bluuebunny/crossref_metadata_2025_split huggingface dataset:
1290. Community Screening and Education for HIV and Hepatitis C (HCV) infection in South Texas with Rapid Point of Care Testing and a Mobile Phone Application (app)
Authors: Allison Waridibo E , Melhado Trisha , Kawasaki Keito , Desai Anmol , Bobadilla Raudel 
Published: October 2019

Abstract

Background
HIV and HCV infection cause considerable morbidity and mortality if untreated. The southern United States has the highest burden of new HIV diagnoses nationwide. Approximately 60% of hepatocellular carcinoma (HCC) in the United States is due to HCV. HCC incidence rates are the fastest growing among all cancers in Texas (TX). We aimed to use community screening events to provide additional diagnostic opportunities and surveillance data for HIV/HCV and to evaluate an HIV/HCV app to optimize public health education and prevention.

Methods
Two community HIV/HCV screening/education events occurred in April 2019 in the border city of Laredo, TX (at a community park) and San Antonio, TX (on a university campus). Those screened for HIV/HCV using point of care rapid tests completed a demographic and risk factor questionnaire. HIV/HCV education was offered to attendees via an app with a teach-back feature to assess short-term knowledge gains in specific areas: HIV and HCV cure, body organ impacted by HCV, HCV transmission, HCV symptoms.

Results
Attendees: Laredo event—approximately 260 people; San Antonio event approximately 100 people. 60 people were screened for HIV and HCV. 77% were Hispanic, 63% were female, 68% were 18–25 years old, 63% reported not having a primary care provider. One HCV seroreactive case was identified and linked to care. The most commonly reported risk factors were having tattoos (43%) and body piercing (37%). Other risk factors included street drug use (12%), home finger stick blood checks (12%), dental surgery outside the United States (12%). Fifty-three people utilized the HIV/HCV education app. 91% correctly identified that HIV cannot be cured, 87% correctly identified that HCV impacts the liver and that a test can confirm HCV infection. 81% correctly identified how HCV can be transmitted and 79% corrected identified that HCV can be cured. The app was rated 4.8/5, as “very useful” on a Likert scale.

Conclusion
Features of those screened included not being engaged in primary care, having risk factors for both HCV and HIV infection and the majority being young adults. The HIV/HCV mobile phone app was an acceptable education tool for those who utilized it. Appropriately developed and implemented apps can be effective in teaching key knowledge points about HIV/HCV infection.

Disclosures
All authors: No reported disclosures.
1296. Should HIV Disclosure at ED Based on Preliminary Results?
Authors: Aguilera Elizabeth A , Del Bianco Gabriela P , Murphy Daniel , Rodriguez Gilhen , Heresi Gloria , Murphy James , Prater Samuel 
Published: October 2019

Abstract

Background
It is recommended that all adults presenting to Emergency Departments (ED) be offered opt out testing for HIV. There is evidence that detection of HIV infection, disclosure of infected status to the patient, and enrollment into HIV care are best accomplished during the ED visit. Any delay results in loss of patients. Among critical variables are capacities to conduct screening and confirmatory testing during the time the patient is a resident in the ED. We report on a facility where HIV screening is performed during ED patient dwell times but confirmatory results follow in ≥24h. The conundrum is whether patients found HIV positive by a screening test should be informed of the positive screening finding before confirmatory results are in hand.

Methods
Data obtained from a routine opt-out HIV screening program for the interval June 2017 to March 2019 conducted at the ED in Houston, Texas were evaluated. Patients between 18–65 years with Glasgow Score >9 were eligible for testing. HIV fourth-generation ADVIA Centaur™ Ag/Ab COMBO (Siemens) was used for screening. Positives screening tests were followed by Gennius™ HIV1/HIV2 confirmatory test.

Results
12,040 HIV fourth-generation tests were performed; 232 (1.9%) were positive; the specificity of the screening testing was 98.2%. Twenty-two (9.5%) of screening test positive individuals were found HIV false positive (Ag/Ab positive and Gennius negative). The population had a mean age of 43.8 years (21–64), was predominately female (63.6%) and white (40.9%). Further testing was completed for 14 of the 22 patients with false-positive screening tests. 13 had negative tests for HIV RNA and 1 had a second HIV Ag/Ab test with negative findings. 8 (36.3%) screening test false-positive patients could not be located after their departure from the ED.

Conclusion
If patients were disclosed of their HIV-positive status because of the screening test result, approximately 10% of these individuals would have been incorrectly categorized generating significant personal and social disruption while waiting for the confirmatory result.

Disclosures
All authors: No reported disclosures.
1318. Examining Multimorbidity as a Moderating Effect on the Relationship Between Substance Use and Viral Suppression Among People Living with HIV
Authors: Crawford Timothy N , Thornton Alice 
Published: October 2019

Abstract

Background
Substance use and multimorbidity (≥2 chronic conditions) are highly prevalent among people living with HIV (PLWH). However, their impact on achieving viral suppression are not well understood. The purpose of this study was to examine the relationship between substance use and viral suppression and the potential moderating effect of multimorbidity.

Methods
A retrospective cohort study was conducted at an academic Ryan White Funded clinic in central Kentucky. Individuals were included if they were diagnosed with HIV, seeking care between 2010 and 2014, had at least one year of follow-up, and did not have a chronic condition at the time they entered care. The primary independent variable was substance use which included alcohol, nicotine use, and/or illicit drug use; the moderating variable was multimorbidity (0, 1, ≥2 chronic conditions); and outcome was viral suppression (≤50 copies/mL). A logistic regression model was developed to examine the interaction between substance use and multimorbidity on achieving viral load suppression. The model controlled for medication adherence, insurance status, age, and CD4+ cell counts.

Results
A total of 941 individuals were included in the study, with an average age of 43.9 ± 11.7 years. Approximately 67.0% reported substance use; 54% had ≥2 chronic conditions diagnosed. The three most prevalent conditions diagnosed were hypertension (34.6%), mental health (33.9%), and diabetes (21.5%) Approximately 61.0% of substance users had ≥2 conditions. Those with viral suppression were less likely to be substance users, but were more likely to have ≥2 conditions compared with their counterparts. There was a significant interaction between substance use and multimorbidity (P = 0.037). Stratified by multimorbidity, substance use was associated with unsuppressed viral loads; among those with ≥2 chronic conditions substance users had lower odds of achieving viral suppression compared with nonusers (OR=0.24; 95% CI=0.10–0.55).

Conclusion
Substance use may impede the opportunity for PLWH to achieve viral suppression, increasing their risk of transmission and progression of disease. More research is needed to understand the role substance use plays in impacting viral load, specifically among those with multiple chronic conditions.

Disclosures
All authors: No reported disclosures.
1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views
Authors: Yonga Paul Otieno , Kalya Stephen Kiplimo , Lynen Lutgarde , Decroo Tom 
Published: October 2019

Abstract

Background
Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce.

Methods
A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews.

Results
342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders.

Conclusion
A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up.

Disclosures
All authors: No reported disclosures.
1326. Comorbid Mental Health Disorders Are a Key But Manageable Barrier to Suppression of HIV Viral Load
Authors: Stivers Tiffany , Porterfield J Zachary , Collins Jana , Yang Justin , Parrish Robert , Thornton Alice 
Published: October 2019

Abstract

Background
Kentucky sits at the epicenter of the HIV epidemic in the United States and harbors 54 of the top 220 HIV/HCV outbreak vulnerable counties in the United States; 44 of which are served by the Bluegrass Care Clinic at the University of Kentucky. Understanding the barriers to care at the frontlines of the epidemic is of critical importance in the work toward the eventual elimination of HIV in the United States and elsewhere.

Methods
The Bluegrass Care Clinic has achieved viral suppression in 90% of the HIV-positive patients enrolled in care. Given the catchment area served by this clinic, however, the unsuppressed 10% of patients likely represent the tip of an iceberg of undiagnosed patients or those lost to care from remote and at-risk communities. We developed a quality improvement project to specifically review the barriers to achieving viral suppression in this subset of patients in our clinic. Additionally, we developed an outreach algorithm for patients identified as having comorbid mental health issues to increase engagement in both HIV and mental healthcare.

Results
We found that nearly 45% of virally unsuppressed patients in our clinic had comorbid mental health disease and 30% had substance use disorders. Female sex was associated with being unsuppressed (P = 0.003); however, age and race were not predictive. Of the patients identified as having mental health barriers to care, 58% were able to be contacted using our outreach algorithm and 58% of these patients accepted referral into a mental health service. In this first 12 months of this program 26% of these patients achieved viral suppression and an additional 18% had substantial decreases in their viral loads.

Conclusion
This preliminary report highlights the importance of identifying and addressing barriers to care. Comorbid mental disorders have consistently been associated with greater difficulties in achieving viral suppression. We present an effective and successful program for engaging patients in mental healthcare using an interdisciplinary outreach program that is designed to be generalizable. These data set the stage for reaching the missing subset of patients who are not currently engaged in HIV care, a critical next step for universal test and treat and 90/90/90 strategies.

Disclosures
All authors: No reported disclosures.
1337. Development, Maintenance, and Application of Opsonophagocytic Assays to Measure Functional Antibody Responses to Support a 20 Valent Pneumococcal Conjugate Vaccine
Authors: Scully Ingrid L , Cutler Mark W , Gangolli Seema , Belanger Todd , Cooper David , Jones Thomas , McKeen Andrew , Tan Charles , Watson Wendy , Anderson Annaliesa S , Jansen Kathrin U , Pride Michael W 
Published: October 2019

Abstract

Background
Opsonophagocytic assays (OPAs) are an important tool for assessing vaccine-induced functional antibody responses. OPAs are complex assays composed of many biological components (eg serum, complement sources, bacteria, and human phagocytes) which contribute to assay variability and may result in titer drift if not carefully controlled. Rigorous development and validation coupled with routine monitoring of assay performance are required to ensure that high-quality OPA serological data are consistently generated throughout the lifetime of existing and next-generation pneumococcal vaccines.

Methods
OPA specificity was demonstrated by competing functional antibody activity with pneumococcal polysaccharides. Assay qualification/validation assessed accuracy, precision, and sample linearity. Assay performance over time was assessed through the implementation of quality control serum data tracking systems and longterm serum proficiency panels that are routinely tested during assay performance. Human quality control sera are included on each assay plate to ensure that each plate meets pre-specified acceptance criteria. Proficiency serum panels are comprised of individual human serum samples derived from subjects immunized with pneumococcal vaccines and are used to monitor performance across a range of serological titers and over time.

Results
The OPAs were shown to be specific and reproducible. Monitoring of assay performance over time demonstrated that the assays are stable. For the 13 serotypes contained in 13vPnC reliable titers have been generated in over a decade of testing which is an essential prerequisite in the evaluation of next-generation pneumococcal conjugate vaccines such as 20vPnC, whose licensure depends on demonstration of non-inferiority to 13vPnC.

Conclusion
Maintenance and careful monitoring of high-quality assays to measure functional antibody responses, such as OPAs, is critical for the delivery of reliable serological data to support the advancement of pneumococcal vaccine programs. Pneumococcal OPAs must be rigorously maintained to ensure continuity of serological data over time and inform licensure decisions of next-generation vaccines as well as postmarketing and seroepidemiology studies.

Disclosures
All authors: No reported disclosures.
1338. Development of a Novel Application for Differential Diagnosis of Tick-borne Diseases
Authors: Meyer Corey , Sanjak Jaleal , Cerles Audrey , Garnier Christian , MacMillan Laurel 
Published: October 2019

Abstract

Background
Early diagnosis and treatment of tick-borne diseases (TBDs) is critical for mitigating their adverse health outcomes, but the differential diagnosis of TBDs is challenging because many symptoms are nonspecific and commonly used diagnostic assays have significant shortcomings. Furthermore, although the local incidence of TBDs is recognized as an important factor in diagnosis, tools to help clinicians formally consider surveillance data in their decision-making are not available. To address these gaps, Gryphon Scientific developed a differential diagnosis application (app) for TBDs that calculates a patient’s likelihood of infection with specific TBDs based on their symptoms, risk factors, and state of suspected tick exposure.

Methods
A differential diagnosis model for TBDs was developed using data on: (1) TBD symptom and risk factor prevalence in TBD patient populations, collected from clinical studies; and (2) human TBD incidence data from notifiable disease surveillance systems and tick infection prevalence data from reports and public databases, which were combined to develop an environmental risk measure. These data were used to build a Bayesian Belief Network (BBN) model that predicts TBD infection probabilities based on a patient’s symptoms, risk factors, and state of suspected tick exposure. Performance of the model was validated using case studies from the biomedical literature. The model was incorporated into an app developed using R-shiny, called TBD-DDx (Figures 1 and 3).

Results
A pilot application was developed that includes 10 states (AR, CT, MA, ME, MN, MO, NH, RI, VT, and WI) and the 11 TBDs endemic to those states. The differential diagnosis model identified the patient’s true disease as the top-predicted disease in 56% of cases and within the top three predicted TBD in 84% of cases. The inclusion of incidence factors in the model improved performance (Figure 4).

Conclusion
These results demonstrate that the TBD-DDx app is a promising tool for informing clinical diagnoses of TBDs to guide selection of diagnostic testing and treatment. This study represents the first use of a BBN modeling approach that incorporates an environmental risk measure and could be adapted for differential diagnosis of other diseases with environmental or other exposure risks.

Disclosures
All authors: No reported disclosures.
1341. Development of a Series of High-Throughput Screens to Identify Leads for Nontuberculous Mycobacteria Drug Design
Authors: McGuffin Sarah , Mullen Steven , Early Julie , Parish Tanya 
Published: October 2019

Abstract

Background
Nontuberculous mycobacteria (NTM), particularly Mycobacterium avium complex and Mycobacterium abscessus complex, cause significant morbidity and mortality in patients with impaired host immunity or pre-existing structural lung conditions. NTM infections are increasing at an alarming rate worldwide and there is a dearth of progress in regard to the development of efficacious and tolerable drugs to treat such infections. Traditional drug discovery screens do not account for the diverse physiological conditions, microenvironments, and compartments that the bacilli encounter during human infection. In order to help populate the NTM drug pipeline, and explore the disconnect between in vitro activity, in vivo activity, and clinical outcomes, we are developing a high throughput in vitro assay platform that will more closely model the unique infection-relevant conditions encountered by NTM.

Methods
We are developing and validating a suite of in vitro assays that screen compounds for activity against extracellular planktonic bacteria, extracellular bacteria within biofilms, intracellular bacteria, and nutrient-starved non-replicating bacteria.

Results
We are using both the smooth and rough morphotypes of M. abscessus and M. avium. We have validated high throughput assays to pharmaceutical standards for replicating and non-replicating M. abscessus. We have also tested a panel of 18 known anti-mycobacterial compounds. Assay development is currently underway to test compounds for activity against NTM in biofilm and inside macrophages as well.

Conclusion
To enhance hit identification for scaffolds to use as starting points for NTM drug development, focused libraries of compounds that have undergone significant preclinical profiling and/or compounds with known activity against M. tuberculosis (TB) will be screened. Such a “piggyback” approach usurps advances made in TB drug development and leverages them for NTM drug discovery. This will help expedite novel drug development, reduce attrition rate, and offer a shorter route to clinical use as it exploits the prior investment in medicinal chemistry, pharmacology, and toxicology.

Disclosures
All authors: No reported disclosures.
1344. Interferon Gamma Release Assay (IGRA) Responses in HIV-Infected and -Uninfected Women in Pregnancy
Authors: Kaplan Samantha , Matemo Daniel , Mecha Jerphason O , Kinuthia John , John-Stewart Grace , LaCourse Sylvia 
Published: October 2019

Abstract

Background
Pregnancy and HIV-associated immunologic changes may affect latent TB infection (LTBI) interferon-gamma release assay (IGRA) QuantiFERON TB Gold Plus (QFT-Plus) diagnostic performance.

Methods
In this ongoing study, HIV-infected and -uninfected women 20–34 weeks gestation without TB in the past year are enrolled from antenatal clinics in western Kenya and tested with QFT-Plus. Mean quantitative IFN- γ responses to mitogen, and M. tuberculosis antigens (TB1 [primarily CD4+] and TB2 [addition of CD8+ response]) were compared using two-sample t-tests. Proportions for categorical variables were compared using univariate logistic regression.

Results
Among 306 women (HIV+ 127 [41.5%], HIV− 179 [58.5%]) enrolled between January 2018 and March 2019, median maternal and gestational age were 25 years (IQR 21–28) and 28 weeks (IQR 24–32), respectively. Among HIV-infected women at enrollment, 99.2% were on ART, median CD4 count was 440 cells/mm3 (IQR 235–703), 37.5% were virally suppressed, and 60.6% reported having received isoniazid preventive therapy (IPT). Overall, 95 (31.1%) women were QFT-Plus positive (HIV+ 38 [29.9%], HIV− 57 [31.8%], OR 0.90, 95% CI 0.54–1.48, P = 0.671); 190 (62.1%) were negative (HIV+ 81 [63.8%], HIV− 109 [60.9%]), and 21 had indeterminate results (HIV+ 8 [6.3%], HIV− 13 [7.3%], OR 0.83, 95% CI 0.33–2.09, P = 0.690). Mean response to mitogen was similar between HIV-infected and -uninfected women (6.0 vs. 6.1 IU/mL, P = 0.663]. Among QFT-Plus positive women, HIV+ women had significantly lower TB1 responses than HIV− women (HIV+ 2.7 vs. 4.2 IU/mL, P = 0.035). Mean TB2 responses had a similar pattern, but did not reach statistical significance (HIV+ 3.1 vs. 4.3 IU/mL, P = 0.107). Both TB1 and TB2 were positive for 82 women (86.3%), 4 women were only TB1 positive (4.2%), and 8 women were only TB2 positive (8.4%).

Conclusion
Among pregnant women, HIV-infection was not associated with increased prevalence of QFT+ responses. However, among QFT-positive women, TB1 responses were lower in HIV-positive women with a similar trend observed for TB2 responses. These findings suggest that HIV-associated immunologic changes may influence QFT test performance.

Disclosures
All authors: No reported disclosures.