bluuebunny/crossref_metadata_2025 huggingface dataset:
P-450. Burden of Fungal Infection among People Living with HIV (PLHIV): A Nationwide Inpatient Data Analysis (2019-2021)
Authors: Macaraeg Chef Stan L , Aldecoa Kim Abbegail
Published: January 2025

Background

Fungal diseases represent a significant healthcare concern in the general population. Their prevalence and impact are even more pronounced among PLHIV, yet data within this population remains limited. The study aims to investigate the most prevalent fungal infection among PLHIV and its corresponding healthcare burden. Additionally, it explores the sociodemographic of fungal infection among PLHIV.

Methods

The National Inpatient Sample database from 2019 to 2021 was utilized to identify all patients with a primary diagnosis of fungal infection. Patients were categorized into HIV and non-HIV. We used Stata 18.0, with a p-value < 0.05 indicating statistical significance.

Results

Among the 66, 225 hospitalized patients with fungal infection, there were 3543 weighted HIV patients (4.9%). HIV patients were significantly younger (43.8 vs. 62.9), Black (52.7%), with Medicaid (51.2%), and with a low median income of ≤ $49,000 (50.2%). No specific trend was observed from 2019 to 2021 in the prevalence of fungal infections among PLHIV (4.9%, 5.1%, 4.7%) and total hospital costs ($25600, $26913, $25869)

There remains an increased likelihood of cryptococcus (OR: 5.69, 95% CI: 4.6-7.0) and pneumocystis (OR: 10.71, 95% CI: 8.7-13.2) among PLHIV compared to the general population after adjusting for age and sex. Cryptococcus infection has a longer length of stay (LOS) compared to other fungal infections among PLHIV (13.5 vs. 7.6, p< 0.05) and higher total hospital costs ($52470 vs. $20153, p< 0.05). The result was consistent with multivariate analysis after adjusting for age, sex, and Charlson comorbidity index (CCI).

In contrast, pneumocystis infection among PLHIV had shorter LOS compared to other fungal infections (8.3 vs. 9.8, p< 0.05), and the total hospital costs were significantly lower ($21331 vs. $33542, p< 0.05). However, in a multivariate analysis after adjusting for age, sex, and CCI, only the difference in total hospital costs remained significant.

Conclusion

Fungal diseases remain a serious concern among PLHIV, presenting with unique sociodemographic characteristics and significant healthcare costs, particularly with cryptococcus infection. Future strategies should be directed at ways to reduce this significant healthcare burden.

Disclosures

All Authors: No reported disclosures
P-463. Diversity of KSHV Subtypes in People Living with HIV in a Large Urban Center in Dallas, Texas
Authors: Knights Sheena , Marshall Vickie A , Labo Nazzarena , Miley Wendell , Castro Elena Cornejo , Lazarte Susana , Chiao Elizabeth , Whitby Denise , Nijhawan Ank E
Published: January 2025

Background

Human herpesvirus-8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV), causes Kaposi’s sarcoma (KS) and other KSHV-associated disease (KAD). We previously described high KSHV seroprevalence and high KS incidence in a population of men who have sex with men (MSM) with HIV in Dallas, Texas. We now describe viral genetics in the same population.Table 1:Participant Characteristics

Methods

We analyzed samples from participants recruited in 2 different studies, one enrolling MSM with HIV with and without KAD, and the other enrolling MSM with HIV and KAD. We measured KSHV IgG in serum using a combination of ELISA and a bead-based multiplex assay. Oral fluid samples of all individuals with KAD and seropositive individuals with no KAD were analyzed by RT-PCR to detect and quantify KSHV DNA. Samples with detectable KSHV underwent Sanger and/or next generation sequencing to determine K1 subtype.Figure 1:Phylogenetic Tree of Participant Samples

Results

Overall, 281 participants were recruited; 59 shed enough virus for K1 subtyping. Of these, 37 did not have KAD, and 22 had KAD, all had KS. Table 1 describes the demographic characteristics of these participants. Notably, those with KS had lower median CD4 countsthan those without KS (p < 0.01). All known K1 subtypes, except for D, were identified in this cohort, including the rare E and F subtypes. The latter, which only recently had been described outside Africa was identified in 6 individuals. Four participants had mixed infections with 2 or more KSHV subtype (Figure 1). Figure 2 illustrates clinical presentations by KSHV subtype. Limitations in sequencing technology and study design permit no inferences on possible associations between KSHV subtype and KS onset or severity. We observed a larger proportion of subtypes B and F, typical of African populations, in participants with KS, than those with no KAD (8/27 subtypes detected vs 3/37). However, A and C were the most commonly identified subtypes in KS (19/27 subtypes in those with KS vs 32/37 subtypes in those without KS), including in advanced cases (i.e. T1 stage, 10/13).Figure 2:KSHV Subtypes and Clinical Presentation

Conclusion

In conclusion, we observed extreme diversity in KSHV genomes sequenced in a single institution in Dallas, TX. Further studies are needed to better understand the relationship between viral genetics and KSHV epidemiology and disease risk in the southern US.

Disclosures

Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support
P-468. Prevalence and Associated Factors of Patients Presenting with Advanced HIV Disease in Tertiary Hospital in Bangkok
Authors: Songaurailam Artima , Chumsantivut Suppavit , Piyapan Pattraporn
Published: January 2025

Background

Late entry to healthcare services for HIV patients leads to adverse outcomes and increased mortality particularly advanced HIV disease (AHD) who first presented with opportunistic infection (OI). However, epidemiological data on AHD among Thai patients in suburban government hospital during the Treat-All era was lacking and required to guide the healthcare strategies. This study aims to assess the prevalence, clinical characteristics and risk factors of patients presenting with AHD at Bhumibol Adulyadej Hospital, a tertiary hospital in Bangkok.

Methods

A retrospective cross-sectional study was conducted among newly diagnosed adult HIV patients from 1 October 2019 to 30 September 2023, through electronic chart review. The WHO clinical staging 3-4 was used to define AHD. Logistic regression was used to identify factors associated with AHD.

Results

Among 372 patients, 40.32% presented with AHD, with a median CD4 cell count of 36 (IQR 13-137) cells/mm3. Most of the newly diagnosed HIV patients were single males residing in the hospital’s service area. AHD patients were predominantly aged 30-59 years (62.00%) and identified through clinical suspicious testing (88.67%) rather than voluntary counseling testing (VCT). Risk factors of AHD included ages 30-59 years (adjusted OR (aOR) 1.94 [95%CI 1.13-3.34]) and > 59 years (aOR 4.58 [95%CI 1.49-14.06]), clinical suspicious testing (aOR 11.98 [95%CI 6.61-21.71]), unprotected sex (aOR 1.74 [95%CI 1.01-2.98]), and partner seropositive (aOR 0.18 [95%CI 0.05-0.62]). One-year mortality was significantly higher in AHD who were diagnosed from 2019-2022 (20.31% V.S. 9.88%, p=0.011). The most common OIs among AHD were tuberculosis (54.00%), pneumocystis pneumonia (40.67%) and cryptococcosis (17.33%) consecutively.

Conclusion

Presenting with AHD was common and associated with high mortality. VCT plays a minor role in the study population. The early HIV infection detection program remains needed in all risk groups but should target heterosexual males aged > 30.

Disclosures

All Authors: No reported disclosures
P-472. Development of a Local HIV Care Continuum for the Kansas City Metropolitan Area (KCMA)
Authors: Price Austin , El Atrouni Wissam
Published: January 2025

Background

There were 36,136 new HIV diagnoses in the USA in 2021. Still, an estimated 13% of persons living with HIV (PLHIV) are unaware of their infection. The status of the HIV epidemic can be better understood by constructing an HIV care continuum.Figure 1.Diagnosis-Based KCMA HIV Care Continuums 2019-2022Local diagnosis-based care continuums for 2019-2022 compared with the most recent national HIV surveillance data.

Methods

HIV surveillance data reported to the Kansas Department of Health and Environment (KDHE) and Missouri Department of Health and Senior Services (DHSS) were utilized to create diagnosis-based HIV care continuums for 2019-2022. This included data from Johnson, Wyandotte, and Leavenworth counties in Kansas, and Jackson, Clay, and Platte counties in Missouri. Prevalence-based care continuums were constructed for Kansas City, Missouri for 2019-2021 utilizing the CD4-depletion model employed by CDC. Diagnosis, receipt of care, retention in care and viral suppression are per CDC definitions.Figure 2.Prevalence-Based Kansas City, MO HIV Care Continuums 2019-2021Local prevalence-based care continuums for 2019-2021 compared with the most recent national HIV surveillance data.

Results

From 2019 to 2021, receipt of HIV care in KCMA remained stable, while retention in care (49% to 41.6%) and HIV viral suppression (65.6% to 57.2%) decreased (Figure 1). From 2019 to 2021, HIV diagnosis rates in the 3 counties of Kansas City, Missouri, remained stable at about 87%, but receipt of care rates decreased (41.7% to 35.9%), with stable viral suppression rates (∼54%) (Figure 2). Linkage to care improved from 70% to 75% for the 6-county KCMA from 2019 to 2022 (Figure 3).Figure 3.KCMA Linkage to HIV Care 2019-2022Local linkage to HIV care estimates compared with the most recent national linkage to care estimates.

Conclusion

Knowledge of status appeared to approximate national estimates. However, linkage to care was significantly lower (70-75% vs 82%), which likely negatively impacted downstream stages of the continuum. Local estimates for receipt of care, retention in care, and viral suppression were consistently below national levels. This highlights the importance of ongoing initiatives targeted at the more proximal stages. Reaching undiagnosed PLHIV requires a robust public health infrastructure which utilizes innovative diagnostic approaches to meet at-risk individuals in the spaces where they live and interact. Optimizing more distal stages of the continuum is contingent upon ongoing efforts to ensure all diagnosed PLHIV are efficiently linked to care and started on antiretroviral therapy (ART) in a timely fashion.

Disclosures

Wissam El Atrouni, MD, ViiV Healthcare: Advisor/Consultant
P-476. Pilot Implementation of HIV Self-Testing in Ghana: Analysis of the Community-Based Demand Generation Approach
Authors: Amoabeng Ortsin Ernest , Teye Jonathan Tetteh-Kwao , Adzesi Richard Socrate , Owusu Kwadwo , Ashinyo Anthony , Ayisi Addo Stephen
Published: January 2025

Background

Under the auspices of the Ministry of Health (MoH) and National AIDS/STI Control Programme (NACP), Ghana piloted an HIV Self-Testing (HIVST) project in 2023. The implementation took place in 50 HIV high burden districts and it was spearheaded by Ghana HIV and AIDS Network (GHANET), a grassroots civil society organization (CSO) with membership across the country. This paper examines the strategies and outcomes of the project which was sponsored by the Global Fund and currently being expanded as part of Grant Cycle Seven (GC7) implementation from 2024 to 2026.

Methods

One hundred and fifty (150) volunteers from 50 community-based organizations (CBOs) were trained to distribute ORAQUICK HIVST kits to local residents in the selected districts. Video instructions on the effective use of the test kits (produced in English and six different Ghanaian dialects) were made available to persons who voluntarily received the kits. Through an online portal (GHANET Information Management System (GIMS)) data about the distributions were recorded. Follow-ups were conducted to ascertain, among others, how the kits were used. The data was quantitatively analyzed and descriptive statistics was used to summarize the data using Statistical Package for Social Science (SPSS v.28).

Results

A total of 123,088 ORAQUICK HIVST kits were distributed (with follow-ups) to 73,853 (60%) females and 49,235 (40%) males. Young people aged 20 – 24 received the highest number of kits totaling 28,790 which is about 23%, followed by those aged 25 – 29 who received 25,006 which is about 20% and those aged 30 – 34 who received 17,460 which is about 14%. A total of 422 persons comprising 304 (72%) females and 118 (28%) males self-reported their results as reactive. Of this number, 329 persons comprising 72% of females and 28% of males were confirmed positive. And, out of that number, 202 persons comprising 73% females and 27% males were successfully initiated on antiretroviral therapy (ART) in health facilities.

Conclusion

Male participation of 40% in the testing exercise was encouraging as it above the national average of 20% . It is therefore recommended that in Ghana, HIVST should, particularly, be targeted men.

Disclosures

All Authors: No reported disclosures
P-499. HIV Risk Perception, Substance Use, and Sexual Practices Among Circuit Party Attendees
Authors: Dubov Alex , Veltman Jennifer , Miles Ethan
Published: January 2025

Background

Circuit parties are large-scale dance events catering to the LGBTQ+ community. Research suggests high rates of HIV and substance use among participants. This study explores HIV knowledge, awareness of prevention services, perceived and actual HIV risk among attendees of the White Party, a circuit party held in California with an estimated 30,000 participants.

Methods

Data were gathered from 137 attendees who visited a health booth, where interested individuals completed a self-administered survey on a tablet computer. The survey used the validated Minority AIDS Initiative (MAI) Adult Questionnaire assessing demographics, perceived risk related to substance use and sexual activities, and self-reported risk behaviors in these domains. Following survey completion, participants received a non-monetary incentive (event merchandise).

Results

The average age of respondents was 38 years, with 26% identifying as Hispanic, 63% as White, 8% as Black, and 17% as Asian. Bivariate and multivariable logistic regression analyses were conducted to explore associations between knowledge of HIV status, awareness of HIV prevention resources, reports of unprotected sex, and the number of sexual partners. Younger participants and those with lower income levels were less likely to know their HIV status. Similarly, Hispanic respondents and those with lower income levels were less likely to know how to access HIV and SUD prevention. A higher perceived risk did not reduce a high incidence (82%) of unprotected sex. Individuals with a history of intimate partner violence (IPV) (18%) were more likely to engage in unprotected sex. Additionally, non-injection substance use was correlated with binge drinking and a higher number of sexual partners.

Conclusion

This study highlights the need for comprehensive interventions at LGBTQ+ events, addressing substance use and HIV risk simultaneously. Interventions focusing on raising awareness of HIV risks may not be effective in changing behavior. Available interventions should include screening and support for IPV, prioritizing HIV testing among younger attendees, offering culturally tailored outreach in Spanish, and addressing socioeconomic barriers to accessing prevention services.

Disclosures

All Authors: No reported disclosures
P-501. Concerns and Opinions of People Currently or Previously on Oral and Long-Acting Injectable Forms of HIV Preexposure Prophylaxis (PrEP)
Authors: Schaack Alice , Allamong Maxwell , Hung Frances , Barfield Richard , McKellar Mehri
Published: January 2025

Background

Long acting injectable (LAI) preexposure prophylaxis (PrEP) is an effective tool that has the potential to increase PrEP uptake and adherence. However, the majority of studies investigating interest and opinions surrounding LAI PrEP were theoretical, done prior to its approval. It is important to better understand peoples’ opinions about LAI PrEP as uptake increases.

Methods

We administered a cross-sectional electronic survey to clients at an urban PrEP clinic in the US South. Eligible participants were 18+ years and had previously taken or been prescribed oral or LAI forms of PrEP. Participants were recruited at clinic appointments or through a link sent via the electronic medical record. Participants were asked about their preferences and concerns about oral and LAI PrEP and barriers to access PrEP.

Results

Between January 10-April 5, 2024, 110 participants completed the survey: 73 during in-person appointments and 37 via online links. Of those, 22 were currently using LAI PrEP, 71 oral PrEP, and 17 were not currently on a form of PrEP. Participants were mostly men (89.1%), and mean age was 38 (range 17-78). 54.5% of respondents were White, 30% Black, and 14.5% Latinx. Most participants preferred an injection versus a daily pill (100% of people already on LAI, 46.5% of people on oral PrEP, and 58.8% of people not currently on PrEP). The most common concerns about PrEP for all groups were side effects, cost of medication, and cost of clinic visits and tests. Of people taking oral PrEP, 59.2% had not switched to injectable either because it was not offered to them, or they were not aware of it. The most common reasons for stopping PrEP amongst people not currently using either form were side effects and no longer needing PrEP.

Conclusion

LAI PrEP is desired by many, but not all, people who are currently or have previously taken PrEP. Common concerns about PrEP include side effects and cost of medication and/or clinic visits. People on oral PrEP are frequently not offered LAI or do not know it exists. These data demonstrate the importance of improving LAI PrEP accessibility and offering people choice between PrEP methods.

Disclosures

Mehri McKellar, MD, Gilead: Grant/Research Support
P-502. Incorporating Behavioral Economics to Educate Adolescents and Young Adults about HIV Pre-Exposure Prophylaxis
Authors: Guss Carly , Gluskin Brittany , Krakower Douglas , Wisk Lauren
Published: January 2025

Background

Despite disproportionately high rates of HIV diagnoses, knowledge about and interest in pre-exposure prophylaxis (PrEP) is low among adolescents and young adults (AYA) in the USA. AYA need PrEP educational strategies that are tailored to their developmental stage. We hypothesized that behavioral economics techniques could help optimize PrEP messaging.

Methods

The research team developed two brief social media-style educational videos on PrEP. Both videos reviewed the same facts, but one used gain-framed messaging (emphasized positive effects of using PrEP) while the other featured loss-framed messaging (emphasized negative consequences of non-use). Thirty AYA were shown the videos and interviewed about their overall impressions, opinions on facts presented, message framing preferences, and impact (e.g., what steps they might take after viewing). The deidentified interview transcripts were reviewed for emerging themes by two coders until consensus was reached.

Results

Interviews were held May – October 2023. Participants ranged in age from 15-25 years (mean 21.5 years, IQR 17-23.8 years) and identified as White (70.0%) or Black/African American (13.2%). Most (80.0%) identified as cisgender and 16.7% as transgender. A third (33.3%) had ever tested for HIV, none had an HIV diagnosis, and 36.7% did not feel that PrEP applied to them (i.e., viewed themselves as low risk for HIV). Thematic findings included: participants generally expressed positive views of PrEP, would like to see the video in a doctor’s office, and viewing the video would lead them to do their own research. Gain-framed messaging was preferred over the loss-framed video messaging, though some youth felt the videos were too similar. PrEP efficacy was the most important medical fact presented. Youths disliked advertisement-like or “staged” video elements and favored genuineness and relatability.

Conclusion

AYA preferred gain-framed over loss-frame PrEP messaging, and information on PrEP efficacy delivered by authentic messengers is likely to resonate. These findings offer novel insights into AYA perspectives around PrEP messaging for brief videos that could be disseminated through social media for PrEP education, which could help empower AYA to make informed decisions around PrEP as part of their sexual health.

Disclosures

Douglas Krakower, MD, FluidForm Bio: Stocks/Bonds (Private Company)|Gilead: Grant/Research Support|Matchbox Health: Stocks/Bonds (Private Company)|Medscape: Funding to develop educational content|Merck: Grant/Research Support
P-506. Improving HIV Pre-exposure Prophylaxis (PrEP) among Transgender Individuals
Authors: Wang Heather M , Biswas Ruchi , Daudelin Isaac , Czeresnia Jonathan M , Dalla-Piazza Michelle L , Reyes Raquel , Swaminathan Shobha , Finkel Diana
Published: January 2025

Background

Due to numerous structural factors, transgender (TG) individuals are disproportionately affected by HIV in the United States. Prioritizing PrEP for this population remains a priority. In 2020, only an estimated 3% of TG individuals were taking PrEP. However, one study showed that TG women who had access to gender-affirming care were more likely to discuss PrEP use with their healthcare provider. This study aims to evaluate PrEP prescription patterns among TG individuals seen in our integrated infectious disease and gender-affirming care practice.

Methods

We conducted a retrospective chart review for all patients who were prescribed PrEP from January 1st, 2022 to December 31st, 2023 at our institution. Data from 2017 to 2023 was collected to evaluate the frequency of PrEP prescriptions over time.

Results

Two hundred and five total individuals were prescribed PrEP in 2022-2023 at our institution. Of these, 125 (61.0%) patients identified as male, 33 (16.1%) as female, 42 (20.5%) as TG female, 6 (2.9%) as TG male, and 3 (1.5%) as nonbinary. Of the 48 TG patients, 19 (39.6%), 18 (37.5%), and 13 (27.1%) were Black, Latinx, or White, respectively. Out of 48 TG patients, 32 (66.7%) were new to PrEP at our institution compared to 98 (47.8%) of all patients prescribed PrEP (p< 0.01). Thirty-four TG individuals (70.8%) remained on PrEP by the end of the study period, compared to 130/205 of all patients prescribed PrEP (63.4%; p=0.22). Linear regression indicated an increase in prescription rates in TG patients from 2017 to 2023 (R2 = 0.86).

Conclusion

At our institution, gender-affirming care integrated within an infectious disease practice led to higher levels of PrEP uptake and persistence for a marginalized TG patient population. Improving access to high-quality gender-affirming care is an essential component of HIV prevention programs with the goals of ending the HIV epidemic and ensuring equitable access to services.

Disclosures

Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant
P-508. Opportunities for Prep Prescription At Two Urban Academic Healthcare Institutions
Authors: Caputo Matthew , Ridgway Jessica , Mason Joseph A , Achenbach Chad , McNulty Moira
Published: January 2025

Background

Pre-exposure prophylaxis (PrEP) use for HIV prevention remains unequal across groups vulnerable to HIV. Reasons for inequalities include both individual and healthcare level factors. We sought to understand opportunities for prescribing PrEP at two urban academic healthcare institutions in Chicago, Illinois.

Methods

We analyzed electronic medical record data from both institutions including persons >18 years of age with >1 negative HIV test between 1/1/2015-12/31/2021 who had indications for PrEP. Data included demographics, social history, medications, sexually transmitted infections (STI), and encounters. Indications for PrEP included STI with gonorrhea, chlamydia, and/or active syphilis infection or injection drug use (IDU). Eligible encounters were those within six months after an STI, or as long as IDU was documented. We categorized encounters as inpatient, emergency department (ED), primary care, infectious disease (ID), obstetrics and gynecology/women’s health (OBGYN) and other outpatient settings.

Results

In total, 9644 persons contributed 53031 encounters that resulted in 941 people with PrEP prescriptions. The two healthcare institutions had differing patient demographics, institution A had more 18-24 year olds (58.3% vs 31.3%), more African Americans (83.8% vs 27.9%), and more women (65.7% vs 46.3%). Institution B had more White (40.6% vs 7.1%) and Hispanic persons (14.0% vs 4.2%), and more men who have sex with men (MSM) (15.2% vs 3.3%). Institution A had more eligible encounters in the ED (30.8% vs 7.3%) as well as in infectious disease, inpatient, OBYGN, and primary care settings. Institution B had more eligible encounters in other outpatient settings (67.7% vs 18.7%). Institution B accounted for the majority of PrEP prescriptions (89.1%).

Conclusion

Institution A contained persons historically underrepresented in PrEP prescriptions, while institution B had more encounters in other outpatient settings where ]PrEP prescriptions commonly occur. These factors are likely to be responsible for our findings. Future work will examine associations between these factors and the likelihood of PrEP prescriptions in a combined as well as institution specific models.

Disclosures

Jessica Ridgway, MD, Gilead Sciences: Expert Testimony Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant
P-509. Impact of an Innovative Educational Initiative Using Community-Based Organization Partnerships to Reach Young Adults at Risk for HIV
Authors: Clement Meredith E , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Pillinger Kelly E
Published: January 2025

Background

Young adults (YA) are particularly vulnerable to acquiring HIV due to low self-perceived risk, low rates of HIV testing, and lack of knowledge/awareness about pre-exposure prophylaxis (PrEP).

Methods

Between 3/23 – 8/23, six education sessions for YAs were conducted in the Southeastern U.S. by local healthcare professionals (HCPs) along with community-based organizations (CBOs) in non-clinical settings (e.g. college campuses, breweries). Pre- and post-surveys were administered, with follow-up surveys 3 weeks later. A scale-up education toolkit was disseminated to HCPs nationwide.

Results

A total of 264 YAs participated in the education sessions (mean age: 24 years; 85% female; 54% Caucasian; 87% heterosexual) with 29% previously tested for HIV and 21% who previously discussed PrEP with a HCP. YA’s knowledge of different forms of PrEP improved significantly (38% pre- vs. 96% post-activity; p < 0.001) as did their confidence in protecting themselves from acquiring HIV (55% pre vs. 93% post; p < 0.001). In addition, awareness of local resources for HIV testing improved from 60% to 93% (p < 0.001) with a significant increase in YAs who stated they were likely to get tested for HIV (26% pre vs. 63% post, p < 0.001).

Seventy-five HCPs and CBO leaders also participated. Interestingly, there was a disconnect between CBO/HCPs’ perceptions of barriers to HIV/STI testing compared to YAs’ reported challenges (Fig 1). All providers stated they were likely/very likely to organize another session. A follow-up survey of HCPs (N = 10) found they helped 58 YAs access HIV testing and 33 access PrEP since the education, with 70% of HCPs using the materials during 1:1 counseling with YAs, suggesting sustainability of the resources.

HCPs (N = 867) who reviewed the toolkit had improvements in their confidence in differentiating between PrEP options and identifying who would benefit from each approach (p < 0.001) and counseling YAs about PrEP (p < 0.001).

Conclusion

Providing HIV prevention education to YAs in informal, community settings increases reach to those who may not have these discussions with their HCPs during regular visits. This type of educational initiative, which includes partnering with CBOs, is scalable and sustainable.

Disclosures

Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor
P-517. Low Awareness but High Acceptability of HIV Post Exposure Prophylaxis (PEP) among Transpeople Receiving Telemedicine Gender Affirming Care across Rural, Suburban and Urban Areas in the United States
Authors: Aitcheson Nancy , O’Brien Caroline , Li Yun , Feng Yixuan , Kyweluk Moira , Momplaisir Florence , Dowshen Nadia
Published: January 2025

Background

Transgender people are disproportionately impacted by the HIV epidemic and face unique barriers in accessing HIV prevention services. Post-exposure prophylaxis (PEP), which requires surmounting these barriers within 72 hours of potential HIV exposure, is underused among transgender individuals. Little is known about barriers to using PEP in this population. This survey explored knowledge of and attitudes toward PEP among individuals engaged in gender affirming care (GAHC) via telemedicine.

Methods

We surveyed clients of a telemedicine gender affirming healthcare company in December 2023, using purposeful sampling to ensure representation of all genders, and across geographies. Participants were >18 years old and currently accessing GAHC. Zip codes were classified by urban, suburban, and rural by modified Rural Urban Commuting Score. The online survey asked about knowledge, perceived barriers, and willingness to use PEP. Chi-squared tests were used for statistical comparisons.

Results

Of 387 respondents, 212 identified as transfeminine, 170 as transmasculine and 5 had unknown gender identifications. Participants were spread across geographies of rural (53), suburban (126) and urban (168). Zip codes were missing for 40 participants. 82.7% were white and 51.9% were between the ages of 18-25. 23.8% reported not knowing their HIV status. Awareness of PEP was low among all participants—26.6% had heard of PEP prior to the survey. However, the majority (66.2%) of participants were willing to take PEP if recommended and prescribed by their GAHC providers. Those in rural areas were more likely to be uninsured (37.7%) than those residing in suburban (28.8%) or urban (11.3%) areas (p< 0.001).

Conclusion

Knowledge about PEP was limited among this population, but those seeking GAHC via telemedicine were willing to take PEP and have it prescribed by their GAHC providers. Given the relatively lower rates of insurance coverage, individuals residing in rural areas may experience greater barriers to accessing PEP. Integrating PEP into GAHC may be a strategy to increase timely access to this HIV prevention tool.

Disclosures

All Authors: No reported disclosures
P-518. High Acceptance of Integrating HIV Pre-Exposure Prophylaxis into Gender Affirming Care among Transpeople Receiving Telemedicine Gender Affirming Hormone Therapy across Rural, Suburban and Urban Areas in the United States
Authors: Aitcheson Nancy , O’Brien Caroline , Feng Yixuan , Li Yun , Kyweluk Moira , Momplaisir Florence , Dowshen Nadia
Published: January 2025

Background

Transgender people are disproportionately impacted by the HIV epidemic, experiencing heightened risk factors for seroconversion and barriers to HIV prevention, such as a dearth of gender-affirming medical providers and concerns about drug-drug interactions with existing hormone regimens. Recent literature indicates urban-residing transgender women with access to gender affirming care (GAHC) may have higher awareness and uptake of pre-exposure prophylaxis for HIV (PrEP). This project explores PrEP knowledge, experience, and acceptability among individuals accessing GAHC via telemedicine in urban and rural settings.

Methods

We surveyed clients of a telemedicine gender affirming healthcare company in December 2023, using purposeful sampling to ensure representation of all genders, and across geographies. Participants were >18 years old and currently accessing GAHC. Zip codes were classified by urban, suburban, and rural by modified Rural Urban Commuting Score. The online survey asked about knowledge, perceived barriers, and willingness to use PrEP. Chi-squared tests were used for statistical comparisons across geographical settings.

Results

Of 387 respondents, 212 identified as transfeminine, 170 as transmasculine and 5 had unknown gender identifications. Participants were spread across geographies of rural (53), suburban (126) and urban (168). Zip codes were missing for 40 participants. 83% were white and 51% were between the ages of 18-25. 24% reported not knowing their HIV status. Awareness of PrEP did not vary significantly across geographies, with 57% of rural, 56% of suburban, and 64% of urban residents reporting being aware of PrEP prior to the survey. Less than 3% had ever taken PrEP. Two-thirds (67%) of participants were willing to take PrEP if recommended and prescribed by their GAHC provider and did not differ across geographical settings.

Conclusion

Compared to recent literature, this survey of geographically diverse trans people engaged in GAHC demonstrated lower PrEP awareness and use of PrEP. However, there was consistent interest in PrEP if recommended and prescribed by a GAHC provider. Integrating HIV prevention into GAHC may be an effective avenue to reaching a vulnerable community.

Disclosures

All Authors: No reported disclosures
P-521. Assessing Infectious Disease Screening and Prevention Practices for Persons who Inject Drugs in a Large Midwestern Academic Medical Center
Authors: Bailey Rosemary C , Tischendorf Jessica S , Hollnagel Fauzia
Published: January 2025

Background

Persons who inject drugs (PWID) are at risk for infection, including HIV, hepatitis C virus (HCV), and sexually transmitted infections (STIs). Harm reduction counseling, HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and routine STI screening are recommended to prevent infectious complications among those with substance use disorder (SUD). Hospitalizations serve as an opportunity to provide these infection prevention and screening interventions which are often difficult to access in the ambulatory or community setting for patients with active SUD. We sought to describe the frequency of infectious disease screening and preventive counseling and interventions among PWID admitted to our hospital with a serious injection related infection (SIRI).

Methods

We conducted a retrospective chart review of PWID > 18 years of age admitted to our large tertiary medical center in the Midwest with SIRIs in 2022. The conditions included were bacteremia, endocarditis, skin and soft tissue infection, epidural abscess, septic arthritis, osteomyelitis and other. We assessed the frequency of screening for HIV, hepatitis C, gonorrhea, chlamydia, and syphilis, and the frequency of harm reduction counseling and assessment for HIV-PrEP and PEP eligibility. We collected demographic information, discharge location and conditions, and whether infectious disease and addiction medicine were consulted. Descriptive analysis was performed.

Results

45 patients with SIRIs were admitted in 2022. Of the 45, 56% underwent HIV screening, 53% HCV screening, and 16% received gonorrhea, chlamydia, and syphilis screening during the index hospitalization. Harm reduction counseling was documented for 69% of patients and was almost exclusively documented by addiction medicine. There was no documentation of PrEP consideration despite 36 patients meeting eligibility and no PrEP or PEP was prescribed.

Conclusion

In our institution, there were suboptimal rates of infectious disease screening, harm reduction counseling, and HIV prevention interventions among PWID admitted with SIRI in 2022. The most marked gap in care is regarding consideration for HIV-PrEP. Further work will inform barriers and facilitators to optimizing these practices in the hospital setting.

Disclosures

Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
P-526. A Low Cost, Low Technology Intervention for Hospitalized Patients Who Inject Drugs is Feasible for Increasing Evidence-Based Addiction Care but HIV PrEP Uptake Remains Limited
Authors: Bhadkamkar Tanvi , Gagnon Kelly , Parman Mariel , Ingram Kedarius , Figgat Marry , O’Rear Stephen , Bradford William , Asgari Sara , Eaton Ellen
Published: January 2025

Background

Approximately 14% of new HIV cases in Alabama are from injection drug use, and this does not include HIV transmission from substance use related behaviors such as transactional sex. Hospitalized patients who inject drugs (PWID) present an opportunity to provide addiction treatment and HIV pre-exposure prophylaxis (PrEP). The objective of this study is to assess the feasibility and acceptability of novel, low barrier interventions aimed at increasing uptake of medications for opioid use disorders (MOUD) and PrEP in PWID.

Methods

In this prospective study, 60 hospitalized PWID who were HIV negative and receiving care at UAB Hospital (from October 2022 to February 2024) were randomized in a two-by-two factorial design to 4 arms: a smartphrase summary of evidence-based care added in the medical record (n=15), an outpatient peer recovery coach intervention (n=15), both (n=15), or standard of care (n=15). Patients completed standardized surveys on substance use, HIV risk behaviors, and their preferences for MOUD and PrEP at baseline. Exit surveys were conducted by phone to assess utilization of addiction treatment, PrEP services, and peer coaching. Feasibility was primarily defined by the ability to recruit hospitalized PWID and retain them in the study to determine post-discharge clinical outcomes, but feasibility was also defined by appropriate use of smartphrase and access and engagement with the peer. We assessed preliminary effectiveness by including utilization of MOUD, PrEP, and the peer coach.

Results

In the groups who received the smartphrase with or without the peer (n=30), 70% had documentation of the smartphrase in their provider’s consult note, and 90% had a MOUD referenced in their treatment plan. In the groups who received a peer with or without the smartphrase (n=30), 100% were contacted, and 90% had MOUD referenced in treatment plan. However, PrEP was not provided on discharge for any patients in the study.

Conclusion

In this pilot study of two low barrier interventions for PWID, we found that both interventions are feasible and acceptable, but HIV prevention with PrEP is still lacking. Future directions are to expand the sample size to test if these interventions will increase MOUD and PrEP uptake in a Southern cohort of PWID.

Disclosures

All Authors: No reported disclosures
P-527. A Scoping Review of HIV Pre-exposure Prophylaxis for Indigenous Peoples: Understanding Barriers and Facilitators to PrEP Access, Use and Adherence
Authors: Lim Timothy , Swidrovich Jaris
Published: January 2025

Background

Indigenous Peoples in Canada, which include First Nations, Métis, and Inuit, experience disproportionately higher incidences of human immunodeficiency virus (HIV) infection compared to settler Canadians. Pre-Exposure Prophylaxis (PrEP) involves the daily use of antiretroviral drugs to prevent HIV transmission to HIV-negative people. When taken as prescribed, PrEP can reduce one's risk of getting HIV from sex by over 90% and by more than 70% among people who inject drugs. While PrEP awareness has increased over the years, reasons for its lack of uptake in Indigenous populations remains unknown. A scoping review was done to understand the current literature available how Indigenous Peoples in Canada, United States, Australia and New Zealand conceptualize PrEP.

Methods

We searched electronic databases (Pubmed, Ovid Medline, i-Portal, and Native Health Databases) for studies published between January 2012 and December 2023 for articles using variants of the search terms “Pre-Exposure Prophylaxis” and “Indigenous” . Studies were included if they discussed barriers and/or facilitators to PrEP awareness, interest, uptake, or continuation among Indigenous Peoples. Studies were independently screened by two authors.

Results

Results were synthesized narratively. Of 50 citations identified, 3 studies were eligible for inclusion. Four themes arose from the literature - all of which discussed barriers to PrEP: (1) limited Indigenous engagement and representation in research, (2) stigma and cultural barriers, (3) resource constraints and (4) geographical and socioeconomic barriers to PrEP.

Conclusion

There is a paucity of literature exploring barriers and facilitators to PrEP access, use and adherence in Indigenous Peoples. Given the colonial history and violence that Indigenous Peoples faced and continue to face in western countries such as Canada, United States, Australia and New Zealand, greater attention to culturally safe and trauma informed interventions will likely improve PrEP awareness and use in Indigenous populations.

Disclosures

All Authors: No reported disclosures
P-571. Assessment of Failures of Long-Acting Cabotegravir and Rilpivirine in a Real-World Treatment Setting
Authors: Yared Nicholas F , Gudipati Smitha , Payne Shannon , Brar Indira
Published: January 2025

Background

Cabotegravir (CAB) + rilpivirine (RPV) is the first complete long-acting all injectable (LAI) antiretroviral therapy (ART). While well-tolerated with low risk of virologic failure (VF), understanding reasons for CAB + RPV (CAR) discontinuation in a real-world setting was the objective of our study, so as to better define appropriate patients for LAI.

Methods

We performed a retrospective cohort study to assess CAR failures. CAR failure was defined as regimen discontinuation after receipt of at least one CAR dose due to either virologic failure (VF) or side effects. VF was defined as viral load (VL) ≥ 30 copies/mL on 2 occasions at least 4 weeks apart. Genotypes incorporated detection of drug resistance mutations (DRMs) at frequency < 10%. We included PWH at Henry Ford Health who were virologically suppressed on their current ART and switched to CAR on or before March 2023. Demographics, clinical characteristics, and outcomes were extracted from the electronic medical record (Table 1).

Results

Of the 58 PWH initiating CAR, 46 had HIV VL testing available at 12 months after initiation of CAR and 45/46 PWH (97.8%) were undetectable (< 30 copies/mL). Five PWH failed CAR: 2/5 secondary to injection site reactions and 3/5 due to VF with new resistance (Table 2). Among those with VF, they had been living with HIV for a mean of 20 years and all had BMI > 30 kg/m2. One had a pre-existing G140R DRM (1.2% frequency) and developed the E138K NNRTI and Q148R INSTI DRMs ( > 10% frequency). A second patient developed the Y188L and E138E/K NNRTI and Q148K INSTI DRMs ( > 10% frequency). The third patient with history of oral NNRTI use developed the M230I and E138E/K NNRTI DRMs ( >10% frequency).

Conclusion

In our clinic more patients (8.6%) discontinued CAR than had been reported in randomized clinical trials. While the clinical significance of < 10% DRMs is unclear, one patient with pre-existing G140R < 10% DRM developed VF despite on-time injections leading to loss of NNRTI and INSTI class efficacy. Previous studies have shown that the detection of drug-resistant < 10% DRMs in NNRTI significantly increases the risk of treatment failure. Larger studies are needed to determine the impact of HIV-1 < 10% DRMs for other classes of ARTs, such as INSTIs, as this may have a big impact while evaluating appropriateness of a patient for CAR.

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-572. Real-World Experience with Long-Acting Injectable Cabotegravir/Rilpivirine (CAB/RPV LA) in an Academic Medical Center
Authors: Semeniuk Oleksandr , Ogilvy Alexander , Ruiz Maria Elena , Lucar Jose A , Roberts Afsoon , Ware Chelsea , Siegel Marc O
Published: January 2025

Background

Since the approval of CAB/RPV LA, over 50 patients followed in the MFA Infectious Diseases clinic have transitioned to long-acting injectable CAB/RPV. Several patients were found to have low-level viremia despite no documented resistance to either component of CAB/RPV LA. We investigated the incidence of low-level viremia and associated risk factors in this patient population.

Methods

We reviewed the charts of all patients who received at least 3 doses of CAB/RPV LA and evaluated the incidence of HIV viral loads (VL) ≥50 copies. Those patients were categorized into 3 groups: a) blips – isolated VL of 51-200 copies that resolved on subsequent test, b) low-level viremia – sustained VL of 51-200 copies on consecutive tests, c) virologic failure – VL over 200 copies. For all patients, we reviewed age, gender, race, weight, BMI, HIV VL, CD4 count/CD4% before initiating CAB/RPV LA, prior antiretroviral therapy, history of prior resistance mutations, comorbid conditions (diabetes, kidney disease, chronic hepatitis, cancer), tobacco use, and statin use.

Results

51 patients met inclusion criteria for the study. Seven patients (13.7%) had blips, one patient (2%) had low-level viremia, and one patient (2%) had evidence of virologic failure, although this was not sustained on repeat testing. Four patients discontinued treatment due to side effects or social reasons. The only statistically significant risk factor for subsequent viremia was the presence of viremia prior to initiation of CAB/RPV LA: 2.7 % (1/37) in the group with no VL≥50 after the initiation of therapy vs. 33.3% (3/9) in the group that later had blips or viremia, p=0.02. There was also a tendency to the higher incidence of viremia in patients with diabetes mellitus although it did not reach statistical significance (7.1% vs. 33.4%, P=0.06).

Conclusion

CAB/RPV LA is a valuable option for HIV management in the outpatient setting. We documented a relatively small incidence of viral blips and low-level viremia in our population, with statistical significance seen in those with detectable viremia at initiation of CAB/RPV LA. Of the patients included in the analysis, there was no sustained virologic failure confirmed by viral load retest and resistance testing.

Disclosures

All Authors: No reported disclosures