bluuebunny/crossref_metadata_2025 huggingface dataset:
1276. Human Immunodeficiency Virus (HIV) Diagnostic Limbo: A Retrospective Review of Discordant HIV Test Results in a Large, Academic Health Center Over a 10-Year Period to Guide Clinicians in Distinguishing False-Positive vs. Acute HIV Infection
Authors: Commanday Alexander , Rose Stacey R , Hemmige Vagish S , Rubin Jack , Giordano Thomas P
Published: November 2018

Background

The Centers for Disease Control and Prevention (CDC) recommends universal HIV screening with a fourth-generation HIV-1/2 antigen–antibody immunoassay followed by an HIV-1/-2 antibody differentiation immunoassay. Discordant results require nucleic acid testing (NAT) to distinguish acute HIV from false positives. In practice, NAT can be delayed, leaving clinicians and patients in limbo. Better understanding of factors associated with acute HIV vs. false positivity among discordant HIV tests is needed.

Methods

From 2014 to 2018, positive fourth-generation HIV-1/-2 enzyme-linked immunosorbent assay (ELISA) tests were retrospectively analyzed across centers in the Harris Health system in Houston, Texas. Discordant results were defined as a positive fourthgeneration HIV-1/2 ELISA with a negative HIV-1/-2 antibody confirmation test and were resolved via NAT (if possible). Duplicate results and patients with a previously positive HIV-1 viral load were excluded. Results were analyzed (Fisher’s exact test or Chi square) by year, setting (clinic/hospital), sex, age, race, and comorbid conditions (pregnancy, rheumatoid arthritis, lupus, hepatitis B and syphilis [rapid plasma reagin, or RPR>1:4] for associations with acute HIV vs. false positivity).

Results

Of 7,077 positive fourth-generation HIV-1/2 ELISA tests, 488 (13%) discordant cases were identified. Eighty-six (18%) represented acute HIV while 322 (66%) were false positives; 80 remained unresolved (no NAT performed). Median time to resolution via NAT was 21 days. Clinic setting, female sex, older age, non-Black race, and negative RPR status were associated with significantly higher rates of false positivity vs. acute HIV (P < 0.02 for all associations).

Conclusion

In this large HIV testing program in a multicenter metropolitan health system, 66% of discordant fourth-generation HIV tests represented false positives. Several clinical factors correlated with a higher rate of false positivity, likely reflecting the impact of disease prevalence on the positive predictive value of any diagnostic test. Clinicians may consider these factors when counseling their patients during the limbo period. Efforts to expedite NAT to resolve discordant cases is paramount to reducing diagnostic uncertainty.

Disclosures

All authors: No reported disclosures.
1280. Geospatial Spread of HIV in the Cologne-Bonn Region, Germany: From 2001 to 2016
Authors: Stecher Melanie , Hoenigl Martin , Eis-Huebinger Anna-Maria , Lehmann Clara , Fätkenheuer Gerd , Wasmuth Jan-Christian , Knops Elena , Metha Sanjay , Vehreschild Janne , Chaillon Antoine
Published: November 2018

Background

Geographical targeting of interventions of hotspots of HIV transmission increases the impact of HIV intervention. We combined molecular epidemiology and geospatial analyses to provide insights into the drivers of HIV transmission and the contribution of geographical hot spots to the rapidly evolving local HIV epidemic of Cologne-Bonn.

Methods

We included 714 HIV-1-infected ART naïve individuals, followed at the University Hospitals Cologne and Bonn between 2001 and 2016. Phylogenetic and network analyses were performed to infer putative relationships. Assortativity index (AI, i.e., shared attributes) and characteristics of genetically linked individuals were analyzed. The geospatial diffusion of the local epidemic (i.e., viral gene flow) was evaluated using a Slatkin-Maddison approach. Geospatial dispersal of local HIV transmission was determined by calculating the average distance between genetically linked individuals (centroids of 3-digit zip code of residency, ArcGIS®).

Results

Of 714 sequences, 217 (30.4%) had a putative linkage with at least one other sequence, forming 77 clusters (size range: 2–8). Genetically linked individuals were significantly more likely to live in suburban areas (P = 0.035), <30 years of age (P = 0.013), infected with HIV-1 subtype B (P = 0.002). AI for concurrent area of residency showed that individuals were nonassortative in the network (−0.0026, P = 0.046), indicating that clustering individuals tended to cluster with individuals living in a different zip code. Geospatial analyses revealed that the median distance between genetically linked individuals was 23.4 km, significantly lower than expected (median 39.68 km; P < 0.001) (Figure 1A). Slatkin Maddison analyses revealed increased gene flow originating from Central Cologne toward the surrounding areas (P < 0.001, Figure 1B).

Conclusion

Phylogeographic analysis suggests that central Cologne may be a significant driver of the regional epidemic. While clustering individuals lived closer than unlinked individuals, they were less likely to be linked to others from their same zip code. This may reflect individuals reaching out of their neighborhoods and social circles to meet new partners.

Disclosures

All authors: No reported disclosures.
1283. Pretreatment HIV-1 Drug Resistance in Transmission Clusters of the Cologne-Bonn Region, Germany
Authors: Stecher Melanie , Hoenigl Martin , Eis-Huebinger Anna-Maria , Lehmann Clara , Fätkenheuer Gerd , Wasmuth Jan-Christian , Knops Elena , Metha Sanjay , Vehreschild Janne , Chaillon Antoine
Published: November 2018

Background

In Germany, previous reports have demonstrated transmitted HIV-1 drug resistance mutations (DRM) in 10% of newly diagnosed individuals, affecting treatment failure and the choice of antiretroviral therapy (ART). Here, we sought to understand the molecular epidemiology of HIV DRM transmission throughout the Cologne-Bonn region, an area with one of the highest rate of new HIV infections in Europe (13.7 per 100,000 habitants).

Methods

We analyzed 714 HIV-1 ART naïve infected individuals diagnosed at the University Hospitals Cologne and Bonn between 2001 and 2016. Screening for DRM was performed according to the Stanford University Genotypic Resistance Interpretation. Shared DRM were defined as any DRM present in genetically linked individuals (<1.5% genetic distance). Phylogenetic and network analyses were performed to infer putative relationships and shared DRMs.

Results

We detected 123 DRMs in our study population (17.2% of all sequences). Prevalence of any DRM was comparable among risk groups and was highest among people from an endemic area (i.e., country with HIV prevalence >1%) (11/51, 21.6%). Nucleoside-and non-nucleoside reverse transcriptase inhibitor (NRTI/NNNRTI) resistance mutations were detected in 49 (7%) and 97 (13.6%) individuals, with the E138A in 29 (4.1%) and K103N in 11 (1.5%) being the most frequent. Frequency of DRM was comparable in clustering and not clustering individuals (17.1% vs. 17.5%). Transmission network analysis indicated that the frequency of DRM in clustering individuals was the highest in PWID (3/7, 42.9%) (Figure 1A). Genetically linked individuals harboring shared DRMs were more likely to live in suburban areas than in Central Cologne (18.8% vs. 8% of clustering sequences with DRM; Figure 1B).

Conclusion

The rate of DRMs was exceptionally high in the Cologne/Bonn area. Network analysis elucidated frequent cases of shared DRMs among genetically linked individuals, revealing the potential spread of DRMs and the need to prevent onward transmission of DRM in the Cologne-Bonn area.

Disclosures

M. Hoenigl, Gilead, Basilea, Merck: Speaker’s Bureau, Research grant and Speaker honorarium.
1285. Impact of an Educational Program on Knowledge, Attitude and Practice to Prevent HIV Infection Among HIV-Negative Heterosexual Partners of HIV-Infected Patients
Authors: Khawcharoenporn Thana , Srirach Chanika , Chunloy Krongtip
Published: November 2018

Background

Data on knowledge, attitudes, and practices to prevent HIV transmission are limited and effective strategies to improve such knowledge, change attitudes, and reduce risk behaviors are unknown among serodiscordant couples.

Methods

A quasi-experimental study was conducted among HIV-negative adult heterosexual partners of HIV-infected patients. The intervention was an educational program consisting of a 1-hour educational session on knowledge about HIV infection and transmission prevention, a condom use teaching session, group discussion and experience sharing, and free HIV testing. Self-administered survey was conducted pre- and post-intervention on the same day to assess effectiveness of the program in improving HIV knowledge and changing attitudes toward HIV prevention. The participants were invited to participate in the program again 6 months later to assess retention of the knowledge and positive attitudes and practices to prevent HIV.

Results

A total of 88 participants were enrolled. The median age was 39 years and 49 (56%) were male. The median number of correct answers to the 30 statements about HIV infection and transmission prevention was significantly higher after the program compared with before the program (28 vs. 21; P < 0.001). After the program, higher proportions of the participants would encourage treatment of their HIV-infected partners (77% vs. 58%), use pre-exposure prophylaxis (59% vs. 38%), have a regular HIV blood test every 6 months (94% vs. 81%) and think that they and their partners can have a baby together safely with the current HIV transmission prevention strategies (48% vs. 17%) compared with before the program (all P < 0.05). Among the 35 participants who participated in the educational program twice, most of the knowledge and positive attitudes were retained. The rates of regular HIV testing every 6 months and consistent condom use had increased from baseline to 6 months later (29% to 74% and 71% to 91%, respectively). None of the participants acquired HIV from their partners.

Conclusion

The educational program was shown to be effective in improving HIV knowledge, attitudes, and practices toward HIV prevention among the seronegative partners.

Disclosures

All authors: No reported disclosures.
1286. Evaluating Strategies to Reduce Risk of HIV Infection in the US Blood Supply
Authors: Goldstein Robert , Sacks Chana , Walensky Rochelle
Published: November 2018

Background

Due to risk of HIV transmission, the FDA recommends a ban on blood donation from men who have sex with men (MSM). Revised in 2015, the current restriction applies to men who have had sex with a man in the year before donation. Given advances in HIV testing and the option of risk-based screening, the current approach may not represent the optimal strategy for ensuring a safe blood supply.

Methods

Using a decision tree, we compared three strategies: (1) the current standard: a deferral for MSM followed by fourth-generation HIV antibody/antigen (Ab/Ag) and viral load (VL) testing of all donated units; (2) test-only: no deferral, with Ab/Ag and VL testing; (3) risk-based: deferral for all male donors who report condomless anal intercourse in the past 6 weeks, followed by Ab/Ag and VL testing. The primary outcome was the expected number of accepted HIV+ donations per million units of donated blood. Key input parameters include MSM prevalence (3.6%), HIV testing sensitivity for chronic (99.96%) and acute (75%) infection, and false negative rate of the current MSM deferral question and the risk-based screening question (2.6% for each). In sensitivity analyses, we assessed the impact of variation in these parameters.

Results

In the base case, the current strategy resulted in 5.39 HIV+ accepted blood donations per million; the testing only strategy resulted in 7.10 HIV+ accepted blood donations per million; and the risk-based strategy resulted in 2.54 HIV+ accepted blood donations per million. In sensitivity analyses, the risk-based strategy was superior across plausible ranges of HIV test sensitivity and MSM prevalence. The risk-based strategy was superior when the false negative rate generated by the risk-based screening question was <10.4%; at higher rates, the current strategy was superior. The current strategy was superior when the MSM deferral question yielded <0.8% false negative rate; at higher rates, the risk-based strategy is superior. Compared with the current standard, a risk-based strategy could add 5 million low-risk MSM to the potential donor supply.

Conclusion

A risk-based screening question, combined with Ab/Ag and VL testing, may be more effective than the current strategy. The quality and ability of screening questions to accurately assess risk is key to any pre-donation screening strategy.

Disclosures

All authors: No reported disclosures.
1291. Assessing Uptake of HIV Pre-Exposure Prophylaxis (PrEP) Among High-risk Demographics in a Community-Based Clinic in Brooklyn
Authors: Marryshow Terry , Ojeda-Martinez Hector , Stefanov Dimitre
Published: November 2018

Background

PrEP is a proven, effective means of preventing HIV. Uptake in groups at highest risk of HIV, such as Black men who have sex with men (MSM) and Hispanics, has been disproportionately low nationwide. We analyzed the demographics of PrEP patients in the STAR Health Center in East Flatbush, Brooklyn (BK) to assess our effectiveness in PrEP uptake and retention among at-risk groups.

Methods

We performed a retrospective analysis of 134 consecutive patients who enrolled in our clinic for PrEP between June 2016 and December 2017. We assessed risk factors, demographics, insurance status, location, and retention in care. Retention was defined as completing medical visits within 3 months of prior visit. We compared demographics, sexual practices, and locations of our patients to those among new HIV diagnoses in BK, as reported by NYC Department of Health’s 2016 surveillance report. Fisher’s exact test was used to detect differences in gender, race, and sexual practices.

Results

Only 11.94% of those enrolled in our clinic and prescribed PrEP were women, compared with 27.19% of BK new HIV diagnoses (P < 0.005). There was no statistically significant difference in race, and distributions were similar between the two groups. There was a higher proportion of MSM among those prescribed PrEP (71.64%) compared with BK new HIV diagnoses (46.64%) (P < 0.005). Retention rates were low, with female gender (6/16, 37.5%) and White race (12/32, 37.5%) having the lowest retention in care, compared with Hispanic patients (13/21, 61.90%) who had highest retention. 41.04% of PrEP patients were uninsured. ZIP codes with highest HIV incidence per NYC Department of Health surveillance report were well represented in our clinic for PrEP.

Conclusion

In STAR, PrEP uptake was similar across race and location when compared with people who newly acquired HIV. There was a larger proportion of individuals known to be MSM among those prescribed PrEP. This study shows that STAR’s efforts at targeting at-risk groups are reaching the appropriate demographics. However, there was a detectable disparity in PrEP uptake in women. Research into further interventions to increase PrEP access for women and improve retention overall is needed. Nevertheless, STAR’s program presents a model to follow for other areas with disparities in PrEP uptake among at-risk groups.

Disclosures

All authors: No reported disclosures.
1292. HIV Pre-Exposure Prophylaxis (PrEP) Implementation at Silom Community Clinic in Bangkok, Thailand, 2016–2018
Authors: Kung Vanessa , Pattanasin Sarika , Ungsedhapand Chaiwat , Wimonsate Wipas , Thigpen Michael , Dunne Eileen
Published: November 2018

Background

Since 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent HIV among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand.

Methods

SCC staff routinely counseled MSM and TGW attending HIV voluntary counseling and testing about PrEP. If clients believed that they were at substantial risk of HIV and were interested in PrEP, they could receive PrEP after screening that included HIV and renal function testing. Eligible clients received a 30-day supply of daily oral tenofovir-emtricitabine costing 800 Baht (30 USD), and completed a baseline computer-assisted self-interview (CASI) on knowledge and behaviors. At every 3-month follow-up, PrEP clients had a CASI on adherence; if they were interested in discontinuation of PrEP, they completed a CASI that included reasons for discontinuation. We conducted a descriptive analysis of baseline and follow-up CASI results.

Results

From March 2016 to February 2018, 192 clients were prescribed PrEP, and 80 (42%) continued PrEP for at least 6 months. The median age of clients starting PrEP was 31 years (range, 17–67 years), and 98% were MSM. Overall, most (77%) reported at least 1 of four risk behaviors in the last 3 months; among the 148, 120 (81%) had a sex partner with unknown or positive HIV status, 99 (67%) had anal sex without a condom, 22 (15%) reported an STI, and 16 (11%) received money or goods in exchange for sex. Among the 166 clients who returned for at least one follow-up visit, 135 (81%) completed the CASI at the last follow-up visit; of those, 106 (78%) reported 100% adherence to daily PrEP in the last 7 days, and 126 (93%) reported ≥80% adherence in the last 30 days. Of the 36 clients who discontinued PrEP and completed CASI, 33% reported the reason for discontinuation was no current HIV risk (33%); most (69%) reported that they would consider PrEP in the future.

Conclusion

Most PrEP users reported adherence to daily PrEP, and almost one half of those starting PrEP continued through month six. PrEP use at SCC is dynamic, and commonly started and stopped based on self-assessed risk. Regular review of PrEP implementation, with a focus on client needs, will optimize use of this prevention approach.

Disclosures

All authors: No reported disclosures.
1295. Advancing the PrEP Continuum: A Novel Collaboration Between a Public Health Department and a Federally Qualified Healthcare Center in the Southern United States
Authors: Clement Meredith , Eagle Cedar , Taylor Destry , Goldstein Benjamin , Johnston Barbara , Sena Arlene
Published: November 2018

Background

While pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention, some high-risk persons have limited access to care, particularly Black and Latino men who have sex with men (MSM). Disparities also exist by region: the Southern United States accounts for over half of new HIV diagnoses but only a third of PrEP prescriptions. We evaluated a novel PrEP program based on a collaboration between a local department of public health (DPH) and a federally qualified health center (FQHC) providing care to underserved racial/ethnic minorities in Durham, North Carolina.

Methods

In May 2015, the Durham County DPH and Lincoln Community Health Center, an FQHC, developed a program to offer PrEP services using existing resources. The model included initial no-cost screening for sexually transmitted infections (STIs), hepatitis B/C, and HIV at the DPH STI clinic, followed by referral to the FQHC for PrEP services. We profiled the PrEP continuum for patients starting at program initiation until March 2018. For PrEP initiators and non-initiators, comparisons were made using Wilcoxon rank-sum test for continuous variables, and Chi-square or FisherÕs exact tests as indicated for categorical variables.

Results

Of 196 unique patients evaluated in the STI clinic and referred to the FQHC, 117 (60%) persons attended their initial PrEP appointments. Among these, 84 (43%) filled a PrEP prescription, 69 (35%) persisted in care for at least three months, and 58 (30%) reported >90% adherence at follow-up (see figure). Among those presenting for initial appointments (n = 117), more than half were Black (n = 62, 53%) and 21 (18%) were Latino. Most were MSM (n = 95, 81%) and 9 were transgender. Almost half (n = 55, 47%) were uninsured. We found statistically significant differences between PrEP initiators vs. noninitiators based on race/ethnicity (P = 0.02), insurance status (P = 0.05), and history of sex work (P = 0.05).

Conclusion

A collaborative model of PrEP care between a DPH and an FQHC in the Southern United States was able to reach predominantly Black and Latino MSM at high-risk for HIV. Although this program is sustainable, efforts to improve steps along the PrEP care continuum are still needed in this population.

Disclosures

A. Sena, Gilead: Grant Investigator, Research grant.
1302. Antibiotic Prescribing Knowledge: A Brief Survey of Providers and Staff at an Ambulatory Cancer Center During Antibiotic Awareness Week 2017
Authors: Stohs Erica , Krantz Elizabeth M , Sweet Ania , Zier Jacqlynn , Paleologos Maria , Pergam Steven A , Liu Catherine
Published: November 2018

Background

Antibiotics have contributed significantly to advances in cancer therapy and hematopoietic cell transplantation, but rising antibiotic resistance threatens this progress. Little is known about knowledge and perceptions surrounding antibiotic use and resistance among staff at cancer centers.

Methods

We conducted a brief cross-sectional survey of healthcare professionals (HCP) at a large ambulatory cancer center to assess knowledge of antibiotic prescribing and resistance during Antibiotic Awareness Week, November 13–19, 2017. A convenience sample of providers and staff who participated in one of two 2-hour Antimicrobial Stewardship Program “open house” events was used. Questions evaluated knowledge about antibiotic use for upper respiratory tract infections (URIs).

Results

There were 179 respondents. The proportion of correct responses to each question by employee type is displayed in Table 1. There was a statistically significant decreasing trend in the proportion correctly answering all four questions by employee type from providers, to pharmacists, to nurses, to others (P <0.001) (Figure 1).

Conclusion

Providers were more likely to correctly answer questions pertaining to antibiotic use compared with other HCP. Due to the multidisciplinary nature of cancer care, patients often encounter a variety of HCP over the course of treatment. Opportunities exist to improve antibiotic stewardship education across the spectrum of HCP at our cancer center, including pharmacists, nurses, and other staff.

Disclosures

All authors: No reported disclosures.
1307. Emerging Treatments in Ongoing Battle Against Community-Acquired Bacterial Pneumonia (CABP): The Positive Impact of Online Education
Authors: Hurst Simi , Smith Susan
Published: November 2018

Background

The leading infectious cause of hospitalization and infection-related mortality, pneumonia imparts a significant, but often underappreciated, burden. Agents in the antibiotic pipeline have the potential to improve both individual and public health, as well as support antibiotic stewardship programs

Methods

To address knowledge gaps among ID specialists, a CME/CE-certified, 30-minute, video-based, multidisciplinary panel discussion was developed and posted online on March 27, 2018. Featuring four expert faculty, the activity addressed: The evolving etiology of CABP; Emerging antibiotics for CABP treatment; and Antibiotic stewardship

Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to multiple-choice, knowledge questions and a self-efficacy confidence question were analyzed. A chi-squared test assessed changes pre- to post-assessment. P values <0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Data were collected through April 23, 2017.

Results

A total of 6,146 healthcare providers, including 2,936 physicians have participated in the activity. Data from ID specialists (n = 130) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P = 0.024; V = 0.080) and in several specific areas of assessment (figure). Following activity participation, 34% of ID specialists indicated increased confidence in assessing key attributes of emerging agents and 79% of ID specialists indicated a commitment to incorporate one or more changes into practice. Lastly, the findings uncovered educational needs that require further educational intervention.

Conclusion

Participation in this online educational intervention significantly improved ID specialists’ knowledge with regard to the key similarities and differences between agents in the CABP antibiotic pipeline and the potential role of these agents in patient care. These findings highlight the positive impact of well-designed online education.

Disclosures

All Authors. Nabriva Therapeutics: Independent Medical Education, Educational grant.
1308. Predictors of Career Interest in Infectious Diseases Among US Pharmacy Students
Authors: Jeffres Meghan , Biehle Lauren , Macdougall Conan
Published: November 2018

Background

Pharmacists have a central role in infectious diseases (ID) and antibiotic stewardship efforts across multiple healthcare settings. The demand for pharmacist to fill ID and stewardship-related careers will likely increase as institutions create antibiotic stewardship programs in response to the 2016 Joint Commission standard. The objective of this study was to compare students’ perceptions of their school’s ID curriculum between students interested in an ID career and those who are not.

Methods

A cross-sectional survey study of students graduating from US pharmacy schools was conducted in September 2017. Students received the survey link from the ID faculty at participating schools.

Results

Five hundred thirty-seven students from 28 pharmacy schools completed surveys. Quality of ID didactic education was rated as Very Good by 220 (41%), Good by 219 (40%), Acceptable by 76 (14%), and Poor by 22 (4%) respondents. The most common career interests were ambulatory care (44%), community practice (38%), and infectious diseases (29%). The most common preferred practice settings for students with an interest in ID (n = 157) were inpatient/hospital (86%), inpatient stewardship (70%), and inpatient ID consult service (66%). Differences in responses about didactic ID education between students interested in an ID career and those not interested included: perception of education as Very Good (52% vs. 37%, P = 0.005), faculty providing handouts and/or worksheets (89% vs. 82%, P = 0.009), and the desire for more time allocated to antibiotic stewardship (47% vs. 31%, P < 0.001). Multivariate logistic regression found variables to be predictive of pharmacy student interest in an ID career including: pharmacy school curriculum (OR 2.5, 95% CI 1.5–4.0), perception of a Very Good didactic ID education (OR 1.5, 95% CI 1.0–2.3), and faculty mentor(s) (OR 1.8, 95% CI 1.2–2.7).

Conclusion

Pharmacy students expressing interest in ID as a career had positive views of their didactic ID education, were more likely to report faculty mentorship, and desired more time for antibiotic stewardship in the curriculum. These results can inform efforts to encourage pharmacy students to pursue careers in ID.

Disclosures

All authors: No reported disclosures.
1315. Mind the Gap: Medical Trainees Require Training in Hepatitis C, Drug Use and Mental Health to Help Address the Opioid Crisis
Authors: Corace Kimberly , Ares Isabelle , Schubert Nicholas , Altenberg Jason , Willows Melanie , Kaluzienski Mark , Garber Gary
Published: November 2018

Background

Dramatic increases in acute hepatitis C (HCV) incidence is linked to the opioid epidemic and increased injection drug use. Over 50% of people with HCV also have a mental illness. IDSA/HIVMA calls for the integration of infectious diseases, addiction medicine, and mental health as key to addressing the opioid epidemic. Barriers identified include limited physician education and stigma. This study examined medical trainees’ gaps in training and attitudes toward HCV, drug use, and mental illness.

Methods

Medical students and residents (N = 98) at a large Canadian University completed questionnaires assessing stigma, attitudes, knowledge, and training related to HCV, drug use, and mental illness.

Results

Most participants were medical residents (71%). Within-subjects ANOVAs showed that trainees worked with more patients with mental illness (71%) than drug use (55%) or HCV (21%) (P’s < 0.001). Trainees reported less positive experiences with patients with drug use (34%) and HCV (36%) compared with those with mental illness (55%) (p’s < 0.05). They reported that injection drug use (68%), prescription opioids (66%), and heroin use (59%) were the most challenging substance use problems to treat (P < 0.001). They were less satisfied working with patients with drug use (40%) or HCV (40%) than mental illness (59%) (P’s < 0.01). Trainees reported they were more able to help patients with mental illness (83%) than HCV (65%) or drug use (73%) (P’s < 0.01). Only 34% saw HCV treatment as central to their professional role. Their training better prepared them to treat mental illness (58%) than drug use (41%) or HCV (19%) (P’s < 0.001). They were more interested in training in drug use (76%) and mental health (71%) than HCV (62%) (P’s < 0.01).

Conclusion

Medical trainees report being ill-equipped to treat patients with HCV and drug use (specifically opioids) and are less satisfied with this work. Many report attitudes that may be viewed by patients as stigmatizing. There is a large knowledge gap related to the effectiveness of HCV treatment. Addressing the opioid crisis requires a physician workforce that is prepared to integrate treatment for HCV, drug use, and mental illness. Infectious disease specialists can take a leadership role in building capacity to foster integration.

Disclosures

All authors: No reported disclosures.
1316. An Integrative Approach to Teaching History of Medicine in Medical School
Authors: Slosar-Cheah Magdalena , Nosanchuk Joshua , Pirofski Liise-Anne
Published: November 2018

Background

Medical history plays a foundational role in shaping the characters and habits of thought of developing physicians. Specifically, it cultivates an ability to assess the quality and durability of current knowledge and contributes to the growth of resilience, humility and intellectual curiosity. Especially for Infectious Diseases, knowledge of its history fosters an appreciation for our evolving understanding of the field and an opportunity to spark interest in a future career. Nevertheless, it is hard to find the space for this content amidst competing priorities in the medical school curriculum. An integrative approach has been described as a way to introduce history as a longitudinal component of the existing curriculum. Our aim, using this approach, was to pilot the incorporation of history modules into the Microbiology and Infectious Diseases (Micro/ID) course at Albert Einstein College of Medicine.

Methods

Students participating in Micro/ID were shown four history modules integrated into the existing course. The first was embedded within the introductory lecture and the remaining three were prerecorded videos available through the virtual learning environment. The modules offered context to course material and introduced principles of medical history, such as the potential pitfalls of retrospective diagnosis and changing definitions of disease over time. Comprehension and retention were assessed via two questions on each of two exams. Students had the opportunity to evaluate the course material in both their examination and end-of-course evaluations.

Results

On the first examination, 99% and 68% of students answered correctly. On the second examination, 92% and 54% answered correctly. Student evaluation of the content was positive overall with 91% rating the content satisfactory, very good or excellent. However, some questioned the value of the material while others requested expansion of the modules to include topics such as history of research ethics (Tuskegee and syphilis) and more recent history (the HIV epidemic).

Conclusion

An integrative approach to teaching medical history is largely well-received by students and offers a way to introduce historical topics to an entire class. Comments from students serve as a guide to topics of interest for future iterations of the course.

Disclosures

All authors: No reported disclosures.
1325. HIV, Aging, and Comorbid Conditions: Case-Based, Online Education Improves HIV/ID Specialists’ Management Strategies
Authors: Hurst Simi , Smith Susan
Published: November 2018

Background

Over half of people living with HIV are over 50 years of age. Clinicians must balance HIV care with the management of age-related comorbidities such as, cardiovascular disease, diabetes, liver and kidney disease, and cancer.

Methods

To improve HIV/ID specialists’ ability to develop a comprehensive care strategy for aging men and women living with HIV, a CME/CE/CPE-certified educational intervention comprising two patient case scenarios was developed. It launched on a website dedicated to continuous professional development on March 23, 2018. The interactive, text-based, “test and teach” approach elicited cognitive dissonance; clinicians were presented with multiple-choice questions to evaluate their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to teach. Educational effectiveness was assessed with a repeated pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to three multiple-choice, knowledge questions, and one self-efficacy confidence question were evaluated. A chi-squared test assessed changes pre- to post-assessment. P values of <0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (<0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; >0.26 extensive effect). Data were collected through April 27, 2018.

Results

4,130 HCPs, including 795 physicians, participated in the activity. Data from HIV/ID specialists (n = 76) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P < 0.0001; V = 0.496) and in several specific areas of assessment (figure). Following activity participation, the % of ID specialists who answered all assessment questions correctly increased dramatically: 9% (pre) vs. 88% (post). Additionally, 77% of HIV/ID specialists indicated a commitment to incorporate one or more changes into practice.

Conclusion

Participation in this online, interactive, case-based educational intervention significantly improved ID specialists’ ability to care for aging patients living with HIV. These findings highlight the positive impact of well-designed online education.

Disclosures

S. Hurst, ViiV Healthcare: Independent Medical Education, Educational grant. S. Smith, ViiV Healthcare: Independent Medical Education, Educational grant.
1329. Beyond Reporting: Using an Accreditation Council for Graduate Medical Education (ACGME) Milestone-Linked Evaluation System to Improve Clinical Infectious Diseases Rotations for Baylor College of Medicine Internal Medicine (BCM IM) Residents
Authors: Herrera Lauren Nicholas , Hamill Richard J , Rose Stacey R
Published: November 2018

Background

ACGME requires reporting of trainee performance on specialty-specific “milestones.” Online evaluation platforms facilitate reporting by linking evaluation questions to these milestones. Whether a milestone-linked evaluation system can be used to identify educational strengths and weaknesses within a training program has not been reported.

Methods

In 2016, the BCM IM residency program implemented a milestone-linked evaluation system to increase transparency to residents regarding educational goals and streamline milestone reporting. Residents are evaluated on rotation-specific educational objectives; scores range from 1 to 5 (Figure 1), or “not observed” if the skill was not observed during the rotation. Evaluation data from residents on infectious diseases (ID) rotations between 2016 and 2018 were analyzed to compare performance by post-graduate year (PGY) and to assess curricular strengths and deficiencies.

Results

Two hundred five inpatient and 43 ambulatory ID rotation evaluations were analyzed. In the inpatient setting, mean scores for PGY-1, -2, and -3 trainees were 2.62, 3.06, and 3.88. Residents scored highly on communicating consult recommendations and collecting data from the health record. Residents received lower scores on identifying infections associated with immune deficiencies and in knowledge of antimicrobial spectrum/indications. In the ambulatory setting, mean scores for PGY-2 and -3 trainees were 3.44 and 3.61. Relative to the inpatient setting, more objectives on ambulatory rotations were rated as “not observed.” Objectives with high rates of “not observed” ratings included managing infections in returning travelers (70%); testing/treating latent tuberculosis (63%); interpreting viral hepatitis studies (31%); and managing sexually transmitted infections (25%).

Conclusion

Data from a milestone-linked evaluation system identified educational strengths and weaknesses of clinical ID experiences for internal medicine residents. Objectives with consistently low or “not observed” ratings may be judged as educational deficiencies, and should prompt modifications to the curriculum to provide increased clinical exposure and/or dedicated didactics to help residents develop these important skills.

Disclosures

All authors: No reported disclosures.
1330. Diagnosis and Management of NTM Lung Disease: Effect of Online Educational Interventions on Infectious Disease Specialist Knowledge
Authors: Jackson Edward , Chatterjee Piyali , Smith Susan , Badal Karen , Griffith David E
Published: November 2018

Background

Diagnosis and management of nontuberculous mycobacterial (NTM) lung disease is challenging for clinicians due to its rarity and the need for complicated, multidrug antibiotic regimens. The objective of this study was to determine whether online educational interventions can effectively address knowledge gaps among ID specialists regarding diagnosis and treatment of patients with NTM lung disease.

Methods

Two educational interventions, consisting of a text-based activity with interactive questions, and a video-based discussion between two experts, were developed and made available online. Educational impact of each intervention was assessed using a 3-question repeated pairs pre-/post-assessment study design. Data from a sampling of learners were collected from September 11, 2017 through January 17, 2018. Statistical analyses included a paired (within-physician) two-tailed t-test and McNemar’s χ2 statistic, with Cramer’s V to determine the overall effect of each intervention.

Results

Overall, a total of 1,273 ID specialist learners participated in the two activities from launch through April 30, 2018. Analysis demonstrated a significant improvement (P < 0.05) in overall knowledge with considerable educational impact (V = 0.195 and 0.259). Improvements in specific areas included (figure). Despite gains in knowledge, additional gaps were also identified: (1) Regarding treatment of M. abscessus lung disease, 18% were unable to discern between guideline recommended therapies for M. abscessus and MAC complex NTM, and an additional 14% would treat with a less aggressive, noncurative regimen (n = 211), and (2) regarding treatment of fibrocavitary MAC complex NTM; nearly one-third (31%) would treat a using a thrice-weekly regimen, despite an indication for a daily regimen (n = 114).

Conclusion

Participation in interactive text-based as well as video-based activities improved the ability of ID specialists to make evidence-based decisions in the care of NTM lung disease. The findings also uncovered educational needs that warrant further education in selecting appropriate therapeutic regimens particularly in cases where aggressive therapy is indicated.

Disclosures

E. Jackson, Medscape: Employee, Salary. P. Chatterjee, Medscape: Employee, Salary. S. Smith, BioFire Diagnostics: Independent Medical Education, Educational grant. K. Badal, Medscape: Employee, Salary. D. E. Griffith, Aradigm Corporation: Advisor/consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Bayer Healthcare Pharmaceuticals: Advisor/consultant, Consulting fee. Grifols: Advisor/consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Insmed Incorporated: Advisor/consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Grant recipient and Speaker honorarium.
1333. Developing an Educational Tool to Improve Housestaff Knowledge, Attitudes, and Behavior in Managing Common Infectious Diseases
Authors: Jacob Paul , Person Anna , Bloch Karen , Fiske Christina T , Kuriakose Kevin , Bourgi Kassem , Dougherty David , Dobrzynski David , Staub Milner Owens , Byrge Kelly , Grome Heather , Cohen Caroline , England James , Nair Devika , Kelly Sean
Published: November 2018

Background

Improving internal medicine (IM) trainees skills in managing common infectious diseases is essential to their development as competent physicians. We currently lack quantitative data of the knowledge and attitudes of IM housestaff regarding their management of common infectious diseases. We applied the knowledge, attitude, and behavior model to a pre-intervention survey aimed to uncover housestaff knowledge gaps and discomfort in managing several of the most commonly encountered infectious diseases at our institution. Using this information, we plan to develop a targeted post-survey intervention to increase self-efficacy and improve antimicrobial prescription practices among trainees.

Methods

Survey questions were based on Infectious Disease Society of America (IDSA) guidelines and developed using an iterative process involving interviews of infectious disease physicians and IM housestaff. We chose to focus on cystitis, pneumonia, and skin and soft-tissue infections. The anonymous survey tool was developed using a secure, online platform, and distributed in January 2018. Participation was voluntary and no remuneration for participation was offered.

Results

Out of 165 survey recipients, 50 trainees (30%) responded. Fifty-eight percent of trainees stated that they possessed only an average level of knowledge regarding the management of cystitis, pneumonia, and cellulitis. While 98% of housestaff confirmed that they utilized additional resources for information, only 24% felt routinely comfortable making decisions without an infectious disease consultation. Ninety-six percent of trainees felt that an institution-specific guide describing the management of common infectious diseases would be highly beneficial.

Conclusion

Trainees still lack the knowledge and confidence to make decisions regarding the empiric management of cystitis, pneumonia, and skin and soft-tissue infections at our academic medical center. There is a strong desire for an institution-specific educational resource to provide guidance for these decisions. Increasing trainee self-efficacy and improving their antimicrobial prescription practice patterns should be an educational priority.

Disclosures

All authors: No reported disclosures.
1337. SYN-004 (Ribaxamase) Protects the Gut Microbiome of Patients Treated With Ceftriaxone From Disruption and Reduces the Emergence of Antimicrobial Resistance
Authors: Kokai-Kun John , Le Charles , Trout Kenneth , Cope Julia , Sliman Joseph
Published: November 2018

Background

When β-lactam antibiotics are administered intravenously, a significant portion of each dose can be excreted through the bile into the intestine. This excess antibiotic disrupts the balance of the gut microbiome making the recipient more susceptible to certain infections and can lead to the emergence of antimicrobial resistance. SYN-004 (ribaxamase) is an orally administered β-lactamase designed to be given with IV β-lactam antibiotics (penicillins and cephalosporins) to degrade excess antibiotics excreted into the upper GI tract before they can disrupt the gut microbiome and resistome.

Methods

During a Phase 2b, clinical study with ribaxamase which demonstrated a significant reduction in Clostridium difficile infection in patients receiving ceftriaxone + ribaxamase, longitudinal fecal samples were collected from the patients. DNA extracted from these samples was 16S rRNA and whole genome sequenced, and the sequences were analyzed for changes in the gut microbiome and resistome. Statistical analyses were performed to determine correlations between changes in the gut microbiome and resistome and clinical study data.

Results

Sequence analyses revealed that ribaxamase protected the integrity of the gut microbiome, including preventing enterococcal mono-domination (defined as >30% of the microbiome being from one genus), and identified over 1,300 AMR genes in the gut resistome. LefSe analysis of the gut resistome identified a family of β-lactamases (CfxA) and vancomycin resistance genes which demonstrated a significant increase in placebo-treated vs. ribaxamase-treated patients from pre-to post-antibiotics. Analysis by qPCR supported both new acquisition of these genes and expansion of existing AMR pools. Further statistical analyses demonstrated significant correlations between changes in the gut resistome and clinical study parameters including β-lactamase gene frequency and study drug assignment, and efflux pump gene frequency and vancomycin resistance.

Conclusion

Taken together, these findings demonstrated that coadministration of ribaxamase with IV β-lactam antibiotics can protect the integrity of the gut microbiome and may help limit the emergence of AMR induced by these antibiotics.

Disclosures

J. Kokai-Kun, Synthetic Biologics, Inc.: Employee, Salary. C. Le, Synthetic Biologics, Inc.: Employee, Salary. K. Trout, Synthetic Biologics, Inc.: Employee, Salary. J. Sliman, Synthetic Biologics, Inc.: Employee, Salary.