bluuebunny/crossref_metadata_2025_split huggingface dataset:
1282. A Major Hurdle for HIV Elimination: How Do We Promote Pre-Exposure Prophylaxis Persistence among Men Who Have Sex with Men in the Deep South?
Authors: Gravett Ronnie M , Westfall Andrew O , Kudroff Kachina , Overton Edgar T , Marrazzo Jeanne 
Published: October 2019

Abstract

Background
Pre-Exposure Prophylaxis (PrEP) effectively prevents HIV acquisition in men who have sex with men (MSM), if taken appropriately. Effective PrEP requires persistence in PrEP care. We defined the PrEP care continuum in a Deep South PrEP clinic and examined factors related to persistence in care among MSM.

Methods
We reviewed data for MSM at a university-affiliated PrEP clinic in Birmingham, AL from 2014–2018 to define the PrEP continuum at five major steps: screening, initial visit, follow-up visit, current persistence, and self-reported adherence. We defined persistence as attending a PrEP clinic visit in the last 6 months and nonpersistence as prior attendance without a visit in the last 6 months. We compared demographics, insurance status, and patient-reported behaviors from initial and most recent visits between those who persisted (“persisters”) and did not (“non-persisters”) using Wilcoxon rank sum, chi-square, or Fisher’s exact test.

Results
226 (100%) MSM were screened, 141 (62%) MSM attended an initial visit, 116 (51%) MSM attended follow-up, 43 (19.0%) persisted in PrEP care, and 29 (13%) MSM self-reported good adherence (figure). Among 139 MSM (46 persisters, 93 nonpersisters), persisters were older than nonpersisters (33 vs. 32 yr, P = 0.03), and were less likely to report inconsistent condom use at their initial visit (48% vs. 73%; P = 0.01) as compared with their last visit (69% vs. 63%, P = 0.13). 23% of persisters and 29% of nonpersisters were black (P = 0.39), and 98% of persisters and 90% of nonpersisters were insured (P = 0.50). 60% of persisters and 74% of nonpersisters had multiple sex partners at initial visit (P = 0.19) as compared with 56% and 60% at their last visit, respectively (P = 0.83).

Conclusion
At a Deep South PrEP clinic, persistence overall was poor for MSM. More nonpersisters had inconsistent condom use, indicating higher risk despite nonpersistence. Although not statistically significant, nonpersisters were more likely to be black, uninsured, and have multiple sexual partners when compared with persisters. Disparities seen nationally in new HIV diagnoses are reflected in nonpersisters. Nonpersisters may not realize the extent of their risk of HIV acquisition and warrant intensive engagement interventions.

Disclosures
All authors: No reported disclosures.
1286. Healthcare Provider Attitudes and Knowledge Around Pre-Exposure Prophylaxis (PrEP) for the Prevention of HIV-Infection in Tennessee
Authors: Moore Emily , Kelly Sean , Alexander Leah , Luther Patrick , Cooper Robert , Rebeiro Peter , Zuckerman Autumn , Hargreaves Margaret , Bourgi Kassem , Schlundt David , Bonnet Kemberlee , Pettit April 
Published: October 2019

Abstract

Background
Daily pre-exposure prophylaxis (PrEP) is very effective at preventing HIV acquisition. PrEP use in the southern United States is low despite high regional HIV prevalence. Prior surveys of primary care providers (PCPs) regarding PrEP occurred before recent guideline updates, were not constructed using a theoretical behavioral framework and validated, or did not focus on the South.

Methods
We conducted a cross-sectional survey of Tennessee (TN) PCPs from March-April 2019 to assess PrEP knowledge, attitudes, and prescribing practices. Survey development was guided by the COM-B framework (capability, opportunity, motivation and behavior) and validated by pilot testing and cognitive interviews. Knowledge scores were calculated as +1 point for each correct option and 0 points for each incorrect option (maximum score=8). Wilcoxon rank-sum tests were used to compare scores, and Fisher’s exact tests were used to compare categorical variables, between PrEP prescribers and nonprescribers.

Results
Among 69 respondents, 39% (n = 27) had prescribed PrEP. There were no differences in beliefs about PrEP or sense of obligation to prescribe PrEP between prescribers and nonprescribers. Patient inquiry about PrEP was significantly associated with prescription (P < 0.001); 100% of prescribers had ≥1 patient ask about PrEP in the past year vs. 29% of nonprescribers. Prescribers’ median PrEP knowledge scores were higher than nonprescribers’ (Figure 1). Prescribers had higher self-reported ability to take sexual histories for MSM and heterosexual male patients than nonprescribers (P = 0.007, P = 0.007), and higher self-reported comfort with taking sexual histories for MSM, heterosexual male, and heterosexual female patients (P = 0.061, P = 0.005, P = 0.026, respectively). Nonprescribers frequently cited a need for training in PrEP contraindications and eligibility, cost of PrEP, and administrative burden as barriers to provision.

Conclusion
Less than half of TN PCPs we surveyed prescribed PrEP despite similar senses of obligation and PrEP-related beliefs between prescribers and nonprescribers. Future interventions to improve PrEP provision among PCPs in TN should target PrEP knowledge, ability and comfort with sexual history taking, and patient awareness of and ability to inquire about PrEP.

Disclosures
All authors: No reported disclosures.
1289. Douching and Rectal Inflammation in Sexual Minority Men: Implications for HIV Acquisition
Authors: McGaugh Angela , Miller Charlene , King Justice , McManus Kate , Alcaide Maria L , Bauermeister Jose , Grov Christian , Manuzak Jennifer , Broedlow Courtney , Klatt Nichole , Carrico Adam 
Published: October 2019

Abstract

Background
Rectal douching is the practice of rinsing the anus and rectum prior to, or after, anal sex. Among gay, bisexual, and other men who have sex with men (sexual minority men), rectal douching is likely to enhance HIV acquisition by amplifying inflammation of the rectal mucosa. This study evaluated the association of rectal douching with rectal inflammation among sexual minority men at risk for HIV infection.

Methods
HIV uninfected sexual minority men who reported receptive anal intercourse in the past 3 months (N = 197) were recruited from four STI clinics in South Florida, the leading region for new HIV infections among sexual minority men in the United States. A brief survey assessed rectal douching practices and sexual behaviors in the previous 3 months. Rectal inflammation was assessed by measuring 13 human rectal inflammatory cytokines/chemokines in rectal swabs using the LEGENDplex Human Inflammation Panel in a sample of 38 participants who reported douching and condomless receptive anal intercourse (CRAI).

Results
Average age was 35.8 years (SD=15.4). The sample was multi-ethnic: 42% Caucasian, 38% Hispanic/Latino, 13% Black/African American, and 7% other ethnic minority. Approximately two-thirds of participants (65%) reported any rectal douching in the past 3 months and the median number times participants douched was five. Participants who douched had more CRAI partners (Cohen’s d = 0.4587; P < 0.01), and more CRAI partners to ejaculation (Cohen’s d = 0.4813; P < 0.01) compared with participants who did not douche. Participants who reported douching five or more times in the past 3 months displayed significantly higher levels of IL-8 (Cohen’s d = 0.79; P = 0.02) than those who douched less than five times.

Conclusion
Among sexual minority men who engage in CRAI, more frequent douching is associated with higher levels of rectal inflammation. Assessment of rectal douching should be included when evaluating HIV prevention interventions among sexual minority men, as those who douche are more likely to engage in CRAI and are at higher risk for acquisition of HIV and other sexually transmitted infection. Further mechanistic studies are needed to assess the role of rectal douching in promoting rectal inflammation.

Disclosures
All authors: No reported disclosures.
1291. Comparison of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) Screening Rates Before and After Implementation of a Quality Improvement (QI) Project Aimed at Incorporating Routine “Opt-Out” Testing at a Primary Care Resident Clinic in Columbia, SC
Authors: Pinkney Jodian , Ahuja Divya , Derrick Caroline , Faulkenberry Shannon B , Durkin Martin 
Published: October 2019

Abstract

Background
Southern states account for the majority of new cases of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) in the United States. Despite this, routine screening for these viruses in asymptomatic individuals remains low and patients often present with advanced disease.

Methods
We examined the screening rates for HIV and HCV before and after implementation of a Quality Improvement (QI) project aimed at routine “opt out” testing in asymptomatic individuals. The QI project was implemented at a single primary care clinic in February 2019 and will continue until August 2019. Persons were considered eligible for testing if they were between the ages of 18–65 years for HIV and 18–74 years for HCV. Screening rates were determined by calculating the percentage of eligible patients tested within the study period and compared with baseline screening rates of patients seen June–July 2018. Characteristics of the study population were valued by using descriptive statistics. Chi-square test was used to compare categorical variables. A significance level of P < 0.05 was considered statistically significant. We present 4-week data.

Results
532 patients were seen for the month of February 2019 (347 (65%) females and 185 (35%) males). Mean age was 57 years (SD = 19). Patients seen were predominantly black females. After QI implementation, the screening rate for HIV was 45% compared with the baseline screening rate of 30% (P = 0.014). Similarly, the screening rate for HCV was 47.2% compared with baseline screening rate of 20% (P < 0.001). Gender, age, chief complaint and insurance coverage did not impact screening rates. The major reason persons were not screened was opting out due to patient preference. 34% of eligible persons opted out of HIV testing, while 33% of eligible persons opted out of HCV testing. Provider engagement was initially high but tapered off. No new cases of HIV were found. 4 new cases of HCV with active viremia were identified.

Conclusion
While the implementation of routine “opt-out” testing significantly increased the percentage of individuals screened, a significant number of people are still choosing to opt out of testing. The percentage of persons opting out is higher than that seen in previous studies and may be contributing to the southern epidemic.

Disclosures
All authors: No reported disclosures.
1297. Examining the Successes and Challenges of Implementing HIV Testing Clinical Decision Support in the Emergency Department
Authors: Powell Mariah , