bluuebunny/crossref_metadata_2025 huggingface dataset:
1388. Patients´ perceptions on barriers that prevent and promote the use of telemedicine for HIV care in the public health system of Buenos Aires
Authors: Kierszenowicz Tomas , Bullo Manuela , Acosta Maria C , Rolon Maria Jose , Oshiro Graciela , Cecchini Diego , Rodriguez Claudia Gabriela , Scapellato Pablo , Bottaro Edgardo Gabriel , Losso Marcelo H
Published: November 2023

Background

In October 2020, a research consortium by four HIV and infectious diseases units of general acute public hospitals of Buenos Aires city began an implementation study aimed to analyze obstacles and facilitators on telemedicine (TM) use in the care of people living with HIV(PLHIV). TM visits were conducted through phone or videocalls

Methods

This research aims to analyze shifts in patient´s perception on factors that prevent and promote the utilization of telemedicine after 6 months of implementation of this strategy. We prospectively collected qualitative data through an electronic semi-structured survey delivered at and 6 months after the first teleconsultation. Surveys were anonymous and self-administered. Data was stored in Redcap® platform. These tools collected data on barriers and benefits of this strategy

Results

Between October 2020 and October 2022, 45% (1871) of total enrollees (4118) answered baseline survey. Second tool was completed by 24.5% (1019) of participants. 662 participants answered both surveys. 3% (20) and 5.7% (20) in the baseline and follow-up surveys respectively, reported troubles with technological devices. This perceived barrier increased in 2.7% and this difference was statistically significant (p=0.01).

Avoiding exposures to COVID-19 and other nosocomial viruses was perceived as a benefit by 65% (1216) of patients at baseline measurement. This proportion was reduced to 57% (580) at second survey. The proportion of patients that reported avoiding commuting time as a benefit increased from 44% (823) to 52% (530) between both measurements.

Conclusion

Beyond resource-limited contexts, these preliminary results illustrate a straightforward implementation of telemedicine. During COVID-19 pandemic, main benefits perceived by patients might be related to avoiding exposures to this and other viruses. After the COVID-19 sanitary situation was normalized, a higher percentage of patients reported that avoiding travel time to the hospital would be one of the main benefits of this strategy.

Disclosures

All Authors: No reported disclosures
1996. Invasive Fungal Infections in Orthotopic Heart Transplant: Incidence and Risk Factors in the Modern Era
Authors: Hasan Lana , Brizendine Kyle D
Published: November 2023

Background

Incidence of invasive fungal infections (IFI) in orthotropic heart transplant (OHT) is reported as 3.4–10%. Guidelines from The International Society for Heart and Lung Transplantation recommend considering prophylaxis for invasive molds based on risk factors and local epidemiology. Data defining the risk factors for IFI in OHT patients are lacking. The aim of this study is to describe the epidemiology of IFI in OHT patients and analyze risk factors.

Methods

A retrospective chart review identified all OHT patients who were transplanted at the Cleveland Clinic from 2010-2020. Patients were divided into two groups for comparison: definite or probable IFI within the first year after transplant, and no IFI. We compared the groups to determine independent risk factors for IFI.

Results

We identified 565 OHT patients in the study period; 33 met criteria for IFI with an incidence of 5.8% (95% CI, 4.2–8.1%). Table 1 shows the characteristics of both patient groups. Among 33 patients with IFI, there were 17 (51%) Candida, 9 (27%) Aspergillus, 4 (12%) non-Aspergillus mold, and 3 (9%) Cryptococcus infections. Median time to IFI (IQR) was 44 days (10–238.5). Specifically, for Candida it was 12 days (1-271) and Aspergillus was 90 days (8-335). One-year survival was significantly lower in the IFI group (76 vs. 94%; p =< 0.01). Using multivariable logistic regression analyses, as reported in Table 2, increased odds of IFI were observed with pre-transplant fungal colonization/infection (OR 19; 95% CI, 2-163) and left ventricular assist device (LVAD) infection (OR 2.3; 95% CI, 0.9-6.0). Post transplant reoperation (OR 4.7; 95% CI, 2-11), and extracorporeal membrane oxygenation (ECMO) (OR 2.6; 95% CI, 1.0-6.7) were also associated with increased odds of IFI.

Conclusion

In a large, modern cohort of OHT patients, we observed a significant incidence and increased odds of IFI associated with specific, identifiable risk factors during the pre-transplant and post-transplant periods. These results merit additional study of targeted antifungal prophylaxis with agents offering broad yeast and mold activity in OHT patients with certain risk factors.

Disclosures

All Authors: No reported disclosures
1398. Successful Treatment of primary and refractory Echinococcus (Hydatid Cyst Disease) with Mefloquine and Mebendazole
Authors: Richardson James D , Skeen Venus
Published: November 2023

Background

Treatment regimens for relapsed or refractory Echinococcus (Hydatid cyst disease) are not well defined. Because seropositivity for Echinococcus disease is unpredictable, insurance coverage for expensive regimens are often denied. Improved, effective regimens are needed. Recent laboratory studies in rat model of Echinococcus showed that Mefloquine added to regimens of Mebendazole were effective.

