main outcomes studied. Demographics including age, sex and race were extracted. Average vitals values noted included temperature and O2 saturation. Lab values included average WBC count, creatinine and GFR. Time to first dose of V or C from time of admission and time to transition from V to C were included. Patients who received C-only were combined with the patients who first received V and then transitioned to C (VC). IRB approval was obtained prior to data extraction.Table 1.Demographics, Clinical Data and Outcomes

Results

Initial data extraction yielded 5977 encounters with final analysis for 4511 unique patients. Encounters were excluded for missing demographic data, duplicates or when V or C were not received. The V-only group had 4372 encounters and the C+VC combined group had 139 encounters.

The mortality rate in the V-only group was 609/4372 (13.9%), while that in the C+VC group was 31/139 (22.3%). LOS was 13.22 days and 18.45 days in the V only and C+VC groups, respectively.

The average time to transition from V to C in the VC group was 6.4 hours with maximum of 34 hours.

Average temperature and O2 saturation were not significantly different between the two groups. GFR (mL/min/1.73m2) was 63.86 and 60.30 and WBC (103/µL) count was 11.93 and 14.01 in the V and V+VC groups, respectively.

Conclusion

Preliminary data suggest that V may be superior to C for MRSA pneumonia with respect to mortality and hospital LOS. Average WBC may be greater in the C+VC group, suggesting more severe illness. Reasons for transition of V to C were unknown, however given the short transition time, the impact of V on treatment outcome is likely negligible.

Disclosures

All Authors: No reported disclosures