bluuebunny/crossref_metadata_2025 huggingface dataset:
2356. Standardizing a centralized allocation process for rarely used anti-infective medications across a health system
Authors: Justin Moore W , Dickens Michael , Bland Virginia , Bertram Christie M , Zembower Teresa , Wang Sheila K , Polisetty Radhika S , Postelnick Michael , Hoff Brian M
Published: December 2022

Background

Obtaining scarce antimicrobials used to treat infrequently encountered infections such as malaria have posed a challenge to clinicians and health systems. Due to the rare occurrence of these infections, maintaining adequate, readily available supply for emergent need is challenging, and a lack of clear procurement processes from regional storage sites may contribute to delays in care. In March 2021, artesunate became commercially available for the treatment of severe malaria, a disease for which prompt initiation of therapy is paramount. To improve access to this and other critical but seldom used medications, a centralized storage and allocation process was established throughout our 10-hospital health system. We aim to describe the structure of this program which may serve as a model for other institutions to expedite and streamline access to these lifesaving therapies.

Tracking document for therapy supply management.

Methods

In May 2021, a centralized process was created to track and store rare anti-infective medications for uncommon infections, including those caused by tropical, parasitic, and mycobacterial pathogens (Table 1). Supply is monitored and maintained by clinical pharmacists monthly to ensure adequate courses are available. When needed for a specific patient, infectious diseases physicians and pharmacists recommend therapy which triggers a request to the central pharmacy.

Results

Medications are stored at our large academic medical center (AMC), which manages these cases more routinely compared to other sites. Community hospitals within the health system are able to contact the AMC for prompt distribution of these medications when needed. Since its inception, we have deployed rare use anti-infective medications to partner facilities twice for severe malaria cases, which resulted in expedited receipt of therapy for critically ill patients. The time from therapy recommendation to medication administration was reduced from 12–24 hours to 2–6 hours.

Conclusion

This centralized rare anti-infective medication process expedites and streamlines access for critical therapeutic agents to ensure they are readily available when needed by limiting procurement/storage concerns. This model may be used as a framework for other medications for which timely administration, but rare use, is critical to patient care.

Disclosures

All Authors: No reported disclosures.
2357. Risk Factors for COVID-19 Infection and Outcomes in People Living with HIV
Authors: Hanna John J , Geresu Liyu B , Diaz Marlon , Pickering Madison , Casazza Julia A , Ho Milan , Lanier Heather , Radunsky A L exander P , Saleh Sameh N , Most Zachary M , Perl Trish M , Turer Robert W , Lehmann Christoph U , Chow Jeremy Y , Medford Richard J
Published: December 2022

Background

As the risk for concomitant COVID-19 infection in people living with HIV (PLHIV) remains largely unknown, we explored a large national database to identify risk factors for COVID-19 infection among PLHIV.

Methods

Using the COVID-19 OPTUM de-identified national multicenter database, we identified 29,393 PLHIV with either a positive HIV test or documented HIV ICD9/10 codes. Using a multiple logistic regression model, we compared risk factors among PLHIV, who tested positive for COVID-19 (5,134) and those who tested negative (24,259) from January 20, 2020, to January 20, 2022. We then compared secondary outcomes including hospitalization, Intensive Care Unit (ICU) stay, and death within 30 days of test among the 2 cohorts, adjusting for COVID-19 positivity and covariates. We adjusted all models for the following covariates: age, gender, race, ethnicity, U.S. region, insurance type, adjusted Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and smoking status.

Results

Among PLHIV, factors associated with higher odds for acquiring COVID-19 (Figure 1) included lower age (compared to age group 18–49, age groups 50–64 and >65 were associated with odds ratios (OR) of 0.8 and 0.75, P= 0.001), female gender (compared to males, OR 1.06, P= 0.07), Hispanic White ethnicity/race (OR 2.75, P= 0.001), Asian (OR 1.35, P= 0.04), and African American (OR 1.23, P= 0.001) [compared to non-Hispanic White], living in the U.S. South (compared to the Northeast, OR 2.18, P= 0.001), being uninsured (compared to commercial insurance, OR 1.46, P= 0.001), higher CCI (OR 1.025, P= 0.001), higher BMI category (compared to having BMI< 30, Obesity category 1 or 2, OR 1.2 and obesity category 3, OR 1.34, P= 0.001), and noncurrent smoking status (compared to current smoker, OR 1.46, P= 0.001). Compared to PLHIV who tested negative for COVID-19, PLHIV who tested positive, had an OR 1.01 for hospitalization (P = 0.79), 1.03 for ICU stay (P=0.73), and 1.47 for death (P=0.001).

Conclusion

Our study found that among PLHIV, being Hispanic, living in the South, lacking insurance, having higher BMI, and higher CCI scores were associated with increased odds of testing positive for COVID-19. PLHIV who tested positive for COVID-19 had higher odds of death.

Disclosures

Christoph U. Lehmann, MD, Celanese: Stocks/Bonds|Markel: Stocks/Bonds|Springer: Honoraria|UTSW: Employee Jeremy Y. Chow, M.D., M.S., Gilead Sciences: Grant/Research Support.
2031. Role of Urine Culture Hard Stop in Reducing Catheter-associated Urinary Tract Infections
Authors: Cherian John , Tibbetts Robert , Robinson Paula , Holsey Tarlisha , Alangaden George J , Suleyman Geehan
Published: December 2022

Background

Catheter-associated urinary tract infection (CAUTI) is one of the most commonly reported healthcare associated infections (HAI) reported to the National Healthcare Safety Network (NHSN). However, asymptomatic bacteriuria is common in patients with indwelling urinary catheters (IUC), and inappropriate culturing leads to overdiagnosis in colonized patients, unnecessary antibiotics and increased resistance. We evaluated the effectiveness of an electronic medical record (EMR) “hard stop” in reducing inappropriate urine cultures (UC) and its impact on CAUTI rates.

Methods

This was a pre-post quasi-experimental retrospective study comparing CAUTI rate per 1000 catheter days, UC order rate per 1000 patient days, Standardized Utilization Ratio (SUR) and Standardized Infection Ratio (SIR) in the pre-intervention period (January 2019-December 2020) to the intervention period (April 2021-March 2022) in Southeast Michigan. In March 2021, we implemented a hard stop in Epic® that fired 24 hours after admission in patients with IUC >1 calendar day and until 4 days after IUC removal. The Medical Director of Infection Prevention and Control had the ability to override the hard stop when indicated after reviewing the case upon provider request; education was provided in real-time. We prospectively monitored outcomes, including pyelonephritis and/or bacteremia within 3 days and readmission for sepsis within 30 days in patients UC was deemed unnecessary.

Results

CAUTI rate was 0.52 in the pre-intervention period and 0.09 in the post-intervention period, an 83% reduction (Figure 1). Rate of UC performed was 0.283 in the pre-intervention period and 0.218 in the post-intervention period, a 23% reduction. SUR decreased from 0.809 to 0.716, an 11% reduction (95% CI, 0.875-0.894, p< 0.001). SIR decreased from 0.392 to 0.135, a 66% reduction (95% CI, 0.154-0.0689, p=0.0015). Post-intervention, there were 44 override requests that were denied with no adverse patient outcomes.

Conclusion

Urine culture stewardship, utilizing an electronic hard stop, was effective in reducing inappropriate UC orders, SIR and SUR in patients with IUC without causing patient harm. This strategy combined with real-time education can significantly reduce CAUTI rates.

Disclosures

All Authors: No reported disclosures.
2032. Sources of Primary Bloodstream Infections in Internal Medicine Patients – a Cohort Study
Authors: Oster Yonatan , Ben-yosef Yonatan , Cohen Matan , Schwartz Carmela , Benenson Shmuel
Published: December 2022

Background

The sources of bloodstream infections (BSIs) in internal-medicine patients, on admission and during hospitalization, are not well-defined. We wish to evaluate these infections and determine the proportion of BSIs in which no secondary cause could be defined (i.e. primary-BSI).

Methods

We analyzed all BSIs at the internal-medicine wards of the two campuses of the Hadassah Hebrew-University Medical Center, during 2017-2018. We defined the BSI source of each event (secondary, Central-line associated BSI (CLABSI) or primary non-CLABSI) and compared BSIs present on admission (POA) to hospital acquired (HA).

Flow chart of the classification of bloodstream infection (BSI) events in the internal medicine wards 2017-2018.

Results

There were 595 patient-unique BSI events, 316 (53.1%) POA-BSI and 279 (46.9%) HA-BSI. Overall, 309 (51.9%) were secondary, 194 (32.6%) primary non-CLABSI and 92 (15.5%) CLABSI. Primary non-CLABSI in the POA-BSI group was 20.6% vs. 46.2% in the HA-BSI group (p=0.001). The length of hospital stay (LOS) from culture to discharge of the HA-BSI group was longer than in the POA-BSI group (mean LOS, 19 days vs. 13.6 days, p=0.01) and the mortality rate was higher (48.7% vs. 19%, p=0.001). Staphylococcus aureus was more common in primary non-CLABSI than in CLABSI and secondary BSI (29.5%, 12.8% and 16.2%, respectively).

Conclusion

The proportion of primary non-CLABSI among HA-BSI events is very high (46.2%). The absence of any plausible source for these BSIs, and the fact that most patients in Internal-medicine wards have peripheral lines, suggests that the peripheral catheter is a probable source for primary non-CLABSIs. Measures to prevent peripheral line associated BSI (PLABSI), similar to those implemented successfully for the prevention of CLABSI, should be considered.

Disclosures

All Authors: No reported disclosures.
2037. Epidemiology and Preventability of Hospital Onset Bacteremia and Fungemia in two Hospitals in India
Authors: Gandra Sumanth , Singh Sanjeev , Chakravarthy Murali , Moni Merlin , Dhekane Pruthu , Mohamed Zubair , Kumar Anil , Kaushik Arun , Shameen Fathima , Senthil Priyadarshini , Saravanan Tejaswini , George Anu , Sinclair Dorothy , Stwalley Dustin , van Rheenen Jacaranda , Westercamp Matthew , Smith Rachel Mann , Leekha Surbhi , Warren David K
Published: December 2022

Background

The National Healthcare Safety Network (NHSN) central line-associated bloodstream infection (CLABSI) is a widely accepted quality measure. However, studies from the United States indicate that NHSN reportable CLABSIs account for less than 20% of all hospital-onset bacteremia and fungemia (HOB, i.e., any positive blood culture obtained at least 3 calendar days after hospital admission) events and about 66% of all HOB events are potentially preventable. The incidence and overall preventability of HOB is unknown in low and middle-income countries (LMICs). This study evaluated the epidemiology and preventability of HOB in two hospitals in India.

Methods

Six months data on all consecutive blood cultures processed in two hospitals (Hospital A- 8.16.2020 to 2.15.2021; Hospital B- 1.1.2021 to 6.30.2021) were collected prospectively to calculate HOB and CLABSI incidence. Correlation between HOB and CLABSI rates was assessed using Spearman’s rank correlation. Medical records of 300 consecutive HOB events were retrospectively reviewed to determine the source and preventability of HOB utilizing a structured guide developed for the study.

Results

Among 3,558 hospitalized patients from whom blood cultures were obtained, 10.4% developed HOB with 409 unique HOB events (HOB incidence: 2.87 per 1000 patient-days). Only 15% (59 of 409) of HOB events were reported as CLABSI as per hospital CLABSI surveillance programs. The CLABSI rate was 4.4 per 1000 central line-days. There was a moderation correlation (r=0.51; p=0.07) between HOB and CLABSI rates. Among the 300 HOB events for which medical records were reviewed, the most common organism isolated was Klebsiella pneumoniae and 75% of K. pneumoniae were carbapenem resistant (Figure 1). The most common source of HOB was CLABSI (26.3%) (Figure 2). Fifty-two percent of all HOB events and 45% of HOB events not attributable to contaminants were potentially preventable (Figure 3). CLABSIs accounted for 69% of non-contaminant HOB preventable events.

Conclusion

We found that 69% of the non-contaminant related HOB preventable events were due to CLABSI. Prevention efforts in these hospitals could focus on CLABSI to reduce HOB rates while additional studies are performed to better understand the epidemiology of HOB in LMICs.

Microorganisms identified from 300 Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India.

Source of Hospital Onset Bacteremia and Fungemia Events in Two Hospitals in India (n=300).

Preventability Rating Source of Hospital Onset Bacteremia and Fungemia events in Two Hospitals in India (n=300).

Disclosures

All Authors: No reported disclosures.
2055. Trends in the Incidence of Carbapenem-Resistant Enterobacterales (CRE) and Carbapenemase Producing CRE (CP-CRE) in Davidson and Surrounding Counties, Tennessee, 2016-2021
Authors: Villegas Raquel , Hitchingham Erin , Wilson Christopher , Gambrell Ashley , Mounsey Jackie , Muleta Daniel
Published: December 2022

Background

The spread of Carbapenem-resistant Enterobacterales (CRE) continue to be a public health threat. Tennessee has participated in the Multidrug-Resistant Gram-Negative Bacilli Surveillance Initiative (MuGSI) since 2014. We investigated our data to describe the trends of CRE and CP-CRE and their changes during the COVID-19 outbreak.

Methods

Population-based surveillance targeting selected CRE organisms was conducted in Davidson County and seven surrounding counties in Tennessee. A CRE case was defined as isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. resistant to ≥1 carbapenem from a normally sterile body site or urine, in a surveillance area resident. A case was identified as incident if it was reported for the first time in the surveillance year or was a subsequent report of a case ≥30 days after the last report. The Tennessee state public health laboratory tests for carbapenemase production on CRE isolates received from clinical laboratories. The data analysis was conducted using SAS software version 9.4.

Results

474 incident CRE cases were reported from 2016 to 2021. Females made up 68.63% and the average age was 65 years for both sexes.

The incidence rate of CRE cases increased throughout study period and the rate in 2021 was 1.8-fold of 2016 (lowest rate for the study period) (P-value< 0.001). The incidence rate of CP-CRE increased in 2017 and 2018 compared to 2016 (p-value=0.01). The incidence rate for CP-CRE declined to the lowest level in 2020 (0.3 per 100,000 population). In 2021, the CP-CRE rate significantly increased compared to 2020 (p-value=0.02). The carbapenemase production (CP) positivity rate was also significantly higher in 2017(28.8%), 2018 (26.6%), and 2021 (25.8%) compared to the year 2020 where the positivity rate was the lowest (10.0%) (P-value< 0.05).

Conclusion

The transmission of CP-CRE cases decreased during the years prior to the COVID-19 outbreak despite the steady increase in CRE cases. The transmission of CP-CRE gained momentum during the COVID outbreak as evidenced by an increased infection rate and CP positivity rate in 2021. Renewed focus on implementing coordinated infection prevention strategies is likely to contribute to reducing the spread of antimicrobial-resistant pathogens.

Disclosures

All Authors: No reported disclosures.
2058. Effect of Covid-19 lockdowns on identification of advanced HIV disease in outpatient clinics in Uganda
Authors: Sekar Preethiya , Nalintya Elizabeth , Kavuma Paul , Kigozi Joanita , Ssuna Martin , Kirumira Paul , Naluyima Rose , Namuli Teopista , Skipper Caleb , Hullsiek Kathy Huppler , Boulware David R , Meya David , Rajasingham Radha
Published: December 2022

Background

Despite HIV test and treat initiatives, the World Health Organization (WHO) estimates that 25% to 40% of persons living with HIV (PLWH) have advanced HIV disease (CD4< 200 cells/mcL). The objective of this study is to understand how the Covid-19 pandemic affected identification of persons with advanced HIV disease in Ugandan HIV clinics.

Methods

We retrospectively reviewed data from 67 HIV clinics surrounding Kampala, Uganda. As part of routine data collection for PEPFAR reporting, number of persons entering care by clinic and number of persons presenting with CD4< 200 cells/mcL were summarized by month between July 2019 and January 2022. We used the Johns Hopkins Coronavirus Resource Center website to summarize Ugandan Covid-19 cases by month. Covid-19 lockdown dates were taken from the Ugandan government’s COVID-19 information website. Specifically, between March and May 2020, there was a period of strict lockdown where public transportation was halted. Between May and July 2020 there was a less stringent lockdown (public transportation was available, but schools and many businesses remained closed). Again between June and July 2021 a strict lockdown occurred.

Results

Prior to the Covid-19 pandemic, between July 2019 and February 2020, an average of 16% (265/1675) of PLWH presented monthly with advanced HIV disease. During Covid-19 lockdowns from March 2020 to July 2020, only 9% (102/1124) of PLWH presented with advanced HIV disease. During the period of lockdown, there was a 33% reduction in the monthly average number of PLWH presenting to HIV clinics, and a 62% reduction in the monthly average number of PLWH presenting with advanced HIV disease. From February 2021 to January 2022, 18% (185/987) of PLWH presented with advanced HIV disease. During this period, there was a 42% reduction in the number of persons presenting to HIV care; of those who presented, a larger portion presented with advanced HIV disease.

Conclusion

The Covid-19 lockdowns negatively affected presentation of PLWH to care, most significantly among persons with advanced HIV disease. This reduction in presentation to care has persisted and not recovered to pre-Covid levels. In the past year, 18% of PLWH presented with advanced HIV disease.

Disclosures

All Authors: No reported disclosures.
2065. Increasing the HIV screening rates in Rural Syringes Service Programs
Authors: Collins Jana , Soria Jaime , Thacker James , Corby-Lee Greg , White Connie , Johnson Tisha , Hoven Ardis , Thornton Alice C
Published: December 2022

Background

The Kentucky Income Reinvestment Program (KIRP) is a statewide reinvestment of income generated by the Ryan White HIV/AIDS Program (RWHAP) Kentucky AIDS Drug Assistance Program, which provides comprehensive early intervention services targeting those at the highest risk for HIV infection. The objective of this study was to compare the HIV screening rates in persons who inject drugs (PWID) at Syringe Service Programs (SSP) supported by KIRP versus SSPs not supported by KIRP in Kentucky

Methods

A cross-sectional study was conducted on 54 SSPs. We compared the HIV screening rates in the first quarter of 2020, 2021, and 2022. Fisher's exact test compared the HIV screening rates between the KIRP supported SSPs (KSSP) versus Non-KIRP supported SSPs (NKSSP). Study data were collected and managed using REDCap electronic data capture tools hosted at Kentucky Department for Public Health. The statistical analyses were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results

The analysis included data of 21,072 PWID who attended the SSPs utilizing the REDCap electronic data capture tool during the study timeframe. In the first quarter of 2022, a total of 1,607/4795 (33.5%) PWID were screened for HIV at KSSP vs 12/482 (2.5%) at NKSSP (p=< 0.001). The difference in the screening rates has increased over the years since the KIRP began in 2019 (Figure 1).

Conclusion

The HIV screening rate in PWID has increased significantly in the SSPs supported by KIRP through RWHAP program income early intervention funds. This increase has occurred mainly in rural counties where people who inject drugs remain a significant population at risk for new HIV infections.

Disclosures

All Authors: No reported disclosures.
2069. Prevalence of Cabotegravir and Rilpivirine Resistance Associated Mutations Among Treatment Experienced Patients in a South Carolina Outpatient Clinic
Authors: Vivian Tsai Y , Pizzuti Morgan , Deaney Michael , Bookstaver P Brandon , Ahuja Divya , Derrick Caroline
Published: December 2022

Background

Cabotegravir/rilpivirine (CAB/RPV) long-acting (LA) injectable was recently approved as a switch therapy for people living with HIV (PLWHIV) who are virologically suppressed on oral combination antiretroviral therapy (cART). Data demonstrates RPV resistance associated mutations (RAMs) correlated with CAB/RPV treatment failure. This is the first real-world retrospective, observational study evaluating epidemiology of RPV and CAB RAMs in a heavily treatment experienced population of PLWHIV.

Methods

A cohort of PLWHIV were screened for transition eligibility to CAB/RPV therapy in a large clinic in the Southeastern U.S. between April 1, 2021 and January 31, 2022. The following baseline characteristics were collected: gender, age, race, Charlson Comorbidity Index, current cART, and prior cART exposure. The Stanford University HIV Drug Resistance Database was utilized to evaluate the inferred resistance level for reverse transcriptase (RT), integrase strand transfer inhibitor (INSTI), and protease inhibitor (PI) sequences.

Results

Among 115 patients included, 64.3% were males who were predominately African American (83.4%), with a median age of 37 years old and Charlson Comorbidity Index of 1.65. Ten (8.69%) individuals had at least one RPV or CAB RAM. Among these, 7 (6%) and 3 (2.6%) displayed RPV and CAB resistance, respectively. The most prevalent types of RAMs for RPV specifically were Y181I/C (n = 4) and E138A (n = 2). Five of 7 individuals with RPV RAMs had history of cART use without documented exposure to RPV-containing regimens. Moreover, 2 of 3 individuals with CAB RAMs had history of cART with exposure to an integrase-containing regimen.

Conclusion

This is the first study that characterizes susceptibility patterns that may affect CAB/RPV in clinical practice. Within this rural Southeastern population, prevalence of RPV RAMs is higher than CAB RAMs, and RPV RAMs were commonly observed as transmitted resistance whereas CAB RAMs were typically associated with prior history of exposure to INSTI-containing regimen. It is pertinent to assess the genotypic resistance profile of RTs and history of cART exposure prior to transitioning to CAB/RPV to decrease the risk of virologic failure due to RAMs.

Disclosures

P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
2074. Analysis of Current Pharmacy Statutes and Regulations Governing Pharmacists' Authority to Administer Cabotegravir (CAB) for PrEP in the United States (US)
Authors: Colangeli Hailey
Published: December 2022

Background

The Ending the HIV Epidemic initiative aims to increase PrEP use among eligible Americans to 50% by 2030. As one of the most widely accessible healthcare providers, pharmacists are well positioned to support these efforts. The latest advancement in HIV prevention—long-acting injectable CAB for PrEP—offers a novel solution to the adherence challenges of oral regimens. Understanding the current landscape of medication administration privileges for pharmacists is critical to facilitating uptake of CABr and preventing HIV transmission.

