bluuebunny/crossref_metadata_2025_split huggingface dataset:
982. Formal Education Improves Southeastern United States Primary Care Residents’ Understanding and Attitudes Towards HIV Pre-Exposure Prophylaxis: Results of a Regional Survey
Authors: Weaver Christian D , Mena Leandro A , Ward Lori M 
Published: January 2021

Abstract

Background
HIV pre-exposure prophylaxis (PrEP) has been identified as one of the pillars of the national plan to end the HIV epidemic. Notably, southern states have also been shown to have the lowest PrEP-to-need ratio in the country, and previous work on assessing clinician understanding of and attitudes towards PrEP has mainly focused on in-practice physicians, nurse practitioners, and other clinicians. We aimed to assess the attitudes towards and understanding of PrEP among residents training in programs categorized as primary care in the Southeastern United States.

Methods
Program directors in ACGME approved residency programs in Family Medicine, Internal Medicine, Internal Medicine-Pediatrics, and Obstetrics and Gynecology were asked to distribute an invitation with a link to the survey to their residents during a six week period in May and June 2019. The survey contained questions that assessed demographics, type of program, PrEP awareness, knowledge, attitudes, and formal education Logistic regression was utilized to assess association between formal PrEP education and comfort levels with PrEP and other STI related topics.

Results
We identified approximately 7,574 residents across 247 residencies in 11 states. We received 217 responses to our survey, of which 203 had complete data for analysis. The majority of the sample was 25-29 years old (75%), male (53%), White (46%), and PGY-2 (48%). Twenty-one percent of the sample received formal education on PrEP. After controlling for demographic variables, residents with prior formal PrEP education were more likely to be comfortable taking sexual history from LGBTQI patients, discussing/providing PrEP, discussing PrEP efficacy, discussing PrEP monitoring, side effects, drug resistance, and adherence compared to residents who did not have formal PrEP education (Table 1).
Association Between Formal PrEP Education and Comfort Levels with Discussing PrEP and other STI Related Topics

Conclusion
We found a strong association between formal PrEP education and resident’s confidence in discussing PrEP. Investing in formal resident education programs in the Southern region will be important in achieving the Ending the HIV Epidemic’s goal of reducing new infections by 75% in 5 years and 90% in 10 years.

Disclosures
Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau)
983. Hand Hygiene not only the Motion but the Moments
Authors: Darvish Shahrzad E , Rachoin Jean-Sebastien , Meredith Dennis , Polat Denise , McKnight Jessica , Smith Jes , Hamilton Tracey , Nahra Raquel 
Published: January 2021

Abstract

Background
Hand hygiene (HH) is a paradigm of infection prevention.Often emphasis has been placed on appropriate motion of hand hygiene.The implementation of the 5 moments of HH in clinical practice hindered by the perceived enormous lift of educating healthcare providers.
Hand Hygiene Moments Opportunities

Methods
Retrospective evaluation of education on WHO 5 moments of HH implementation. Other data collected CLABSI, CAUTI, MDR Acinetobacter, MRSA, Clostridium difficile LabID. Education occurred between October and December 2018. Data was collected from January 2018 to December 2019. Baseline 5 Moments of HH was obtained for 3 weeks prior to education as this was newly introduced. Statistical analyses using control charts with testing for special cause variations included all data point before and after education of 5 moments of HH. We used Pearson correlation to assess relation between HAI and HH. 5 moments of HH education was done through direct observation with feedback, traditional lecturing, and computer-based education mandatory to all employees and posters placed in strategic locations through the institution. Determination of patient and hospital zone allowed to streamline the education process. Education on different moments was individualized for each discipline in accordance to its involvement with patients.
Zones by Lay Out

Patient Zone and Hospital Zone

Results
Education increased HH compliance over the 12 months period post intervention. The number of observations per moment per month ranged between 96 and 351 observations most observation opportunities during moment 1 (M1) and 5 (M5).
M1 correlated positively significantly with moment 2 (M2) (P=0.001) moment 3 (M3) (p &lt; 0.001) moment 4 (M4) (p =0,001) but not moment 5 (M5)
M2 correlated positively with M3 (p &lt; 0.001), M4 (p&lt; 0.001) Not M5. M3 correlated positively with M4(p&lt; 0.001) Not M5
No Correlations between CLABSI, CAUTI, CDI, MRSA and M1-M5 or Hand Hygiene.
There is a correlation between the decrease in MDR Acinetobacter incidence and point prevalence and compliance with M1 (p 0.04), M2 (p &lt; 0.001), M3 (p 0.002) and M4 (p 0.028).

Conclusion
Education of 5 moments of HH in a combined effort between infection prevention and front-line staff to identify patient and hospital zone showed an increased adherence to Hand hygiene overtime. Compliance with M 1 was associated with increased compliance with M2, M3 and M4.

Disclosures
Raquel Nahra, MD, Medline sponsored the study (Other Financial or Material Support, Supported financially and provided material)
986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault
Authors: Silva-Nash Jennifer R , Bordelon Stacie , Dare Ryan K , Searcy Sherrie 
Published: January 2021

Abstract

Background
Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines.

Methods
A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period.

Results
During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P&lt; 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P&lt; 0.001) in pre and post periods respectively.
Renal function (37.3% vs 88.6%; P&lt; 0.001), pregnancy (39.0% vs 79.6%; P&lt; 0.001), syphilis (3.4% vs 89.8%; P&lt; 0.001), hepatitis B (15.3% vs 95.5%; P&lt; 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period.
Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP

Conclusion
The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population.

Disclosures
Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)
987. Improving Patient Access to HIV Post-Exposure Prophylaxis with Pharmacist Involvement
Authors: Grossman Katlyn H 
Published: January 2021

Abstract

Background
Appropriate use of post-exposure prophylaxis (PEP) after isolated sexual, injection drug use, or other exposures to HIV is an effective tool to reduce the risk of HIV acquisition. PEP completion rates are low, with literature reporting only 40% of sexual assaulted persons adhering to a full 28-day course. One important barrier to adherence can be access to medications in a timely manner. In the United States, a four week course of PEP costs nearly $4,000 without insurance and can remain unaffordable with high copays and deductibles for patients who are underinsured.

Methods
A pharmacist in the Infectious Disease (ID) clinic was notified of all non-occupational post-exposure prophylaxis (nPEP) cases referred from the Emergency Department for follow up and coordinated benefits investigation, ensured low or no cost medication access, completed medication reconciliation, counseled on PEP adherence, and coordinated filling of same day prescriptions at the hospital based pharmacy. To assess the impact of pharmacist involvement, a retrospective review of nPEP cases over a 6 month period were compared to a 6 month period prior to pharmacist presence in clinic.

Results
16 nPEP cases were seen by a pharmacist compared to 8 nPEP cases seen in the ID clinic without pharmacist involvement. 100% of patients received medications prior to leaving the medical center, compared to 63% of cases filling at the hospital pharmacy prior to pharmacist presence. 25% of patients required an insurance related override in order to access PEP urgently. The average out of pocket cost was $2.25 with maximum total cost being $7.30. Prior to pharmacist involvement, the average out of pocket cost was $475 for complete PEP regimen with a maximum total cost of $3,733.40. 42% of patients completed their entire PEP course and came to follow up appointment after pharmacist involvement, compared to 31% of patients prior to pharmacist presence.

Conclusion
Pharmacist involvement led to a substantial cost savings to patients receiving nPEP. It was also associated with higher capture rates of prescriptions filled at the hospital pharmacy along with a higher rate of PEP completion and follow up.

Disclosures
All Authors: No reported disclosures
988. Overcoming Prescriber Concerns through Successful Access and Affordability of PrEP
Authors: Whelchel Kristen , Zuckerman Autumn , DeClercq Josh , Choi Leena , Rashid Shahristan , Kelly Sean 
Published: January 2021

Abstract

Background
Increasing the number of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) providers expands PrEP access to more eligible patients and aids in ending the HIV epidemic. Non-prescribers of PrEP have noted perceived financial barriers as a limitation to prescribing. The purpose of this study is to describe the PrEP medication access process and outcomes in patients seen at a multidisciplinary PrEP clinic.

Methods
We conducted a single-center, retrospective, cohort study of patients prescribed PrEP with emtricitabine-tenofovir disoproxil fumarate from a multidisciplinary clinic with prescriptions filled by Vanderbilt Specialty Pharmacy between 9/1/2016 and 3/31/2019. Patient data were gathered from the electronic health records and pharmacy claims data. We evaluated three different time periods: patient initial evaluation to PrEP initiation, prescription of PrEP to insurance approval, and PrEP insurance approval to initiation. Treatment initiation was considered a delay of &gt; 7 days from initial evaluation, and reasons for delay were recorded. Continuous variables are presented as median (interquartile range, IQR) and categorical variables are presented as percentages.

Results
Characteristics of the 63 included patients are in Table 1; most were male (97%), white (84.%), commercially insured (94%) with a median age of 38 years (IQR 29—47). The primary indication for PrEP was men who have sex with men at high risk for acquiring HIV (97%). The median time from initial appointment to treatment initiation was 7 days (IQR 4—8); Figure 1. Treatment delays were observed in 25% of patients and were mostly driven by patient preference (50% of delays). Insurance prior authorization was required in 27% of patients, all of which were approved. Median total out of pocket medication costs for the entire study period were $0 (IQR $0 – $0); Figure 2. Most patients (86%) used a manufacturer copay card.
Table 1 Patient Characteristics

Figure 1 Time to Treatment Initiation

Figure 2 Patient Out of Pocket Cost and Savings

Conclusion
In our cohort of mostly commercially insured men, the majority were able to access PrEP with low out of pocket costs facilitated by manufacturer assistance. Though generalizability beyond this population is limited, these results contradict perceived financial barriers to PrEP access.

Disclosures
All Authors: No reported disclosures
994. Risk for Viral Rebound in the Era of U=U; A CNICS Analysis
Authors: Hansen Blake , Liu Tao , Bazerman Lauri , Drainoni Mari-Lynn , Gillani Fizza S , Cachay Edward , Christopoulos Katerina , Crane Heidi , Kitahata Mari , Mayer Kenneth H , Moore Richard , Napravnik Sonia , Rana Aadia , Rodriguez Benigno , Beckwith Curt 
Published: January 2021

Abstract

Background
The “Undetectable equals Untransmittable (U=U)” HIV prevention campaign is a cornerstone of HIV prevention. However, there are few recommendations to guide patients and providers in U=U implementation and limited data on risk factors for viral rebound among persons eligible for U=U.

Methods
We conducted a retrospective multi-center study using data from the CNICS HIV research network to identify risk factors for viral rebound among persons with established viral suppression [two viral loads (VL) and all VLs of &lt; 200 copies/ul within a one-year period (U=U eligible)]. Demographics, patient-reported outcomes, and longitudinal clinical data from 21,359 persons with HIV were analyzed. To include missing data in the analysis, they were treated as a separate category. The primary outcome of viral rebound was defined as any VL &gt; 200 copies/ul within two years after U=U eligibility. A univariable logistic regression model was conducted to identify predictors of viral rebound. Significant variables (p&lt; 0.05) were included in a multivariable logistic regression model. Predictive values of individual variables were captured by adjusted odds ratios (aORs).

Results
From 2011-2019, 12,150 patients met criteria for U=U eligibility and had two years of follow up data. The median age was 46 (IQR: 38-53); 68% male; 51% were white, 39% black. 1544 (13%) experienced viral rebound during follow-up. Forest plot summaries of univariable and multivariable logistic regression models are in Figures 1&2. In multivariable analysis, Black race (aOR=1.56, p&lt; 0.001); MSM-IDU risk (aOR=1.38, p=0.006); lower QoL score (aOR=1.49, p=0.005); poorer ART adherence (aOR=1.84, p&lt; 0.001); duration of lifetime ART [aOR=1.47 (10+yrs), = 1.37 (5-10 yrs); and = 1.28 (2-5 yrs), p&lt; 0.001]; use of InSTIs after eligibility (aOR=1.60, p&lt; 0.001); current smoker (aOR=1.49, p&lt; 0.001), current amphetamine (aOR=1.83, p&lt; 0.001) or cocaine use (aOR=1.46, p=0.012), were associated with viral rebound. In both analyses, older age was protective against viral rebound.
Figure 1. Summary of Univariate Logistic Regression Model