Hydatid cyst pretreatment.

Post treatment liver

Post treatment CT, 2 years after Mefloquine and Mebendazole treatment.

Methods

Described herein, are three cases of patients treated with combination of Mefloquine and Mebendazole. The initial case was a 56 yo farmer who failed standard therapy with Mebendazole, then PAIRS therapy with Mebendazole. His case was determined to be refractory to therapy. Serologic Echinococcus testing was negative, but CT scan showed liver cyst full of Echinococcus progeny. He was placed on Mebendazole bid for one month with mefloquine 250 mg tiw for one month. He was monitored with weekly liver enzyme tests and baseline EKG. Repeat CT scan at 2 months and 2 years show 2 small stable cysts remaining. Since the first treatment, two other primary cases (one liver and one cerebral) were treated with equally effective results. Patients were informed that this regimen was using medicine that was used to treat parasites, but the combination of the two agents had not been studied extensively together.

Results

Three cases of Echinococcus have been treated with combination of Mebendazole and Mefloquine. All have shown clinical cure. Minor elevations of hepatic enzymes were observed with one case, but regimen was not discontinued. No arrhythmias were seen with the regimen. The refractory case is stable at 2 years. The 2 primary cases are stable at 6 months at follow up.

Conclusion

The combination of Mefloquine and Mebendazole was a well tolerated and effective therapy for both primary and refractory Echinococcus disease. It will be difficult to recruit and study this disease due to the paucity of cases in the US. More study of this disease is needed, but this limited study suggests that this combination regimen of mefloquine and Mebendazole has the potential to be a new standard of care. Moreover, this treatment regimen shortens therapy from 3 months to one month.

Disclosures

All Authors: No reported disclosures
1416. Walk a Mile in Someone Else’s Shoes: Navigating the Complexity of Daily Environmental Cleaning – A Quality Improvement Pilot Project
Authors: McKinley Linda , Keating Julie , Hoel Sydney , Parmasad Vishala , Safdar Nasia
Published: November 2023

Background

A major tenet of environmental cleaning is to focus on high-touch surfaces (HTS). HTS in the patient’s proximity have high rates of contamination, yet cleaning compliance of HTS remains low particularly when the patient is present. This quality improvement (QI) project aimed to use stakeholder input to modify a HTS cleaning checklist.

Methods

This pilot project used a Plan-Do-Check-Act cycle to modify and evaluate a daily cleaning checklist across acute and long-term care settings at one Midwestern VA Hospital (Figure 1).

PDCA

Results

Two pre-intervention focus groups (patients, N=8 and EMS, N=5) were conducted to understand stakeholder perspectives and barriers to daily cleaning to inform modifications to the cleaning checklist. Participants viewed the graphic and discussed patients’ and EMS’s possible notions upon EMS entering the patient room. The groups were then asked how these insights could be addressed during the cleaning process. Recurrent themes of stakeholder’s perceived barriers to cleaning are depicted in Figure 2. Integrating the stakeholder suggestions to overcome barriers, and the literature suggesting higher touch and contamination of surfaces within proximity to the patient, the QI team and EMS designed a paradigm shift for the checklist including modifying mental models for: a. cleaning patterns from clean-to-dirty to dirty-to-clean (Figure 3) and b. extent of surface cleaning (Figure 4).

Pre- and post-intervention observations of daily cleaning compliance of 10 HTS showed a significant improvement of 38% (pre, N=7) to 72% (post, N=10) (p = 0.011).

Two EMS interviews were conducted post-intervention to evaluate checklist usability. Emergent themes were discomfort with cleaning any surface near the patient while the patient was in the bed and with the use of the modified cleaning pattern due to discordance with previous training and practices

Graphic Exercise

Cleaning Pattern Mental Model

Modified Checklist

Modified Checklist

Conclusion

Current checklists do not address contextual factors of navigating the environment surrounding patients in bed. HTS cleaning rates may be improved by modifying checklists based on input from local stakeholders. Future research is needed to evaluate modified cleaning processes to facilitate daily cleaning of occupied patient rooms.

Disclosures

All Authors: No reported disclosures
1425. "Influence of outpatient antibiotic prescriptions in prevalence of ESBL producing Enterobacteriaceae in local hospitals"
Authors: Ponce Rafael , Kinsella Patrick , Campbell Darien
Published: November 2023

Background

The increase in antibiotic resistance has been linked to antibiotic exposure. However, initiatives of antibiotic stewardship programs have been associated with decrease in antibiotic utilization but without a clear decrease in antibiotic resistance. We hypothesized that outpatient antibiotic exposure in communities geographically close to hospitals contribute to their incidence of ESBL producing Enterobacteriaceae (ESBL-PE).

Outpatient antibiotic prescriptions per 1000 population by zip code

Total antibiotic prescriptions per zip code

Methods

From March 2022 to March 2023 we evaluated antibiotic utilization in the inpatient and outpatient setting of a healthcare system in central Georgia. Outpatient settings included urgent cares, emergency rooms, and primary care clinics. The incidence of ESBL-PE was obtained from each hospital’s antibiogram. We calculated the number of outpatient prescriptions per zip code. Nearest neighbor analysis was used to determine the closest hospital for each zip code, with each zip code having a unique "nearest" hospital. The number of antibiotic prescriptions for those zip codes were assigned to that hospital. To estimate the antibiotic “burden” for each hospital, we used days of therapy (DOT) per 1000 days present of inpatient antibiotic use, plus antibiotic prescriptions per zip code population. Percentage of ESBL-PE for each hospital was the independent variable. QGIS v3.8 was used for spatial analysis.

Inpatient antibiotic use and ESBL-PE percentage

Outpatient antibiotic use

Results

There were 61 070 outpatient antibiotic prescriptions and 500 092 DOT. Prescriptions were given to residents of over 1000 different zip codes of nearly 20 states. 60% of the prescriptions were from urgent care centers, 1 for every 2 encounters. Inpatient antibiotic use varied among hospitals, with no correlation between antibiotic use and percentage of ESBL-PE. Linear regression model had an R2 of over 0.8 although with a p-value of 0.8.

Conclusion

The geographic reach of outpatient antibiotic prescriptions is of concern. The burden in their surrounding communities could be contributing to antibiotic resistance in hospitals, explaining the discrepancy of inpatient antibiotic use and antibiograms. Efforts to decrease antibiotic resistance should also include interventions in outpatient facilities. Our model didn’t reach statistical significance, likely due to the small hospital sample size, which we are currently evaluating.

Disclosures

All Authors: No reported disclosures
1430. Outbreak Clusters of Invasive Group A Streptococcus Associated with Wound Care in Long-term Care Facilities
Authors: Zipprich Jennifer , Como-Sabetti Kathryn , Bilski Kayla M , Vagnone Paula S , Dale Jennifer L , Wang Xiong , Chochua Sopio , Beall Bernard , Lehnertz Nicholas , Lim Sarah , Juaire Kristi K , Hale Tammy , Lynfield Ruth
Published: November 2023

Background

Residents of long-term care facilities (LTCFs) are at increased risk of invasive group A Streptococcus (iGAS) infections. It is important to identify intrafacility and interfacility iGAS transmission clusters.

Methods

Minnesota Department of Health (MDH) conducts active surveillance for iGAS infections through the Emerging Infections Program, including necrotizing fasciitis, bacteremia, and other normally sterile sites. Clinical and demographic information, including residence, is collected from medical records, and isolates are submitted to MDH and the Centers for Disease Control and Prevention for characterization. Whole genome sequencing (WGS) was used to determine emm type and identify clusters (isolates exhibiting ≤15 single nucleotide polymorphisms [SNPs]). In 2016–18 and 2022–23, iGAS clusters were investigated among LTCF residents.

Results

From March 2016 to May 2018, 749 iGAS cases were reported, 10% were among LTCF residents. Forty iGAS emm89 case-isolates (pairwise distance of 0–11 SNPs, recovered from LTCF residents at 19 different LTCFs, 1–7 cases/LTCF) defined cluster A. From January 2022–March 2023, 489 iGAS cases were reported, 7% were LTCF residents. Twenty iGAS cases (0–7 SNPs, recovered from LTCF residents at 10 different LTCFs, 1–8 cases/LTCF) defined cluster B. The two clusters represented multiple infection types including bacteremia (40%), septic shock (11%), pneumonia (8%), cellulitis with bacteremia (29%), and one case of necrotizing fasciitis. All were hospitalized and 23% died; 76% had wound care prior to iGAS infection. Among cluster A cases 58% had care from a single wound care physician, and among cluster B cases 36% received wound care from a single (but different) wound care physician. Identification of clusters led to MDH investigation on site.

Conclusion

iGAS is associated with severe morbidity and mortality among LTCF residents. We identified two iGAS clusters, each with cases among multiple LTCFs. Investigations identified common wound care providers and lapses in infection prevention practices. WGS enabled identification of complex multi-facility iGAS clusters, additional epidemiologic links, and development of facility-specific recommendations.

Disclosures

Jennifer Zipprich, PhD, Pfizer: Spouse employment
1469. Development and Implementation of a Predictive Model for a Semi-automated Surgical Site Infection Surveillance System
Authors: Lee Sojeong , Joo Jiyeon , Kim Miseo , Ryu Seung Hee , Lee Jeong Young , Yang Hyejin , Park So-Yeon , Kim Eun Ok , Jung Jiwon , Kim Sung-Han
Published: November 2023

Background

Automated surveillance systems for healthcare-associated infections have been implemented worldwide, but monitoring surgical site infections (SSI) is still challenging. Surveillance of SSI requires a review of multiple clinical aspects and medical records, which is time-consuming and prone to human error. We aimed to develop a predictive model for SSI and implement a semi-automated surveillance system.

Methods

The study included 213 major surgeries randomly selected from 25 different types at a tertiary care hospital in Seoul, South Korea, between June 2019 and May 2022. Infection preventionists diagnosed SSI based on US National Healthcare Safety Network criteria. After identifying variables significantly associated with SSI through univariate analysis, we developed several predictive models. We then conducted multivariable logistic regression analysis, calculated coefficients and p-values, and evaluated model performance using Area Under the ROC Curve (AUC) analysis, as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Of 213 surgeries, 13 (6.1%) were exploratory laparotomy, while 11 (5.2%) were cesarean section and ventricular shunting each. 74 cases (34.7%) were diagnosed with SSI. The study found that a predictive model that included use of antimicrobial agent, positive culture test, infection-related imaging findings (e.g., CT, MRI, ultrasonography), record of wound dressing, and pus or dehiscence of wound records, identified patients at high risk for SSI with an AUC of 0.853 (95% CI: 0.795-0.911). We weighted these variables and found that with a cutoff of 4 or higher out of a total of 8 points demonstrated sensitivity of 75.7% (95% CI: 65.9-85.5), specificity of 82.7% (95% CI: 76.5-89.0), PPV of 86.5% (95% CI: 80.7-92.3), and NPV of 80.3% (95% CI: 74.9-85.6). Based on this model, a semi-automated surveillance system was developed.

Conclusion

The predictive model and semi-automated surveillance system of SSI have the potential to improve the efficiency and accuracy. Further optimization of the predictive model by validating it for different types of surgeries and incorporating additional infectious variables and weights for each variable to increase its accuracy and applicability is needed.

Disclosures

All Authors: No reported disclosures
1473. Procedural risk factors for deep and organ/space surgical site infection post-coronary artery bypass graft surgery
Authors: Pearl Abarna , Gordon Patrick S , Feeser Baevin , Pepe Dana , Mehrotra Preeti , Wright Sharon B
Published: November 2023

Background

Advances in coronary artery bypass graft (CABG) surgery have improved graft patency and survival. Our prior work suggested a reduction in deep and organ/space surgical site infection (SSI) with single versus bilateral internal mammary arteries and a skeletonized approach. Even for the same number of arterial grafts used, specific artery type may impact SSI incidence. We aim to assess the effect of potentially modifiable risk factors on post-CABG deep and organ/space SSI, including number and type of vessel grafts, and closure method.

Methods

This was a single-center retrospective cohort study of post-CABG surgery patients from 01/01/19-12/31/22. SSIs were identified during routine surveillance using National Healthcare Safety Network criteria. Data on demographics, comorbidities, surgical technique and surgeon were obtained from hospital and cardiac surgery databases. A sub-analysis evaluated the risk of SSI in patients with two arterial grafts by type of artery used, specifically bilateral internal mammary (BIMA) graft versus single internal mammary artery plus radial graft (SIMA-R). We performed univariate analyses to determine association of risk factors with SSI.

Results

Of the 2050 included patients, 23 developed an SSI . In univariate analyses, diabetes mellitus (OR 5.6, p < 0.001) and negative pressure wound therapy (NPWT) versus surgical adhesive (OR 19.82, p< 0.001) were associated with SSI. There was no significant association between SSI and the total number of arteries or combination of vessel grafts used. In the sub-analysis, 281 patients underwent SIMA-R and 154 underwent BIMA. None of the SIMA-R, versus 4 of the BIMA developed SSI (p=0.02). There were other differences between the groups, including a greater proportion with a skeletonized (versus pedicled) arterial harvest (OR 2.19, p=0.003) and longer case duration (238 vs 217 minutes, p=0.003) in the BIMA group, which could confound this relationship.

Conclusion

In the overall cohort, NPWT was associated with SSI on univariate analysis, though notably this closure method is often used in patients with higher pre-operative risk. Amongst those patients who received two arterial grafts, there was a reduced SSI risk with SIMA-R approach. Future studies should explore the impacts of graft choice and wound care.

Disclosures

All Authors: No reported disclosures
1476. Optimizing Preoperative Antibiotic Administration Timing to Reduce Surgical Site Infections
Authors: Voss Heather , Salim Asra , Postelnick Mike , Borkowski Jaime
Published: November 2023

Background

The administration of clinically indicated antibiotics prior to surgery in combination with other evidence-based practices reduces the risk of surgical site infection (SSI). A retrospective study of SSI at a community-based hospital that performs 5,700 procedures annually revealed broad variability in the timing of prophylactic antibiotic administration in relation to the time of incision. A Tableau dashboard was created to compare antibiotic administration to surgical incision timing and the impact variability may have on the incidence of SSI.

Methods

A multidisciplinary team was formed with surgeons, anesthesia, nursing, antimicrobial and diagnostic stewardship, infection prevention, and analytics representatives. Antibiotics selected for inclusion were those most prescribed for surgical prophylaxis according to organizational practice guidelines. Using the dashboard, optimal administration times were identified based upon the pharmacokinetics of the antibiotic as well as the expected tissue concentration at the incision site when available. (See table) Surgical encounters that received an antibiotic were classified as “pass”, “fail”, or “other”. Antibiotics started within the determined timeframe passed, those started earlier or later than the timeframe failed, and the others received antibiotics not included in the dashboard logic.

Results

In a baseline review 35.5% of cases failed timing criteria. Failures occurred most frequently with cefazolin, ceftriaxone and clindamycin. A retrospective analysis of SSI (n = 34) classified using the National Healthcare Safety Network (NHSN) definitions correlated with the baseline data. The outliers were comprised of antibiotics started too close to or after incision (14.7%) and antibiotics started much earlier than the dosing timeframe and incision (17.6%).

Conclusion

The surgical prophylaxis timing dashboard helped to identify gaps in administration practices and highlighted the need for process improvement initiatives. Ongoing interventions to improve adherence to national guidelines will be evaluated to determine the impact on SSI rates.

Disclosures

All Authors: No reported disclosures
1478. Evaluation Of Anal Cancer Screening Program in men who have sex with men (MSM) persons with HIV (PWH) At Two academic center HIV Clinics 2018-2022
Authors: Achhra Amit , Chan Elizabeth , Applebaum Serina , Guerrero Maggie , Hao Ritche , Pantel Haddon , Virata Michael D , Barakat Lydia A
Published: November 2023

Background

Treatment of anal dysplasia has been shown to reduce incidence of squamous cell carcinoma of the anus (SCCA) in PWH, particularly in MSM. Annual anal cytology (PAP) has been offered for SCCA screening since ∼2010 at our urban academic center ambulatory HIV clinics, and those with abnormal PAP (atypical squamous cells of undetermined significance (ASCUS), or Anal Intraepithelial Neoplasia (AIN) 1-3) are referred for high-resolution anoscopy (HRA) and dysplasia treatment. Evaluation of screening cascade can help better understand and improve SCCA screening protocols.

Methods

We performed a retrospective chart review (2018-2022) on MSM PWH, age 35 and older, enrolled at our two HIV clinics who had at least one clinic visit by 12/31/2019. Of total eligible for SCCA screening, we calculated proportion of those engaged (received at least one screening (PAP or HRA)) and retained (received at least one subsequent screening) in care. Characteristics of people who did not engage in screening were evaluated by logistic regression.

Results

A total of 432 individuals were eligible for SCCA screening. The median [interquartile range] age was 57 [48-62] years, 97% were on antiretroviral therapy, 28% were Blacks, 62% had history of smoking, and 24% had a prior history of anal dysplasia. A total of 219 (50.7%) engaged in screening, and only 113 (26%) were retained (Figure-1). Seventy-four individuals had at least one abnormal PAP during follow-up, of which 35 (47%) received HRA at least once. In multivariable analysis, older age and history of smoking negatively correlated with engagement while history of anal dysplasia positively correlated with engagement (table-1). Race (Blacks vs other) and type of insurance (public/private) did not correlate with engagement.

Conclusion

We noted high rates of loss of engagement and retention in SCCA screening even in PWH highly engaged in HIV care. Older MSM PWH, who are at higher risk of SCCA, were less likely to be engaged in screening.

Disclosures

Michael D. Virata, MD, FACP, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant
2063. Elucidating the Gram-Positive Selective Spectrum Activity of Ibezapolstat; Secondary Analysis from the phase 2a trial
Authors: Lancaster Chris , McPherson Jacob , Alam M Jahangir , Begum Khurshida , Ekramul Karim Md , Hu Chenlin , Basseres Eugenie , Garey Kevin W
Published: November 2023

Background

Ibezapolstat (IBZ) is a non-absorbable antimicrobial currently in phase 2 clinical trials for the treatment of Clostridioides difficile infection (CDI). In vitro and human studies have shown potent activity of IBZ against C. difficile but selective activity against other beneficial Gram-positive gut microbiota shown to reduce the risk of recurrent CDI. As the target DNA Pol IIIC enzyme is present in most Gram-positive species, the reasons for this selectivity are unclear. The purpose of this study was to assess the selectivity of IBZ against Gram-positive gut commensal microbiota.

Methods

Using stool samples and microbiome data from the phase 2a CDI study, concentration changes in certain Gram-positive commensals were analyzed by qPCR over time in patients with CDI given IBZ. Gram-positive isolates were cultured from stool, speciated, and MIC determined. AlphaFold2-enabled drug docking was used to assess in silico differences in drug-binding residue sites predictive of IBZ binding across a large range of Gram-positive bacteria isolated from the stool.

Results

From the phase 2a study, relative abundance of Firmicutes and concentrations of certain species (Clostridium leptum and Clostridium coccoides groups) increased while on IBZ therapy. Thirty-six strains were isolated from Families Clostridiaceae (n=25), Enterococcaceae (n=3), Lachnospiraceae (n=3), and Peptostreptococcaceae (n=5). MIC50/90 values averaged 1.5/3.0 ug/mL (geometric mean) for strains isolated at baseline and early therapy (days 1-3) and 12/126 ug/mL for samples taken later on therapy and three-day follow-up. Two strains isolated at day 30 follow-up were < 2 ug/mL and another was >128 ug/mL. All C. difficile strains were IBZ susceptible (MIC<2 ug/mL). Using a protein sequence alignment from more than 500 Firmicute PolC sequences, potential contact points of interest were identified that helped explain the selectivity of Ibezapolstat.

Conclusion

Increased Firmicute abundance and concentration may be explained by selection of non-susceptible Firmicute species during therapy. Distinct IBZ drug-binding residues in the Pol IIIC enzyme may explain this selectivity. Structural biology experiments will confirm these results.

Disclosures

Eugenie Basseres, PhD, Accurx: Grant/Research Support Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|Ferring: Advisor/Consultant|Paratek: Grant/Research Support
1503. Impact of Sars-Cov-2 (Covid-19) in Patients Living with HIV from United States National Inpatient Sample Database
Authors: Patel Premalkumar M , Acosta Daniel , Vallabhaneni Esha , De Frias Fernando Poli , Singh Yavani , Lopez Christopher , Tuda Claudio
Published: November 2023

Background

The COVID-19 pandemic has raised concerns about the impact on those living with HIV/AIDS due to weakened immune systems. Disruptions to HIV services and medication supplies caused by the pandemic have also raised concerns about increased HIV-related illnesses and deaths. An inpatient sample database was used to investigate the impact of Covid-19 on HIV patients in the US by examining the clinical outcomes of Covid-19 patients with and without HIV in US hospitals.

Methods

The NIS database is a publicly available and extensive database that contains information on millions of hospitalizations in the United States. Using the NIS 2020 database, adult patients who were diagnosed with COVID-19 were identified and categorized based on their HIV status. In order to examine the NIS database, a variety of statistical approaches were employed, such as univariate and multivariate analysis, descriptive statistics, and regression analysis.

Results

A total of 11,080 hospitalized HIV-positive patients were diagnosed with COVID-19. Amongst them, 7,510 were male and 3,570 were female with 23.1% being Caucasian, 50.8% African American, and 19.3% Hispanic. 47% of the patients had a national median household income between 0-25th percentile. Geographically, 27.8% were from the northeast, 19.4% from the midwest, 44.4% from the south, and 8.4% from the west. The most common comorbidities were hypertension at 32.8%, diabetes mellitus with complications at 27.8%, chronic lung disease at 26.7%, obesity at 22.2%, hypothyroidism at 7.6%, drug abuse at 8.6%, and depression at 14.5%. The mean age for patients with HIV who contracted COVID-19 was 56 years with a length of stay (LOS) of 9.7 days and an economic burden of $27,566 in comparison to patients without HIV, who had a mean age of 62 years, LOS of 7.9 days, and cost of $21,553.

Data Analysis : Demographics

Data Analysis: Comorbidities

Data Analysis: Outcomes

Conclusion

In conclusion, hospitalized patients living with HIV, particularly African Americans, face a greater risk for adverse outcomes from COVID-19, which results in increased healthcare utilization. This underscores the need for safeguarding vulnerable populations and monitoring infectious disease spread. Further research is needed to better understand how COVID-19 affects different demographics and how to address their healthcare needs during pandemics.

Disclosures

All Authors: No reported disclosures
1511. Sociodemographic and epidemiological factors related to the acceptability of telemedicine among patients for HIV care in four hospitals in the city of Buenos Aires
Authors: Acosta Maria C , Kierszenowicz Tomas , Acosta Maria Cecilia , Rolon Maria Jose , Cabrini Mercedes , Cecchini Diego , Rodriguez Claudia Gabriela , Scapellato Pablo , Bottaro Edgardo Gabriel , Losso Marcelo H
Published: November 2023

Background

In October 2020, a research consortium by four HIV and infectious diseases units of general acute public hospitals of Buenos Aires city began an implementation study aimed to analyze obstacles and facilitators of telemedicine (TM) in the care of people living with HIV(PLHIV). TM visits were conducted through phone or videocalls

Methods

This research aims to assess the association of sociodemographic and epidemiological factors and the willingness of HIV patients to continue with TM after the sequelae of COVID-19. We prospectively collected quantitative data from medical records and distributed an anonymous semi-structured survey to participants after their first TM visit, collecting data on willingness to continue with this strategy and sociodemographic characteristics. We included all the participants who answered the survey. The data was stored in the Redcap® platform. Continuous data are shown as medians with interquartile range (IQR) and were compared using the Wilcoxon test. Categorical data are described as percentages and compared using the chi-square test. We use R® software

Results

The survey was delivered to 4118 patients who had their first remote visit between October 2020 and October 2022. 1.871 patients (45%) responded the survey. 1.085 (58%) were cisgender men. The median age was 47 years (IQR: 37-54). 1.221 (65%) would like to continue with this strategy, while 618 (33%) would not. 32 (2%) did not respond. 1102 (90%) patients willing to continue TM had wireless access at home and 544 (88%) unwilling to continue had wireless access. Among those who were willing to continue using TM, the proportion of people with viral suppression was 88.6%, while among those who were not willing to continue using TM, the proportion was 87.1%. The median CD4 count was 639 (IQR: 442.5-907) for those who wanted to continue and 657 (423-917) for those who did not

Conclusion

In this adult cohort of PLHIV receiving TM care in public facilities in the city of Buenos Aires, two-thirds of those who answered the survey were willing to continue with this strategy after the COVID-19 crisis. When comparing participants willing or unwilling to continue TM in the future, both groups were similar in terms of age, gender, proportion of participants with wireless access at home, CD4 count and viral suppression

Disclosures

All Authors: No reported disclosures
1520. Exploring the factors linked to prior HIV testing and schistosomiasis treatment in Malawi.
Authors: Kangogo Geoffrey K
Published: November 2023

Background

Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi.

Methods

Enumeration of all resident fishermen was carried out from 2019 to 2020. The fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status, previous receipt of praziquantel and willingness to attend a beach clinic were modelled using random effects binomial regression, accounting for clustering.

Results

A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). Only 40% (1,733/4,465) had received praziquantel in the last 12 months. Every additional year of age was associated with 1% decreased likelihood of having taken praziquantel (aRR: 0.99, 95% CI: 0.98-0.99, p< 0.001). However, recent HIV testing increased the likelihood of taking praziquantel (aRR 2.24, 95% CI: 1.93-2.62, p< 0.001).

Conclusion

In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may lead to good coverage.

Disclosures

All Authors: No reported disclosures
1522. Predictors of Weight Gain in People Living with HIV
Authors: Pedersen Karen B H , Poulsen Susanne Dam , Benfield Thomas
Published: November 2023

Background

Highly effective antiretroviral therapy (ART) and longer life expectancy in people living with HIV (PLWH) has led to increased incidence of lifestyle associated risk factors including overweight and obesity. ART is considered to play an important role in this tendency. Excess weight gain has been reported in PLWH treated with and integrase strand transfer inhibitors (INSTI). For nucleoside/nucleotid reverse transcriptase inhibitor (NRTI) backbone components tenofoviralafenamid (TAF) is associated with higher weight gain compared to tenofovir disoproxil (TDF) and abacavir (ABC). This study aims to investigate ART as predictors of weight gain in a prospective cohort using a target trial emulation.

Methods

The protocol for the target trial was established to evaluate the impact of baseline backbone treatment and various third components on weight gain over a 2-year follow-up period using the Copenhagen Co-Morbidity in HIV Infection Study (COCOMO) cohort. Data was collected from March 2015 to December 2016 in the Capital Region of Denmark. Adult PLWH were included. Subjects were divided into four different treatment groups according to their backbone components: Lamivudine/emtricitabin (XTC)/TDF, XTC/ABC, XTC/TAF or “other”. Regression standardization was applied to the linear regression outcome adjusted for relevant confounders.

Results

In total 704 subject were included in the analysis. Overall median weight gain in the 2-years follow up period was 0.7 IQR[-22.4, 26.0] with the largest weight gain in subjects with XTC/TDF at baseline (median 1.0 IQR[-12.6, 26.0]). Regression standardization of the adjusted linear regression model showed no significant difference in weight gain between backbone groups. In the third-component analysis including subjects with XTC/TDF or XTC/ABC backbone, subjects receiving an integrase inhibitor based regimen at baseline tended to have a 0.75 kg higher weight gain compared to NNRTI- and PI-based regimens, but this was not significant S.E. 0.474, (0.17;1.67 95%CI).

Conclusion

The results suggest that while antiretroviral therapy may contribute to weight gain, the choice of backbone components may not be a significant predictor. Further studies are needed to confirm these findings.

Disclosures

All Authors: No reported disclosures
1528. Retrospective cohort study of factors associated with non-initiation of antiretroviral therapy among adults newly diagnosed with HIV in Andijan, Uzbekistan, 2018-2021
Authors: Usmanov Shokhruh , Horth Roberta , Denebayeva Alfiya , Gazezova Saya , Zikriyarova Sanam , Kurbanov Botirjon , Nasirova Feruza , Nabirova Dilyara
Published: November 2023

Background

Immediate uptake of antiretroviral therapy (ART) by people newly diagnosed with HIV reduces morbidity and viral transmission. Since 2018, in Uzbekistan people newly diagnosed with HIV are immediately offered ARVs, but just over half of people living with HIV are estimated to be on ART. To reach global targets, we assessed factors associated with ART non-initiation.

Methods

We conducted a retrospective cohort study using secondary data from Andijan Region Republican AIDS Center. Our study included all people 18 years of age and older newly diagnosed with HIV between January 1, 2018, and June 31, 2021. We analyzed sociodemographic and behavioral factors associated with non-initiation of ART, defined as not having initiated ART by December 31, 2021. Using multivariable analysis, we calculated risk ratios (RR) and 95% confidence intervals (CI).

Results

From 2018 to 2021 in Andijan Province, 1,098 people were newly diagnosed with HIV, of which 113 (10.3%) did not initiate ART. Participants were mostly 30-49 years old (49%), male (56%), married (46%), and with secondary education (74%). Also, 39% and 31% had HIV clinical stage I and II, respectively. Risk for non-initiation was higher among people with secondary education (RR=8.6 [CI: 1.2–60.9]) compared to higher education, with multiple partners (RR=2.7 [1.5-5.0]), with disease stage I (RR=3.3 [2.0–5.2]) and stage II (RR=4.4 [2.8–7.0]). People with sexual partners living with HIV had higher risk of non-initiation (RR=1.8 [1.2–2.9]) than people with partners that did not have HIV. Being single was associated with reduced risk of non-initiation (RR=0.1 [0.03–0.3]).