Methods

This was a cross sectional analysis of state pharmacy statues and regulations from 50 US states and the District of Columbia (States). Data were obtained from publicly accessible, official websites of the regulatory agencies with jurisdiction over the practice of pharmacy in each respective state. We analyzed current laws in effect as of February, 2022 in accordance with best practices for legal mapping. Using a standardized analysis algorithm, we determined the impact of state laws on pharmacists’ ability to administer CAB.

Results

Current state legislature allows administration of CAB by pharmacists in 44 States (80.3%). Broad authority is granted in 28 states (55.0%) where administration is defined within scope of practice. In 5 states, pharmacists can administer injectable medications if the prescription order contains explicit instructions for pharmacist administration, or a standing protocol. Among 8 states that require a collaborative practice agreement for CAB administration, 3 currently allow pharmacists to administer other long acting injectable medications without restrictions. Of the 6 states where pharmacist administration of CAB is prohibited, 2 allow administration of similar formulations. Private rooms for gluteal injections are only required in 13 states. Furthermore, treatment-specific training is only required in 3 laws, while 11 require completion of relevant continuing education.

Conclusion

Considerable variation exists among state laws governing the practice of pharmacy. Differences in scope of practice definition, medications expressly discussed, and continuing education and training requirements limit the ability of pharmacists to facilitate PrEP uptake through administration of cabotegravir.

Disclosures

All Authors: No reported disclosures.
2076. Increased awareness but persistently restricted access to pre-exposure prophylaxis against HIV (PrEP) in an urban midwestern community
Authors: Uhlar Adrianna , Lewis Steven A , Bogorodskaya Milana , Avery Ann A
Published: December 2022

Background

Pre-exposure HIV prophylaxis (PrEP) was approved by the United States Food and Drug Administration in 2012, but uptake of PrEP by individuals in the community has been slow, especially among populations at high risk for HIV. Our study aims to assess changes in PrEP awareness and access between 2015 and 2020, during which a major community-wide PrEP awareness campaign was initiated in our community.

Methods

We surveyed patients at three sexually transmitted infection clinics in Cleveland, Ohio in 2015 and 2020. The participants’ involvement was voluntary and anonymous. Participants were asked questions regarding demographics, sexual behavior, and awareness and access to PrEP.

Results

Of the 910 and 262 patients surveyed in 2015 and 2020, 31.4% and 20.9% were ≥ 24 years old, 54.2% and 83.2% were Black, and 11.3% and 7.6% were men who have sex with men (MSM), respectively. PrEP awareness increased from 2015 to 2020 (18.0% vs. 57.7%, p< 0.001) while knowledge on how to access PrEP improved but remained low (18.1% vs. 32.0%, p< 0.001). PrEP awareness among Black MSM increased from 41.9% to 72.7% (p=0.02) and in 2020, there was no significant difference in PrEP awareness between Black and non-Black MSM (72.7% vs. 88.9%, p=0.56). Knowledge of access to PrEP was similar among Black and non-Black MSM (44.4% vs. 54.6%). Among Black women who have sex with men (WSM), PrEP awareness increased from 12.9% to 62.0% (p< 0.001) and knowledge of access to PrEP increased from 19.0% to 38.2% (p = 0.001). However, there remained a non-significant difference in knowledge of PrEP access between Black and non-Black WSM in 2020 (38.2% vs. 62.5%, p=0.07). Logistic regression adjusted for year, age, and MSM population showed Blacks were still less likely to be aware of PrEP compared with non-Blacks (OR 0.69, 95% CI 0.49, 0.98).

Differences in PrEP awareness and access between Black and non-Black men who have sex with men (MSM) in 2015 and 2020.

* p< 0.05

Difference in PrEP awareness and access between Black and non-Black women who have sex with men (WSM) in 2015 and 2020.

Conclusion

We observed an increase in PrEP awareness and knowledge of how to access PrEP between 2015 and 2020, especially among the Black population. However, when adjusted for year, age, and sexual preference, Blacks were still less likely to be aware of PrEP compared with non-Blacks. Knowledge on how to access PrEP remains low in the community regardless of race. With increased awareness of PrEP, novel approaches to increase knowledge of PrEP access are needed to address health disparities in our community.

Disclosures

All Authors: No reported disclosures.
2363. Clinician Educators within Infectious Diseases Society of America (IDSA): Who We Are, What We Do, and What We Need to Succeed
Authors: Zimmer Andrea J , Barsoumian Alice E , Hsu Jennifer , Walker Jeremey , Summers Nathan A , Derber Catherine , Allen Bradley L , Ressner Roseanne , Kershaw Colleen , Luther Vera
Published: December 2022

Background

To best support, its membership, the IDSA Medical Education Community of Practice (Med Ed CoP) must know the spectrum of educational duties, common challenges, and needs among its clinician educators (CE). Further, benchmark data for medical education is lacking, including average time to perform duties, salary support, and other resources. Therefore, we conducted a survey to help identify opportunities for institutions and IDSA to support Infectious Disease (ID) CE.

Methods

We conducted an anonymous electronic mixed-methods survey of ID CE faculty in the United States. The survey link was distributed through the IDSA Med Ed CoP and Program Director discussion forums and receptions at IDWeek 2021.

Results

Approximately 90/552 (16%) participants completed a majority of the survey. Respondents were evenly distributed by gender and geographic region. A majority of respondents were Caucasian, aged 30 – 49 years, and at the Assistant or Associate Professor level (Table 1). Overall breakdown of allocated duties is as follows; median education full-time equivalent (FTE) was 0.25, clinical FTE=0.50, administrative FTE=0.16, and research FTE=0 (Table 1). Faculty most commonly taught medical students (95%), physician residents (92%), and fellows (88%) and held positions within ID fellowship programs (69%) and medical schools (50%, Table 2). CE's common challenges included competing responsibilities (69%), lack of medical education mentorship (51%), and inexperience in medical education publication (67%). In addition, 77% reported burnout in the past year, frequently due to an increased pandemic-related workload. CEs would like to see opportunities for IDSA grants, advocacy for salary support, and increased opportunities to publish within IDSA journals. CEs report finding reward in their educational work related to: teaching the next generation, developing relationships with learners and colleagues, and promoting others’ success.

Conclusion

In our study, ID CEs identified common challenges including educational work often requiring more time than allocated FTE, lack of mentors, publishing educational activities, recognition of CE work for promotion, and burnout. Additionally, ID CEs identified practical strategies in which their institutions and IDSA can offer support.

Disclosures

All Authors: No reported disclosures.
2083. HIV Testing Rates in NC Emergency Departments Before and During Covid Mitigation
Authors: Leonard Michael , Thomas Jeremy , Tapp Hazel , Ludden Thomas
Published: December 2022

Background

During the early stages of the COVID-19 pandemic, non-emergent services were limited or suspended in multiple ways. Restrictions in primary care may have limited STI testing, such as HIV, where timely access to testing and care is critical to mitigation efforts. Conversely, Emergency Departments (ED) operated with fewer restrictions and more in-person options. Even though patient census numbers decreased in some areas from those seen pre-covid lockdown, EDs and hospitals often became overwhelmed with patients seeking care for both severe acute illness but just importantly services that might normally have been received in outpatient settings.

Methods

Observational study of HIV screening year-over-year in four EDs that are part of a large healthcare system located in the Southeast. Screenings of individuals 18 and over seen in the EDs were normalized per 1000 patients. Rates were also compared to two primary care clinics, located in the same metropolitan area, serving mainly Medicaid and uninsured patients.

Results

From March 2019 through February 2020 there were 33.47 tests per 1000 patients at two community clinics and 7.79 tests per 1000 patient at four EDs located in the same region during that span. From March 2020 to February 2021, screening numbers in the primary care clinics dropped to an average of 22.7/1000; however, screenings in the ED remained stable and slightly increased to 10.7/1000. From March 2021 to February 2022, screenings in the primary care clinics returned to an average 36.9/1000 with screenings in the ED still above pre-covid levels at 9.48/1000. These trends in the ED screening remained consistent across gender, race, and ethnicity.

Patient census at four ED sites located in the southwestern region of North Carolina dropped significantly during the first year of physical distancing covid-19 mitigation measures when compared to the two years prior. These census numbers increased during the second year of covid-19 but failed to return to previous levels.

During the first year of physical distancing covid-19 mitigation measures HIV testing rates in the emergency department remained constant, and even increased in more urban areas, despite the significant decrease in overall patient census.

Conclusion

With the observation that HIV screening decreased in primary care settings during the beginning of the covid-19 pandemic, there exists the possibility that new HIV infections may yet remain undiagnosed. That HIV testing remained constant in the ED, however, reinforces the importance of having embedded procedures in place for screening and linking both newly positive and at-risk patients into care to help mitigate the HIV epidemic.

Disclosures

All Authors: No reported disclosures.
2086. PrEP Knowledge and Use among Reproductive Age Women in Miami, Florida
Authors: Nogueira Nicholas Fonseca , Luisi Nicole , Salazar Zetina Ana S , Raccamarich Patricia , Klatt Nichole R , Jones Deborah L , Alcaide Maria L L
Published: December 2022

Background

Miami, FL is the epicenter of the HIV epidemic in the US, with 20% of new HIV infections occurring in women. Despite the effectiveness of PrEP, only 10% of eligible women benefit from its use. This study evaluates PrEP awareness and use, and factors associated with PrEP awareness among reproductive age sexually active women in Miami.

Methods

From 2018 to 2022, cis-gender, HIV-negative, 18-45-year-old, sexually active women were recruited as part of a study evaluating HIV risk. Participants completed questionnaires assessing socio-demographics, HIV risk behaviors, prior HIV testing, PrEP awareness and use, and were tested for STIs (chlamydia, gonorrhea, trichomoniasis) and bacterial vaginosis (BV). Factors associated with PrEP awareness were analyzed by Chi-square, Fisher’s exact test, or studentized t-test. Multivariable logistic regression (MLR) was performed to identify factors associated with PrEP awareness.

Results

295 women were enrolled; median age 31 (24-38) years, 49% Black, 39% White, 34% Hispanic, 46% income below poverty line, 24% consistent condom use, 1.6 (±2.57) mean number of partners in the previous month, 80% heterosexual, 73% previously tested for HIV, 22% STI, and 50% BV. Of the 63% who knew about PrEP, only 5% were on PrEP. Women aware of PrEP were more likely to be Black, non-Hispanic, have income below poverty line, non-heterosexual, report prior HIV testing, and have a STI or BV (all p< 0.05). Condom use and number of partners were not associated with PrEP awareness. In MLR, women with income below poverty line (OR=2.00 [1.04,3.87]; p=0.04), more sexual partners (OR=1.30 [1.01,1.68]; p=0.04), prior HIV testing (OR=6.42 [2.83,14.52]; p< 0.01), and BV (OR=2.28 [1.18,4.40]; p=0.01) were more likely to be aware of PrEP. Lower odds of PrEP awareness were associated with being Black (OR=0.38 [0.15,0.96]; p=0.04), Hispanic (OR=0.18 [0.08,0.39]; p< 0.01), Heterosexual (OR=0.29 [0.11,0.77]; p< 0.01), and reporting occasional condom use (OR=0.21 [0.08,0.56]; p< 0.01).

Conclusion

Despite broad PrEP awareness, PrEP use is alarming low among those women at greatest risk. HIV testing presents an opportunity to increase PrEP awareness, but interventions to increase PrEP uptake are needed to end the HIV epidemic among women.

Disclosures

Maria L L. Alcaide, MD, Gilead: Advisor/Consultant.
2091. Transgender Adolescents of Color and HIV: Unique Challenges in Preventing New Infections
Authors: Collins-Ogle Michelle , Garcia Matthew , Acevedo Sahara
Published: December 2022

Background

An estimated HIV prevalence of 9.2% for all transgender persons nationally with a significantly higher prevalence for transgender women at 14.1%. A paucity of published data exists defining the risk of HIV in transgender or non-binary (TGNB) youth of color. The Bronx has the highest incidence of homelessness and the highest unemployment rate in the country, which peaked at 24.6% during COVID19. We assessed SDOH in TGNB youth of color and the impact on their ability to prioritize and access HIV prevention.

Methods

An assessment of sexually active TGNB youth 14-27 years (N=101) in 2021-2022 was conducted to evaluate potential barriers to HIV prevention by querying the 4 U's: 1) Unemployed 2) Uninsured / Underinsured 3) Unstable housing and 4) substance Use disorder. The assessment also integrated questions about gender affirmation, HIV / STI prevention. Information obtained was used to assess knowledge gaps that affect their understanding of HIV risk. Based on the results, a research tool, ARTISTA (Assess Risk for Transmitted Infections in Sexually active Transgender Adolescents) was implemented to improve gaps in understanding HIV / STI risk in TGNB youth. Ultimately, ARTISTA can be used to influence policies for HIV Prevention in this population.

Results

Patient's mean (+sd) age was 20 (+ 2.7) years, 50% were trans female, 50% trans male, 66% were youth of color. Gender affirming care was associated with increased odds of STI testing (adjusted odds ratio = 1.90 95% confidence interval = 1.33-2.73 with no relation to gender identity. Despite awareness, initiation of PrEP and adherence among trans females was disappointing. Trans females, 24%(10/41) initiated PrEP, 2 seroconverted; 1 stopped and 7 are 70% adherent to daily oral PrEP. Unemployment (23%), Unstable housing (11%), Uninsured (10%) and Substance Use disorder (40%) were priorities over prevention.

Conclusion

Gender affirmation is associated with an opportunity to improve awareness of HIV / STI prevention. ARTISTA assessment reveals it's not just about PrEP, but about the social / structural barriers to access and uptake. SDOH must be addressed in this population if we are serious about ending the epidemic.

Disclosures

All Authors: No reported disclosures.
2104. Cytomegalovirus DNAemia Patterns in Mismatched Solid Organ Transplant Recipients: A Retrospective Cohort Study.
Authors: Garcia Oscar A Fernandez , Kabbani Dima , Doucette Karen , Robbins Mark , Cervera Carlos
Published: December 2022

Background

Cytomegalovirus (CMV) seronegative solid organ transplant (SOT) recipients who receive grafts from seropositive donors are at high risk of CMV disease. Antiviral prophylaxis in usually given to this group of patients to prevent illness. Patients are still at risk of CMV after completion of prophylaxis. Surveillance after prophylaxis is used in some centres to prevent late CMV disease, but there is scant information of its efficacy. Finally, little is known on CMV kinetics post-prophylaxis in high-risk patients.

Methods

This was a retrospective cohort study including adult CMV mismatch (D+/R-) SOT recipients between 2003-2017 at a multiorgan transplant center in Canada. Post-prophylaxis CMV kinetics were classified into 3 patterns of DNAemia: no DNAemia, single episode of DNAemia and recurrent episodes of DNAemia. We calculated the cumulative incidence of each DNAemia pattern. We also compared 5-year mortality according to CMV DNAemia pattern by Cox-regression analysis. Patients were monitored weekly with CMV viral load for 12 weeks after completion of prophylaxis.

Results

Two-hundred and forty-five transplant patients were included (Table 1). Median follow up time was 9.2 years (7-12.7). Death occurred in 32 patients during the study period, the median time to death was 7.3 years (4.9-10). Pattern 1 (no CMV DNAemia) occurred in 38%, 27% had a single episode (pattern 2) of CMV DNAemia and 35% had recurrent (pattern 3) CMV DNAemia. Median time to DNAemia was 186 days. The first episode occurred at a significantly shorter interval in liver recipients when compared to non-liver recipients, 158 days (134-217) vs. 208 days (149-315), p=0.0164. Recurrent CMV DNAemia (pattern 3) was significantly more common in lung transplant recipients compared to non-lung transplant recipients. (63% vs. 32% p=0.003).

Mortality at 5 years was statistically not different between CMV patterns, adjusted by organ transplanted and age (Pattern 1 reference; pattern 2 HR 1.484 [0.24-9. Table 1.Population characteristics.* Includes 16 simultaneous kidney-pancreas, pancreas after kidney or pancreas alone, 1 combined liver-kidney, 1 multivisceral. ATG: Anti-thymocyte globulin.

Conclusion

A surveillanceafter prophylaxis strategy allowed us to characterize the CMV kinetics post-prophylaxis, with 35% of CMV mismatch patients having recurrent CMV episodes. CMV kinetic pattern was not associated with 5 years mortality in CMV high-risk patients.

Disclosures

Carlos Cervera, Associate Professor, Astra-Zeneca: Advisor/Consultant|AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|Lilly: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Sunovion: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Honoraria|VerityPharma: Advisor/Consultant.
97. A Cross-kingdom Vaccine Protects against Multiple Healthcare-associated Infections
Authors: Singh Shakti , Barbarino Ashley M , Youssef Eman , Ghbremariam Teklegiorgis , Nabeela Sunna , Alkhazraji Sondus , Ibrahim Ashraf S
Published: December 2022

Background

Rise in multi-drug-resistance (MDR) among pathogens and increasing populations at risk for these infections raises the threat of nearly untreatable infectious diseases. Thus, novel vaccine strategies to prevent and/or treat MDR pathogens would benefit global health immensely. Candida albicans (CA) cell wall proteins Als3p and Hyr1p protect against candidemia due to CA and MDR C. auris (CAU). Further, Hyr1p shares structural homology with conserved hemagglutinin (FhaB) and OmpA proteins in many Gram-negative bacteria (GNB) Acinetobacter baumannii (AB), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA). Thus, Hyr1p antigen-based active and passive vaccinations protect against AB and KP pneumonia. We hypothesized that a dual Als3p/Hyr1p antigen vaccine formulated with CAF01 (a clinical stage adjuvant) that can promote a balanced Th1/Th2/Th17 immune response is likely to protect against multiple healthcare-associated infections caused by Candida species and MDR GNB.

Methods

To formulate Als3p/Hyr1p antigen, we mixed CAF01 with Als3p and Hyr1p antigens in the following ratios: 0/0, 10/10, 10/30, 30/10 and 30/3 µg for each dose. CD-1 mice with each dose subcutaneously, followed by booster immunization on day 21. For efficacy evaluation, vaccinated mice (n=20 mice/group) were immunosuppressed by administration of cyclophosphamide and cortisone acetate on day -2 and +3, relative to infection with either CAU, AB, KP or PA. Infection occurred two weeks following the booster immunization. For, CA infection, immunocompetent mice were infected intravenously two weeks following a primary booster or after a second booster given on day 35.

Results

All Als3p/Hyr1p formulations induced robust immunity against both antigens. For CA infection, two booster immunizations provide superior protection over one booster immunization. For CAU and GNB, one booster dose was enough to provide significant protection. Further, both 30/10 and 10/10 vaccine formulations protected significantly against all five infections. Specifically, for fungal infections, 30/10 and 10/10 formulations showed 30-40% and 40-50% survival efficacies (vs. 0% for placebo), respectively.

TABLE 1. Survival efficacy of Als3p/Hyr1p formulations against Candida species and Gram-negative bacterial infections.

Conclusion

Our study shows that the Als3p/Hyr1p induced a robust protective immunity against CA, MDR CAU and GNB.

Disclosures

All Authors: No reported disclosures.
2132. Placental histopathology and long-term outcomes of children with antenatal Zika virus exposure
Authors: Mulkey Sarah B , Puscasiu Elena , Corn Elizabeth , Ansusinha Emily , Arroyave-Wessel Margarita , Rossi Christopher T , Delaney Meghan , du Plessis Adre , Cure Carlos A , DeBiasi Roberta L
Published: December 2022

Background

It is unclear whether placental changes in ZIKV infection influence short- and long-term child outcomes. The objective of this study is to determine if placental histopathology findings in ZIKV correlate with offspring outcomes at birth and age 4-5 years for children with in utero ZIKV exposure without congenital Zika syndrome.

Methods

24 placentas collected from pregnant women with symptomatic ZIKV infection enrolled in a prospective ZIKV study in Colombia were formalin fixed and reviewed by a placental pathologist, blinded to child outcome. Children had neuroimaging as newborns and were longitudinally evaluated to age 4-5 years with the Bracken School Readiness Assessment (BSRA) and Pediatric Evaluation of Disability Inventory (PEDI-CAT). Scores were compared by presence of placental findings of perivillous fibrin deposition, calcifications, and increased syncytial knotting. T-test, fisher exact, and one way ANOVA were used for analysis; significance, p< .05.

Results

All 24 placentas had at least one abnormal pathological finding (Table 1). 14 (58%) placentas had extensive ( >30% coverage) and 7 (29%) had mild-moderate perivillous fibrin deposition (Fig. 1a). Placental calcifications were many ( >10) in 10 (42%) cases, and mild in 7 (29%) cases (Fig. 1b). 14 (58%) placentas had increased syncytial knotting. Placentas stained positive with CD163 for Hofbauer macrophages (Fig. 1c). All infants were born at term with normal birth weight, height, and head circumference, and 22 had a normal ponderal index. There was no difference in measurements based on each placental finding. There was no relationship between placental findings and non-specific neuroimaging. 20 (83%) children with placentas were evaluated at age 4-5. Children without placental calcifications scored higher on BSRA than children with mild/severe calcifications (p = .031). Children with increased syncytial knotting had lower scores on PEDI-CAT social/cognitive ability (p = .024).

Conclusion

Placentas from ZIKV-infected pregnancies have pathological findings that indicate risk of impaired fetal perfusion, but these were not associated with preterm birth or growth. There may be associations between placental findings and long-term neurodevelopment in ZIKV-exposed children requiring additional studies.

Disclosures

All Authors: No reported disclosures.