Figure 2. Summary of Multivariable Logistic Regression Model

Conclusion
We identified multiple risk factors for viral rebound among PWH with viral suppression. Further research is needed to identify synergistic risk factors that increase probability of viral rebound to inform optimal implementation of U=U.

Disclosures
Edward Cachay, MD, MAS, Gilead (Consultant, Grant/Research Support)Merck Sciences (Grant/Research Support) Heidi Crane, MD, MPH, ViiV (Grant/Research Support) Benigno Rodriguez, MD, Gilead (Speaker’s Bureau)ViiV (Speaker’s Bureau)
996. The Potential for Reducing Opioid and Analgesic Prescriptions Via Herpes Zoster Vaccination
Authors: Poirrier Jean-Etienne , Carrico Justin , DeMartino Jessica K , Hicks Katherine A , Stoddard Jeffrey J , Nagar Saurabh P , Meyers Juliana 
Published: January 2021

Abstract

Background
Herpes zoster (HZ), or shingles, is a common neurocutaneous disease caused by the reactivation of latent varicella zoster virus that often includes rash and neuropathic pain that may last for months. Opioids and other analgesics may be prescribed. Recombinant zoster vaccine (RZV) is preferentially recommended for the prevention of HZ in adults aged 50 years and older. This study aimed to assess the impact of RZV vaccination on opioid and other analgesic prescription-related outcomes.

Methods
Estimates of analgesic prescription rates (opioids, benzodiazepines, and other analgesics) among HZ cases were established using Truven claims data from 2012-2018 for adults aged 50 years and older. HZ case avoidance with RZV vaccination was calculated using a previously published cost-effectiveness model. This data was included in a calculator assessing the impact of RZV vaccination on analgesic prescription-related outcomes (compared to no vaccination).

Results
Between 24.4% and 28.0% of HZ cases in the observed claims had at least one opioid prescription, dependent on age group (4.5%-6.5% and 8.6%-19.6% for benzodiazepines and other analgesics, respectively). The mean number of opioid prescriptions per person in each age group with at least one opioid prescription was between 1.7 and 1.9 (1.7-2.3 and 1.7-2.0 prescriptions for benzodiazepines and other analgesics, respectively). Assuming a 1-million-person population and 65% RZV coverage, the calculator predicts RZV vaccination will prevent 75,002 cases of HZ and will prevent 19,311 people from being prescribed at least 1 HZ-related opioid, 4,502 people from being prescribed benzodiazepines, and 12,201 people from being prescribed other analgesics. Additionally, 34,520 HZ-related opioid prescriptions will be avoided (9,413 benzodiazepine prescriptions; 22,406 other analgesic prescriptions).

Conclusion
HZ is associated with high levels of opioid, benzodiazepine, and other analgesic use. Primary prevention of HZ by vaccination could potentially reduce opioid and other medication exposure.

Disclosures
Jean-Etienne Poirrier, PhD, MBA, The GSK group of companies (Employee, Shareholder) Justin Carrico, BS, GlaxoSmithKline (Consultant) Jessica K. DeMartino, PhD, The GlaxoSmithKline group of companies (Employee, Shareholder) Katherine A. Hicks, MS, BSPH, GlaxoSmithKline (Scientific Research Study Investigator, GSK pays my company for my contractual services.) Saurabh P. Nagar, MS, RTI Health Solutions (Employee) Juliana Meyers, MA, GlaxoSmithKline (Other Financial or Material Support, This study was funded by GlaxoSmithKline.)
1001. HIV RNA monitoring after hospitalization for non-HIV-related illness in patients on combination antiretroviral therapy prior to admission
Authors: O’Donnell Paul , Murray Milena M , Kauer Sakhi , Motan Reem 
Published: January 2021

Abstract

Background
Hospitalization presents risk for loss of virologic suppression (VS) in people living with HIV (PLWH) due to issues with combination antiretroviral therapy (cART). cART medication errors or drug-drug interactions with new maintenance medications may lead to loss of VS. Appropriate monitoring of HIV RNA post-discharge to ensure ongoing VS may not occur following non-HIV-related illnesses. The objective of this multi-center study was to describe HIV RNA monitoring and VS in PLWH following hospitalization for non-HIV-related illnesses.

Methods
PLWH at least 18 years old with a CD4 count &gt;200 cells/mm3 on cART prior to admission, hospitalized for 24 hours or more at either of two large, academic medical centers (where they also attended follow-up clinic visits) for a non-HIV-related illness, and that survived to hospital discharge between January 1st 2010 and December 31st 2015 were eligible for analysis. The primary outcome was the presence of an HIV RNA measurement as recommended by national guidelines within 6 months of hospital discharge. Secondary outcomes included the incidence of transient viremia and loss of VS after discharge.

Results
A total of 329 patients were included. The median age was 51 years (interquartile range [IQR] 44-58), 76.6% were male, and 48.3% were African American. The median CD4 count was 484 cells/mm3 (IQR 357-629) and 85.4% (n=281) had an undetectable HIV RNA prior to admission. Among the 97.6% (n=321) of patients with an HIV RNA measurement after hospital discharge, the median time to HIV RNA measurement was 2.4 months (IQR=1.2-4.1) and 86.3% (n=284) had an HIV RNA measurement within 6 months. Among patients who were undetectable prior to admission, transient viremia after discharge occurred in 7.1% (n=20) within a median of 2.5 months (IQR 1.3-4.1) and 4 of these patients lost VS. Three of the four patients with loss of VS were admitted for a non-HIV-related infection and all were on protease inhibitor-based regimens.

Conclusion
HIV RNA monitoring appears to occur according to guideline recommendations in the majority of PLWH after hospitalization for a non-HIV-related illness. Despite the occurrence of transient viremia, loss of VS was rare. Future studies should focus on risk factors for loss of VS.

Disclosures
Milena M. Murray, PharmD, MSc, BCIDP, AAHIVP, Merck (Speaker’s Bureau)
1003. BIC/FTC/TAF Maintains Viral Suppression in Patients with Documented M184V/I Mutations: A Real World Experience
Authors: Chamberlain Nicholas , Brock James B , Mena Leandro A 
Published: January 2021

Abstract

Background
The M184V/I mutation is a common mutation in treatment-experienced patients with HIV and confers high-level resistance to lamivudine and emtricitabine. Our objective is to assess the effectiveness of bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in a real-world setting in achieving and maintaining viral suppression in patients with documented M184V/I mutations.

Methods
This case series is comprised of treatment-experienced HIV-positive patients with documented historical or newly-identified M184V/I mutations who were placed on BIC/FTC/TAF as a switch strategy or as therapy for patients who had failed a prior regimen. Patients with any resistance to tenofovir or bictegravir were excluded. Our primary outcome was sustained viral suppression at 12 months after initiation of BIC/FTC/TAF.

Results
We included 33 patients (94% black, 52% male, median age 49, range 36-63) with an M184V/I mutation. The majority (91%) showed sustained viral suppression at 12 months of treatment. Non-adherence to medication was the common factor in all three cases of treatment failure. One patient developed an R263K mutation while on therapy, which conferred low-level resistance to bictegravir. There were no other instances of newly-acquired resistance to any of the components of BIC/FTC/TAF.

Conclusion
Our results demonstrate high success rates of BIC/FTC/ATF in achieving and maintaining viral suppression in patients with documented M184V/I mutations who adhere to medications in a real-world setting with a single instance of new treatment-emergent resistance to bictegravir. These findings are congruent with reported sub-group analysis in clinical trial data and support the use of BIC/FTC/TAF in patients with M184V/I mutations.

Disclosures
Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau)