bluuebunny/crossref_metadata_2025 huggingface dataset:
940. Impact of Using Arts Programming to Support Treatment in Adolescents Living with HIV in Eswatini
Authors: Agrawal Vedika , Ness Tara , Small Amanda , Simelane Tandzile T , Lukhele Bhekemusa , Dlamini Sandile , Petrus Jamie
Published: January 2021

Background

Adolescents and young adults with HIV are a unique population given the distinct psychosocial challenges of their age-group coupled with having a stigmatizing disease. In 2018, approximately 1.6 million adolescents were living with HIV worldwide, with the highest HIV prevalence found in Eswatini. As this group struggles more than any other age-group with medication adherence, novel interventions that are peer-inclusive and empowering should be explored to support their treatment.

Methods

We piloted a theater camp to determine the impact of fostering creative expression amongst adolescents and young adults enrolled at our HIV clinic in Mbabane, Eswatini. A two-week camp was conducted in collaboration with a non-profit organization of professional teachers, actors, and musicians. We emphasized enrollment of patients struggling with medication adherence, teen mothers, and those on second-line antiretroviral treatment. Twenty individuals (ages 12-23) participated in self-expression activities, story development, and a final play performed for the community. To assess impact, we compared viral loads pre- and post- camp as well as surveyed participants on effect of participation on areas such as personal stigma, sense of community, and confidence.

Results

Of those who participated, 25% showed a substantial decrease and 10% a substantial increase in viral load after the camp (>0.1 log10 change). Those who completed the survey (n=18) felt the camp helped them with confidence (13/18), teamwork (13/18), and friendships (11/18). Quotes from participants reinforced this growing sense of community, confidence, and decreased personal stigma. One wrote “theater camp helped me know that I can do a lot of things in life to achieve my future goals although I am HIV positive” and another stated “it made me not feel sorry for being an HIV positive person.”

Conclusion

Our pilot program demonstrates creative arts programming has beneficial psychosocial effects, aids in community building, and potentially enhances the effectiveness of medical treatment. Further programs and studies should continue to investigate creative arts as an avenue for treatment support, self-expression, and community building among vulnerable populations such as adolescents and young adults with HIV.

Disclosures

All Authors: No reported disclosures
942. Lung Cancer Screening in at-risk patients with HIV in a Midwestern Clinic
Authors: Lopez Wilfredo , Sayles Harlan R , Bares Sara H , Fadul Nada
Published: January 2021

Background

Patients with HIV (PWH) have an increased risk of lung cancer compared to the general population. In 2013, the U.S. Preventive Services Task Force (USPSTF) released their lung cancer screening (LCS) guidelines for the general population. The objective of this study is to evaluate the frequency of and factors associated with LCS using computed tomography in at-risk PWH.

Methods

A retrospective chart review of patients 55-80 years old seen at a Midwestern HIV Clinic between July 1, 2016 to June 30, 2018 was conducted. Demographic, clinical, laboratory, and referral for LCS information were collected. Descriptive statistics and logistic regression models were used for analysis.

Results

We reviewed 347 patients, out of whom 91 were excluded for the following reasons: never smoked (8), deceased (38), pack history unknown (39), and prior lung cancer diagnosis (6). Mean (sd, range) for age was 61 (5.0, 55-78). A total of 256 patients were included in the analysis, out of whom 104 (41%) met the USPSTF criteria. No effect was identified for demographic information including race, ethnicity, gender, or insurance status on LCS referral. LCS referral was made for 22 out of 256 patients (9%) (13% of patients who met the USPSTF criteria and 5% of those who did not). Patients who received tobacco cessation counseling (OR 7.83, P=0.047) and with hepatitis C infection (OR 4.32, P=0.002) were more likely to receive LCS referral. Out of those who received LCS referral, 12/22 (55%) completed the referral. Patients with hepatitis C infection were more likely to complete LCS referral (OR 8, P=0.038).

Conclusion

Only 13% of patients who met USPSTF criteria were referred for LCS. Patients who received tobacco cessation counseling were more likely to receive a referral. Patients with hepatitis C infection were more likely to receive and complete LCS referral. Quality improvement efforts to improve rates of LCS in PWH are needed. Future prospective studies should examine the factors associated with LCS in PWH.

Disclosures

Sara H. Bares, MD, Gilead Sciences (Grant/Research Support)
943. Older Gay Black Men Living with HIV Report Higher Quality of Life than Older Gay White Men, Despite Facing Additional Burdens
Authors: Mazonson Peter , Loo Theoren , Berko Jeff , Adeyemi Oluwatoyin , Oglesby Alan , Spinelli Frank , Zolopa Andrew
Published: January 2021

Background

Improving quality of life (QoL) is an important goal of care for people living with HIV (PLWH). This analysis uses data from the Aging with Dignity, Health, Optimism and Community (ADHOC) online registry to identify the different challenges faced by older white/Caucasian (“white”) and black/African American (“black”) gay or bisexual men living with HIV, and to assess differences in total QoL between the two groups.

Methods

QoL was measured using the PozQoL, a validated instrument for PLWH. The PozQoL assesses QoL across four domains: health concerns, psychological, social, and functional wellbeing. Total QoL was determined by combining domain scores for a total score. Student’s t-tests and chi-squared tests were used to identify disparities between black and white men. Factors with p< 0.05 were used as control variables in a multivariable linear regression model where PozQoL total score was the dependent variable.

Results

In the ADHOC database, 91% (n=612) of respondents were white men (WM) and 9% (n=59) were black men (BM). Both BM and WM had a median age of 59 years, and had a similar number of comorbidities (7.9 vs 9.2 respectively, p=0.12). Compared to WM, BM were more likely to be single (74% vs 51%, p< 0.001), less likely to have an income greater than $50,000 (25% vs 56%, p< 0.001), less likely to have a college degree or more (42% vs 69%, p=0.034), and less likely to be virally suppressed (87% vs 96%, p=0.001). Even after controlling for these differences in the multivariable model, BM had significantly higher total QoL than WM (Table 1).

Conclusion

In this analysis, there were substantial differences between older BM and WM living with HIV. After controlling for sociodemographic and clinical challenges, BM still reported higher QoL than WM. Programs designed to improve QoL for older gay and bisexual BM and WM living with HIV should take into consideration the unique strengths and challenges faced by each group.

Disclosures

Peter Mazonson, MD, MBA, ViiV Healthcare (Grant/Research Support) Theoren Loo, MS, BS, ViiV Healthcare (Grant/Research Support) Jeff Berko, MPH, BS, ViiV Healthcare (Grant/Research Support) Oluwatoyin Adeyemi, MD, ViiV Healthcare (Grant/Research Support) Alan Oglesby, MPH, ViiV Healthcare (Employee) Frank Spinelli, MD, ViiV Healthcare (Employee) Andrew Zolopa, MD, ViiV Healthcare (Employee)
68. Impact of a Pharmacy-Driven Antimicrobial Time-out on Duration of Therapy in Community-Acquired Pneumonia
Authors: Patel Amolee R , Murrey Timothy F
Published: January 2021

Background

Community-Acquired Pneumonia (CAP) is associated with substantial antibiotic use and potential for overprescribing. Previous studies have demonstrated a reduction in antimicrobial exposure following implementation of provider-driven antimicrobial time-outs (ATOs). ATOs prompt assessment of appropriateness of therapy, clinical response, and duration of therapy. In January 2018, OSF Healthcare System implemented a 48-hour pharmacy-driven ATO in the electronic health record. The purpose of this study was to determine if the implementation of the ATO decreased the duration of antibiotic therapy for CAP at a community hospital.

Methods

This was a retrospective chart review of adults hospitalized with CAP at OSF Saint Anthony Medical Center between May 2016 - October 2017 (pre-implementation; PRE) and April 2018 - September 2019 (post-implementation; POST). The primary outcome was total duration of antibiotic therapy between hospitalization and discharge prescriptions. Secondary outcomes included hospital length of stay (LOS), duration of IV therapy, and rates of treatment failure, relapse, and antibiotic-associated adverse events.

Results

A total of 808 patient charts were reviewed with 155 patients meeting inclusion criteria in both study groups. The mean duration of antibiotic therapy was reduced by 2.14 days (PRE 10.51 days vs. POST 8.37 days; P< 0.001). Duration of IV therapy (3.86% vs. 3.21%; P< 0.001) and 30-day emergency department visit rate (16.13% vs. 3.23%; P< 0.001) were also significantly reduced. Differences in LOS (4.60 days vs. 4.45 days; P=0.279) and 30-day readmission rate (9.03% vs. 4.52%; P=0.114) did not meet statistical significance. Antibiotic-associated diarrhea (28.39% vs. 17.42%; P=0.022) and acute kidney injury (17.42% vs. 6.45%; P=0.003) were significantly reduced while C. difficile infection (2.58% vs. 0.65%; P=0.371) and treatment failure (3.22% vs. 1.94%; P=0.723) only trended downward.

Conclusion

Implementation of the pharmacy-driven ATO was associated with reduced duration of antibiotic therapy in patients hospitalized with CAP, though total durations still exceeded evidence-based recommendations. The ATO maintained the efficacy of treatment and reduced treatment-associated adverse effects, such as diarrhea and AKI.

Disclosures

All Authors: No reported disclosures
950. Venous Thromboembolism in Persons Living with HIV (PLWH): A Single Center Retrospective Cohort Study
Authors: Chan Kok Hoe , Atallah Liana , Ahmed Eyad , Farouji Iyad , Crincoli Joanna , Patel Khamoshi , Shaaban Hamid S
Published: January 2021

Background

Data on risk of thromboembolism in PLWH is limited. HIV is often recognized as a chronic inflammatory disease and has been recognized as a prothrombotic condition. We aimed to analyze the incidence and demographic of venous thromboembolism such as pulmonary embolism and deep vein thrombosis in PLWH admitted to our hospital.

Methods

We conducted a retrospective hospital cohort study on PLWH ≥ 18 years old who were admitted to our hospital between 09/01/2018 and 09/01/2019. Study individuals were recruited if they had complete laboratory profile and well-defined clinical outcomes. Demographic, clinical and laboratory data were reviewed and retrieved. Descriptive analysis was employed to describe the demographic profile of PLWH with venous thromboembolism.

Results

Out of the 192 hospitalized PLWH during the study period, 15 (8%) patients had documented deep vein thrombosis (DVT) and/or pulmonary embolism (PE). History of DVT/PE was present in 5 (33%) patients while the rest had new onset of DVT/PE. Out of the 15 patients, 4 (27%) had DVT and PE, 4 (27%) had only DVT and 7 (46%) had only PE. The median age was 57 years, ranged from 40 to 74 years; 4 males and 11 females. As for ethnicities, 2 Caucasian, 12 were African American and 1 Hispanic.

The average D-dimer was 4491. The median CD4 count for PLWH with venous thromboembolism was 487 and a median viral load of 900. In contrary, the median CD4 count of PLWH without venous thromboembolism was 420 and median viral load of 140. Though not statistically significance, higher viral load seems to associate with risk of venous thromboembolism. Surprisingly, female gender is an independent risk factor for venous thromboembolism in PLWH (z-score 2.75, p=0.0059; odds ratio [OR], 4.67; 95% confidence interval [CI], 1.56-13.69).

Conclusion

Our observation of PLWH with venous thromboembolism suggest that this population has an increased risk of venous thromboembolism as compared to general population. Female gender is an independent risk factor for venous thromboembolism in PLWH and higher HIV viral load seems to associate with higher risk. Larger prospective studies in this population are needed to dissect the interplay between HIV and venous thromboembolism.

Disclosures

All Authors: No reported disclosures
951. Weight Gain Associated With Antiretroviral Therapy
Authors: Patel Yesha , Okere Sheila , Lustberg Mark , Malvestutto Carlos
Published: January 2021

Background

Obesity is a global public health crisis with a growing prevalence in persons with human immunodeficiency virus (PWH) population. In this study, we aimed to investigate factors associated with weight gain in the PWH population.

Methods

This was a single-centered, retrospective cohort study of our clinic patient population from January 1, 2015 to January 1, 2019. Patients with human immunodeficiency virus (HIV) were identified from the electronic health record and a randomized sample of 300 patients who had at least two follow up appointments, were on antiretroviral therapy, and had viral loads less than 200 were evaluated. The primary outcome was weight change over follow up. Cox Proportional Hazards models were used, taking a weight gain > 3 kg as the outcome, and the time on therapy between visits as the time to event. Robust linear regression was used to model mean changes in weight, accounting for influential observations. All analysis were performed in STATA 16.0.

Table 1

Results

At baseline, 87% were male, 63% were white, and 65% were overweight/obese. 30% were on a protease inhibitor, 46% were on non-nucleoside reverse transcriptase inhibitor, and 37% were on an integrase inhibitor. 64% were on Tenofovir disoproxil (TDF), 8% were on Tenofovir alafenamide (TAF), and 19% were on Abacavir. Mean weight change over follow up was significantly increased at 1.31 kg (95% CI = 0.58 – 2.04 kg, p= 0.0004). TAF use and male gender were significantly associated with risk of weight gain > 3 kg in univariate analysis [respectively, OR = 2.53, 95% CI = 1.30 – 4.92, p = 0.006; OR = 2.60, 95% CI = 1.05 – 6.45, p = 0.04]. In multivariate analysis, TAF use was significantly associated with weight gain > 3 kg, while male gender was of borderline significance [respectively, OR = 2.29, 95% CI = 1.17 – 4.47, p = 0.01; OR = 2.40, 95% CI = 0.96 – 5.97, p=0.060]. Significant factors associated with weight change are noted in Table 1.

Conclusion

As PWH are living longer on effective ARV therapy, monitoring for weight gain is required as obesity contributes to morbidity and mortality from cardiovascular disease and metabolic diseases. Key factors for weight gain in our clinic population include male gender, baseline diagnosis of hypertension, use of TAF, bictegravir use, and rilpivirine use.

Disclosures

Carlos Malvestutto, MD, Gilead Sciences (Advisor or Review Panel member)ViiV Healthcare (Advisor or Review Panel member)
952. Weight-Gain in Treatment Naive Newly Diagnosed HIV-Infected Persons After Initiation on Integrase Strand Inhibitor Based Treatment Regimens
Authors: Szep Zsofia , Cui Saishi , Conway Heather , Evans Alison
Published: January 2021

Background

We performed a retrospective cohort study of treatment-naive patients with newly diagnosed HIV-infection enrolled at an urban university specialty clinic to identify whether INSTI-based ART regimens were associated with greater weight gain compared to NNRTI and PI based regimens in the first 12-18 months of treatment. The secondary aim of this study was to determine differences in weight gain between males and females within each of the three ART classes

Methods

Differences in weight change and BMI change were compared across ART class using nonparametric tests, specifically the Wilcoxon rank sum test. Nonparametric tests were also used to compare differences in weight change and BMI change between males and females within each ART class. Data were analyzed using R Core Team, 2020

Results

Among the 348 individuals included in the study, 73% were African American and 79% were male and the median age was 32 years. There were 155 individuals initiating therapy on NNRTI based regimens (44%), 58 were on PI based regimens (17%) and 135 were on INSTI regimens (39%). The median weight at baseline was 170.5 lbs. and the median body mass index was 25.4 kg/m2. Median weight increased across all 3 ART regimens within the first 12-18 months of treatment. Median weight gain among the PI group was the greatest, at 6.8 lbs. (p= 0.04). Median weight gain among the NNRTI group was the lowest, .88 lbs (p=< .01). Median weight gain among those on INSTI based regimens was 4.8 lbs. (p= 0.11). Among those on INSTI-based regimens, women had a greater median increase in weight compared to men, 10.1 lbs. compared to 3.2 lbs., (p=0.046).

Conclusion

Overall, among individuals initiating HIV treatment those initiating PI based regimens experienced the most weight gain and individuals initiating INSTI based regimens did not experience a significant weight gain. Women on INSTI based regimens did experience a significant weight gain in comparison to men.. More research is needed to elucidate specific ART regimens’ causal role in weight gain and to identify risk factors for ART-associated weight gain.

Disclosures

All Authors: No reported disclosures
953. Frailty Among People Living with HIV In Miami, A Cross Sectional Pilot Study
Authors: Salguero Douglas , Rodriguez Jornan , Raccamarich Patricia , Abbamonte John , Pallikkuth Suresh , Rodriguez Allan , Pahwa Savita , Alcaide Maria L
Published: January 2021

Background

Frailty, a status of high vulnerability, is a clinical syndrome associated with adverse health outcomes and characterized by a constellation of various health deficits. Although age is a major contributor of being frail, HIV infection is associated with accelerated aging, and likely contributes to frailty. This association has seldom been evaluated. This study evaluated factors associated with frailty among PWH in Miami.

Methods

Cross-sectional study. Adults (> 18 years), HIV infected (HIV+) and uninfected (HIV-), virologically suppressed for at least 1 year (< 50 copies/ml). Sociodemographic factors and the self reported FRAIL scale was administered (Fatigue, Resistance or ability to climb a single flight of stairs, Ambulation or ability to walk one block, Illnesses or non-HIV associated comorbidities, and more than 5% weight Loss in the previous year). Groups were categorized base on the FRAIL scale scoring as Non-Frail (0), Pre-Frail (1-2), and Frail (3 or more). The association by Frail categories were analyze using descriptive statistics and ordinal logistical regression.

Results

N (40), median age was 43 years (SD 20.6); 35% White; 20% Hispanic; 52% females; 25 (62.5%) HIV +/ 15 (37.5%) HIV -. A small number of participants reported use of tobacco 2 (5%) and alcohol 7 (18%). More than half of the participants were frail or pre- frail (18 or 45% Non-Frail, 18 or 45% Pre-Frail, and 4 or 10% Frail, and HIV+ were more likely to be pre-frail or frail than HIV-, 72% vs 26%, p = 0.019). Frail scale symptoms were common among all participants but HIV+ reported higher fatigue than HIV- (85% vs 14%, p= 0.01). On Regression analysis, both HIV status and age were significant predictors of frailty status (HIV χ2 (1) = 4.36, p = .037 and age χ2 (1) = 13.48, p < .001). When controlling for age, being HIV - on average reduced frailty by an odds of 2.16 (b = -2.164, SE = 1.04, p = .037, 95% CI [-4.2 -0.13]). When controlling for HIV status, for every one year of increase in age, the ordered log odds of being frail increased by 0.07 (b = 0.07, SE = 0.02, p < .001, 95% CI [0.03 0.1]).

Conclusion

Using the FRAIL scale, a simple tool to screen for frailty, we identified high prevalence of frailty among PWH. Further studies are needed to identify the best tools to assess frailty and prevent poor health outcomes among this vulnerable population.

Disclosures

All Authors: No reported disclosures
957. Efficacy of Using Disease Intervention Specialists (DIS) to Re-engage Out of Care HIV/HCV Co-Infected Persons into HCV Treatment
Authors: Wegener Maximilian D , Brooks Ralph P , Speers Suzanne , Gosselin Deborah , Villanueva Merceditas
Published: January 2021

Background

Published treatment cascades for HIV/HCV co-infection show WHO goals for HCV micro-elimination are not being met. Barriers include entry to care, access to DAA, treatment adherence, and out of care (OOC) patients. A Data to Care approach used to define persons with HIV (PWH) who are OOC, together with DPH-employed DIS to promote re-engagement has been successful for re-engaging OOC PWH. We modified this approach to re-engage OOC HIV/HCV coinfected persons.

Methods

Surveillance databases used: CTEDSS (CT Electronic Disease Surveillance System used for HCV) and eHARS (electronic HIV/AIDS Reporting System). Two OOC cohorts studied: HIV OOC for 12 months (no HIV lab 10/2018-10/2019) and 18 months (no HIV lab 12/2017-6/2019). Lists generated for the 2 cohorts matched to CTEDSS to determine the coinfected OOC. DIS supervisor performed pre-work/case conferencing on lists to assess DIS intervention eligibility. DIS success was defined as those who reengaged (made/kept appointment) out of those successfully contacted. Analysis: tests of homogeneity performed between those OOC and not OOC; evaluation of cases at each level of the intervention; measures of dispersion/central tendency performed illustrating reengagement workload.

Project Flow Chart

Results

12-month OOC: Non-baby boomers (p-value 0.05) and those with detectable HIV VLs (0.04) were more likely to be OOC; 53.7% were DIS-eligible; DIS initiation to client contact, 7 days average (range 4-11); 75 calls and 31 field visits for those successfully contacted; reengagement success rate, 39%. 18-month OOC: Non-baby boomers (0.017), Hispanic and Black race/ethnicity (0.043), and those with detectable HIV viral loads (0.002) were more likely to be OOC; 44% were DIS-eligible; DIS initiation to client contact, 12 days average (range 8-18); 74 calls and 36 field visits for those successfully contacted; reengagement success rate, 43%.

Results for the Two Cohorts

Out of Care and Workload Results

Conclusion

A data-to-care approach successfully identified, characterized, connected OOC HIV/HCV coinfected patients. DIS provided patient education, facilitating reengagement to care. DIS Success rates are encouraging but small; efforts were labor intensive. Additional strategies focused on preventing non-baby boomers, persons of color, and those with detectable HIV VLs from becoming OOC should be studied.

Disclosures

All Authors: No reported disclosures
958. Feasibility and Acceptability of HIV Self-Test Kit Distribution Through PrEP Clients’ Friendship and Sexual Networks
Authors: Balan Shuba , Klose Katie , King Katherine , Kanamori Mariano , Michniewicz Mara , Spencer Emma , Doblecki-Lewis Susanne
Published: January 2021

Background

Personal networks can influence behaviors, beliefs, attitudes, and values through contact and communication. The University of Miami Mobile PrEP Program offers low-barrier pre-exposure prophylaxis (PrEP)/HIV prevention services through a mobile clinic in five highly impacted neighborhoods in Miami-Dade, the county with the highest HIV incidence in the US. The highest rates are among black and Latino men who have sex with men (MSM). The goal of this study is to understand the acceptability and feasibility of expanding the reach of testing through our clients’ friendship and sexual networks.

Methods

This study was implemented in five locations across Miami from December 2019 to February 2020. During scheduled PrEP quarterly follow-up clinic visits, participants were offered Ora-Quick oral fluid self test (ST) kits, free of cost for distribution to up to four sexual partners and/or friends. In addition to the information available in the testing kit, brief training regarding the test and resources for post-test engagement were provided. A survey evaluated participants’ distribution plan, comfort level and concerns in offering the test kits to friends/sexual partners. Descriptive statistics included frequencies for categorical variables, and means and ranges for continuous variables.

Results

A total of 84 participants were offered the ST kits, of which 49 (58%) accepted. Of those accepting kits, 40 (81.63%) of 49 were Latino MSM. Participants requested an average of 3 (mean=2.9, range 1-4) kits, for a total of 144 kits. Overall, 41(84%) felt very comfortable and 47(96%) indicated they felt very comfortable offering this test to their friends/sexual partners. Also, 29(59.2%) planned to distribute kits only to friends, 2(4%) only to sexual partners, 11(22.4%) to both sexual partners and friends and 7(14.2%) to either family or self-test to provide ‘moral support’ to those taking the test. None of the participants expressed any concerns about offering kits to friends or sexual partners.

Conclusion

Distribution of home based self-test HIV kits through current Mobile PrEP clients’ friendship and sexual networks is acceptable and feasible. Similar social network strategies may be considered to expand reach of HIV testing and PrEP engagement to those with barriers to care.

Disclosures

All Authors: No reported disclosures
959. HIV-1 DNA Testing Identifies Drug Resistance in Viremic Patients with Pan-Sensitive Plasma Virus
Authors: Curanovic Dusica , Martens Sharon K , Rodriguez Milka A , Hammill Hunter A , Petropoulos Christos J , Walworth Charles M
Published: January 2021

Background

HIV-1 drug resistance mutations (DRMs) are lost from plasma virus in the absence of selective drug pressure. Therefore, viremic patients who present with pan-sensitive plasma HIV-1 may harbor archived drug resistance that hinders virologic suppression upon reinstatement of therapy. We sought to determine if testing HIV-1 DNA in peripheral blood mononuclear cells (PBMCs) can identify drug resistance in patients with pan-sensitive plasma virus.

Methods

Sixty-four patients were identified who had HIV-1 RNA and HIV-1 DNA drug resistance testing performed on the same day and demonstrated pan-sensitive virus on the HIV-1 RNA test. Antiretroviral (ARV) resistance and DRMs identified by each test were compared between 66 test pairs. Patients were stratified by viral load (VL) to assess its impact on resistance detection using t-test and correlation analyses.

Results

The mean patient age was 37; 92% were female. Most (94%) were infected with HIV-1 subtype B, with an average VL of 110,000 c/mL (150 - 1,470,000 c/mL) at the time of resistance testing. Resistance to at least one ARV was reported on 20% (13/66) of HIV-1 DNA tests, and was associated with nucleos(t)ide and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs), protease inhibitors (PIs), and integrase inhibitors (INIs) on 4.5%, 9%, 4.5%, and 6% of HIV-1 DNA reports, respectively. Across all HIV-1 DNA tests, 74 DRMs were identified that were not found in the plasma virus, including 12 NRTI, 16 NNRTI, 39 PI, and 7 INI DRMs; M184V was identified on 4.5% (3/66) of HIV-1 DNA reports. The mean VL was not significantly different between HIV-1 DNA tests reporting resistance to at least one ARV (101,000 c/mL) and those reporting pan-sensitivity (110,000 c/mL). Viral load at time of testing did not correlate with the number of ARVs to which resistance was reported.

Conclusion

In viremic patients with pan-sensitive plasma virus, HIV-1 DNA testing can identify drug resistance regardless of VL level. Assessment of drug resistance in HIV-1 DNA may be useful in designing suppressive ARV regimens for patients whose plasma virus DRMs fail to be identified due to lack of adherence or continuity of care.

Disclosures

Dusica Curanovic, PhD, Monogram Biosciences (Employee) Sharon K. Martens, MN, Monogram Biosciences (Employee) Milka A. Rodriguez, PhD, Monogram Biosciences (Employee) Christos J. Petropoulos, PhD, Monogram Biosciences (Employee) Charles M. Walworth, MD, Monogram Biosciences (Employee)
964. Opt-Out HIV- Hepatitis C (HCV) Testing at a Primary Care Resident Clinic in Columbia, SC: Who Gets Tested and Who Opts Out of Testing?
Authors: Pinkney Jodian , Ahuja Divya , Derrick Caroline , Durkin Martin
Published: January 2021

Background

South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies.

Methods

Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data.

Results

1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3)

Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02).

Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019

Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model.

Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model.

Conclusion

Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis.

Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia.

Disclosures

All Authors: No reported disclosures
965. Partnering with State Health Departments: A Road Map for Collaboration Using Public Health Enhanced HIV/AIDS Reporting System (eHARS)
Authors: Bassler John R , Levitan Emily B , Ostrenga Lauren , Crear Danita C , Johnson Kendra L , Cooper Gabrielle , Kay Emma Sophia , Parman Mariel , Nassel Ariann F , Mugavero Michael J , Batey D Scott , Rana Aadia
Published: January 2021

Background

Academic and public health partnerships are a critical component of the Ending the HIV Epidemic: A Plan for America (EHE). The Enhanced HIV/AIDS Reporting System (eHARS) is a standardized document-based surveillance database used by state health departments to collect and manage case reports, lab reports, and other documentation on persons living with HIV. Innovative analysis of this data can inform targeted, evidence-based interventions to achieve EHE objectives. We describe the development of a distributed data network strategy at an academic institution in partnership with public health departments to identify geographic differences in time to HIV viral suppression after HIV diagnosis using eHARS data.

Figure 1. Distributed Data Network

Methods

This project was an outgrowth of work developed at the University of Alabama at Birmingham Center for AIDS Research (UAB CFAR) and existing relationships with the state health departments of Alabama, Louisiana, and Mississippi. At a project start-up meeting which included study investigators and state epidemiologists, core objectives and outcome measures were established, key eHARS variables were identified, and regulatory and confidentiality procedures were examined. The study methods were approved by the UAB Institutional Review Board (IRB) and all three state health department IRBs.

Results

A common data structure and data dictionary across the three states were developed. Detailed analysis protocols and statistical code were developed by investigators in collaboration with state health departments. Over the course of multiple in-person and virtual meetings, the program code was successfully piloted with one state health department. This generated initial summary statistics, including measures of central tendency, dispersion, and preliminary survival analysis.

Conclusion

We developed a successful academic and public health partnership creating a distributed data network that allows for innovative research using eHARS surveillance data while protecting sensitive health information. Next, state health departments will transmit summary statistics to UAB for combination using meta-analytic techniques. This approach can be adapted to inform delivery of targeted interventions at a regional and national level.

Disclosures

All Authors: No reported disclosures
970. Transmitted Antiretroviral Drug Resistance Over a Period of 11 years at a Single Center in Southeast, USA
Authors: Klibanov Olga M , Gillette Chris , Ekwonu Tagbo
Published: January 2021

Background

In the United States, the prevalence of TDRMs is approximately 20%. As newer agents have become available, INSTI-based therapies have become the standard first-line treatment. The objectives of this study were to: (1) examine the incidence of TDRMs during 2008-2019 at a single institution and, (2) examine the association between TDRM and year as well as type of therapy.

Methods

A retrospective chart review was conducted at a single center in the Southeast United States. Resistance was defined on the basis of the International AIDS Society 2019 definition and Stanford University’s HIV Drug Resistance Database. Relative risk and multivariable logistic regression were used to analyze data.

Results

Among 456 treatment-naïve patients who entered care 2008-2019 (80% male, 86% African American, mean CD4 count 359 cells/mm3), the cumulative incidence rate of >1 TDRM was 19.3% (n=88). There has been a steady increase in annual cumulative incidence in TDRMs since 2008, with the highest incidences in 2018 (46,667/100,000) and 2019 (36,585/100,000). Over the 11-year study period NNRTI resistance was most common (67/88; 76%), followed by NRTI (9/88; 10%), PI (4/88; 5%), and INSTI (2/88; 2%). Dual class resistance was noted in 6 (7%) patients, one of whom had TDRMs in the INSTI and NNRTI classes. The relative risk (RR) for TDRMs was 1.76 (95% CI=1.42-2.17). According to the regression model, compared to patients whose initial treatment was NNRTI-based, patients who started treatment on PI-based therapies (OR=5.34, 95% CI=2.17-13.11) or INSTI-based therapies (OR=4.00, 95% CI=1.43-11.20) had significantly greater odds of TDRMs, controlling for age, gender, race, baseline CD4+ count, HIV RNA, hepatitis B status, hepatitis C status, and time period of testing. The time period was not significantly related to TDRM incidence in this model.

TDRM Incidence 2008-2019

Conclusion

The overall incidence of TDRMs in our clinic mirrors national surveillance data, with notably higher incidences in the last 2 years. Prescribing of the newly available INSTI-based regimens reflects the continued increase in the incidence of NNRTI TDRMs.

Disclosures

All Authors: No reported disclosures
971. Unmasking the Undetectable: Identifying and Troubleshooting a Series of Falsely Elevated HIV Viral Load Results in a Group of Patients in a Community Clinic in San Antonio, Texas
Authors: Pinilla Ruth Serrano , Hartzler Anthony
Published: January 2021

Background

Using effective antiretroviral therapy to consistently suppress plasma HIV RNA levels to < 200 copies/mL is known to improve morbidity and mortality at all stages of HIV infection and prevent transmission to sexual partners. Logistical challenges such as transporting, processing, and storing samples may threaten the accuracy of the test results. Plasma Preparation tubes (PPT) or Ethylene Diamine Tetra Acetic Acid (EDTA) tubes can be used for this test. PPT tubes contain an inert gel that migrates during centrifugation, forming a barrier between the plasma and cellular elements. Adequate separation of cellular elements may not always occur, and this can result in falsely elevated HIV Viral load (VL) due to measurement of integrated intracellular virus. It is therefore routine practice to centrifuge samples twice when PPT tubes are used. This is not necessary with EDTA tubes. In addition, there are reports that HIV RNA levels may be higher with PPT tubes are used, compared to EDTA tubes.

Methods

This is a quality improvement project that reviews a series of falsely elevated HIV VL in a group of patients who reported adherence and had been previously virologically suppressed.

Results

A total of 20 unexpectedly elevated HIV VL were identified from January to March of 2020 after introduction of a new phlebotomist in our clinic. VL ranged from 200-2530 copies/ml. Most patients (18/20) had history of virologic suppression and reported adherence. We standardized our process by using only PPT tubes and centrifuging samples twice prior to processing. Our nurses reported visible residual cellular elements in some of the plasma specimens in the tubes even after appropriate centrifugation. We continued to see suspected erroneous results. We repeated the test in EDTA tubes. 16/19 had HIV VL < 20, the remainder ranged from 27-41 copies/ml. We then implemented the use of EDTA tubes in all samples. No further cases of falsely elevated VL have been seen since the change.

Table 1

Conclusion

We describe potential steps that can interfere in the accuracy of HIV VL results. Detailed review of past history and patient’s adherence to treatment is essential to identify systemic problems that may lead to errors. Close communication with staff and laboratory provider will be key to overcome such challenges.

Disclosures

All Authors: No reported disclosures
974. The Effects of Changes in State-Level Policies Affecting Eligibility for the Supplemental Nutrition Assistance Program (SNAP) on Annual HIV Diagnoses in the United States
Authors: Richterman Aaron , Ivers Louise , Tsai Alexander , Block Jason
Published: January 2021

Background

The connection between food insecurity and HIV outcomes is well-established. The Supplementary Nutrition Assistance Program (SNAP), the primary program in the United States that addresses food insecurity, may have collateral impacts on HIV incidence, but the extent to which it does is unknown. “Broad-based categorical eligibility” for SNAP is a federal policy that provides a mechanism for states to increase the income or asset limits for SNAP eligibility. The Department of Agriculture under the Trump Administration has proposed eliminating this policy.

Methods

We estimated the association between the number of new HIV diagnoses from 2010 to 2014 for each state and (1) state income limits for SNAP eligibility as a percentage of the federal poverty level and (2) state asset limits for SNAP eligibility (increased/eliminated vs. unchanged). We fitted multivariable negative binomial regression models with annual incidence of HIV diagnoses specified as the outcome; SNAP policies as the primary explanatory variable of interest; state and year fixed effects; and time-varying covariates related to the costs of food, health care, housing, employment, SNAP outreach, and total spending on Temporary Assistance for Needy Families (TANF) programs.

Results

From 2010 to 2014, 204,034 new HIV diagnoses occurred in the United States. HIV diagnoses within states had a statistically significant inverse association with state income limits for SNAP eligibility (IRR 0.94 per increase in the income limit by 35% of federal poverty level, 95% CI 0.91-0.98), but no statistically significant association with state asset limits (increased asset limit vs. no change, IRR 1.02, 95% CI 0.94-1.10; eliminated asset limit vs. no change, IRR 1.04, 95% CI 0.99-1.10) (Table).

Table

Conclusion

State income limits for SNAP eligibility were inversely associated with the number of new HIV diagnoses for states between 2010-2014. Proposals to eliminate the use of broad-based categorical eligibility to increase the income limit for SNAP may undercut efforts to end the HIV epidemic in the United States.

Disclosures

All Authors: No reported disclosures
976. A Descriptive Retrospective Data Analysis of Maternal Sociodemographic Factors and Access of Healthcare Resources within the African Cohort Study, an Integrated Multicountry Preventative Mother to Child Transmission Program
Authors: Traver Jeanette , Esber Allahna L , Dear Nicole , Polston Elizabeth , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswai Jonah , Crowell Trevor A , Polyak Christina , Ake Julie A , Kunz Anjali
Published: January 2021

Background

Global reduction in new infant HIV infections is largely due to the expansion of prevention of mother-to-child transmission (PMTCT) programs. Identification of gaps in healthcare services is paramount in targeting interventions that identify high-risk populations and healthcare barriers that could lead to increased risk of mother to child transmission (MTCT) of HIV.

Methods

HIV infected women from 5 regions of Africa enrolled in the African Cohort Study (AFRICOS) were followed prospectively with assessments performed every 6 months. Sociodemographic factors, pregnancy outcomes, and access of PMTCT resources were reviewed for retrospectively reported pregnancies and those followed prospectively from study enrollment. Statistical analysis compared the impact of clinical factors on infant mortality and preterm delivery.

Results

The study reported 5591 pregnancies from January 2013 to June 2019 of which 5363 were retrospectively reported prior to study enrollment and 228 occurred after enrollment. Pregnancies followed prospectively had higher rates of linkage to PMTCT services prenatally (92.5% vs 6.8%, P< 0.001), intrapartum (64.5% vs 3.5%, P< 0.001), and post-partum (64.5% vs 2.9%, P< 0.001). This group had higher rates of delivery by a skilled birth attendant (93.4% vs 66.7%, P< 0.001) and antiretroviral therapy (ART) prescribed antepartum (96.1% vs 5.5%, P< 0.001) and post-partum (74.6% vs 3.6%, P< 0.001). Both groups had similar rates of prescriptions for intrapartum ART (98.7% vs 97.9%). The majority of women reported ART adherence (96.5%, P< 0.001) which was associated with a decrease in both preterm delivery and infant mortality (adjusted OR 0.24, 95% CI 0.15-0.39). A significant proportion of women followed prospectively reported their infants received ART with good adherence (51.8% vs 0.3% and 93.4% vs 6.3%, respectively P< 0.001).

Conclusion

Participation in AFRICOS increased linkage to PMTCT programs which resulted in increased likelihood of skilled delivery and appropriate ART use for women and their infants. It highlights that linkage to care continues to be a crucial factor in limiting MTCT of HIV especially in resource-limited settings. Limitations in this study exist due to the low number of prospectively followed pregnancies.

Disclosures

All Authors: No reported disclosures
978. Barriers to Recruitment of Latino Men who Have Sex with Men and Transgender Women to Behavioral HIV Seroprevalence Studies
Authors: Flores John M , Jaramillo Natalie , Pagan-Parillo Patricia , Alvarez Carina , Hodge David , Khosla Shaveta , Brito Maximo O
Published: January 2021

Background

Chicago’s HIV epidemic disproportionally affects people of color. Almost a quarter (23%) of these infections occur in Hispanics. It is important to understand sexual behaviors and HIV risk in Latino MSM and transgender women (TGW) to create targeted culturally sensitive harm reduction interventions. However, participation of minority MSM and TGW in survey-based studies is low. The main objective of the study was to understand the sexual health and of Latino MSM and TGW residing in Chicago, Illinois, United States. We herein report subject’s attitudes towards participating in the study and qualitative observations about perceived barriers to enrollment of this population.

Methods

This study was a cross sectional analysis of a behavioral/HIV seroprevalence survey administered during 2017-2020 to presumed HIV negative, Latino identifying, MSM and TGW individuals. The survey included questions on sexual risk, HIV knowledge and depression scores. We categorized recurrent themes of the most common reasons participants provided for declining to participate in the study. We generated descriptive statistics.

Results

A total of 48 community organizations assisted with recruitment. Of 149 participants screened, only 18 (12%) agreed to complete the survey. Among those who declined to complete the survey (n=131), the most common reasons given were: participants were uncomfortable answering some questions (n=59, 45.0%), participant’s did not have the time to initiate or complete the survey (n=41, 31.3%) and survey was deemed long (n=16, 12.2%).

We categorized barriers to successful recruitment into the following general themes: 1) Participants were unwilling to discuss their sexual history; 2) Participant’s felt uncomfortable taking a rapid oral HIV test; 3) Participant’s lacked transportation; and 3) Participants didn’t have time to complete the survey or thought it was too long.

Conclusion

Despite extensive community networking, we found barriers to recruitment of high-risk Latino MSM and TGW into an HIV seroprevalence study. Further research is needed to better understand and address these barriers, and thus, increase representation of this key population in prevention studies.

Disclosures

All Authors: No reported disclosures