Factors associated wtih initiation of ARV treatment among people newly diagnosed with HIV, Uzbekistan

Conclusion

People with multiple partners and with partners living with HIV should be prioritized for ART initiation support. Increased risk of non-initiation among people in non-symptomatic or mild disease stages earlier disease stages points to the need for interventions to increase awareness of test-and-start among providers.

Disclosures

All Authors: No reported disclosures
1554. Facilitators and Barriers to Engaging in PrEP and Gender Affirming Therapy for Black and Latina Transgender Women in South Florida
Authors: Silvey Rebe , Rosas Yesenia , Ellick Kecia L , Johnson Ariana , Craker Lacey , Lewis Susanne Doblecki , Cunningham Suzanne Randolph , Rehman Aliya F , Kanamori Mariano , Beauchamps Laura
Published: November 2023

Background

Black and Latina transgender women (BLTW) have the highest HIV rates among transgender women (Black: 62%, Latinx: 35%). PrEP-GAT is an EHE grant which evaluated barriers and facilitators to engagement in PrEP and gender affirming therapy (GAT) services and the use of friendship networks to promote these interventions.

Methods

Participants were recruited through the University of Miami’s GenWell Service, which provides bundled PrEP and GAT. This study has two components: qualitative and social networks. Qualitative component: 20 in-depth interviews focused on barriers and facilitators to PrEP and GAT services using Consolidated Framework for Implementation Research (CFIR) constructs. Data was analyzed using thematic analysis. Social network component: 27 social network-based interviews identified friendship dynamics that could promote conversations and encouragement to engage with PrEP and GAT. Analysis included multilevel logistic regression using R and network visualizations using UCINET.

Results

Qualitative Component. Barriers to accessing PrEP and GAT services included cost, need for Spanish-language materials, bias, stigma, and discrimination. Facilitators included access to telehealth, mobile services, pharmacists, and co-located PrEP-GAT services. BLTW were not comfortable disclosing their HIV status due to HIV stigma. “HIV clinics” discouraged individuals from seeking services. Social network component: most participants were using GAT (75%), and more than half reported lifetime PrEP use (56%). Bivariate analysis: having a Latinx friend, a friend who shared GAT status, and higher emotional closeness were associated with future conversations about PrEP and GAT (p< 0.05). Multilevel model: emotional closeness was associated with future conversations about PrEP and GAT (p=0.02).

Conclusion

Mental health, legal, employment and housing services are needed to meet BLTW access to PrEP. Social network approaches can identify key individuals in BLTW friendship networks to promote and disseminate information about PrEP and GAT.

Future Directions: Future research will determine whether bundled PrEP-GAT, social network support, and telehealth is effective to increase BLTW’s engagement in these services.

Disclosures

Susanne Doblecki Lewis, MD, MSPH, FIDSA, Gilead Sciences: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support
1589. Real-World Outcomes with Cabotegravir/Rilpivirine: Does Duration of Pre-treatment Viral Suppression Matter?
Authors: Mesa Daniel , Neha Pandit , Ryscavage Patrick , Schmalzle Sarah
Published: November 2023

Background

The efficacy and safety of long-acting injectable, cabotegravir/rilpivirine (CAB/RPV), was established in people with HIV (PHIV) on a stable oral antiretroviral (ART) regimen with viral suppression ≥ 6 months prior to CAB/RPV initiation and with no history of treatment failure. Given the design of the CAB/RPV clinical studies, there have been varying recommendations for its initiation in real-world settings due to the lack of data in patients with either incomplete, or shorter duration of pre-treatment viral suppression. The objective of this study was to describe virologic outcomes among patients on CAB/RPV based on duration of pre-treatment viral suppression.

Methods

This was a single-center, retrospective, observational study of PHIV initiated on CAB/RPV at an HIV clinic in Baltimore, MD, between Jan 2021-Dec 2022. Patients were stratified by duration of viral suppression prior to CAB/RPV initiation. Viral suppression was evaluated at weeks 8-24 post CAB/RPV initiation and stratified by body mass index (BMI), baseline drug resistance, and CAB/RPV dosing frequency.

Results

A total of 78 patients were included in this study. The mean age was 47 years, 41% were female at birth, and 92% were Black/African American. At weeks 8-24, 62 patients had HIV RNAs available with 87% (54/62) having achieved viral suppression (< 50 copies/ml). Viral suppression was achieved in 94% (n=33/35), 67% (2/3), and 78% (18/23) of patients who had been virologically suppressed for > 12 months, 6-12 months, and 0-6 months, respectively. Of the 8 patients that did not achieve viral suppression, 6 were able to suppress on CAB/RPV between 125-364 days, 1 had no subsequent HIV RNA result available, and 1 discontinued treatment due to increase in HIV RNA but had been durably suppressed for over 12 months prior to CAB/RPV initiation. We found no differences between viral suppression on CAB/RPV and BMI, baseline mutations, and dosing frequency.

Conclusion

Virologic outcomes did not differ based on duration of viral suppression prior to initiation of CAB/RPV. Though larger studies should be completed, long-acting CAB/RPV has remained effective in patients with variable durations of pre-treatment viral suppression and in patients who did not have viral suppression prior to switch.

Disclosures

All Authors: No reported disclosures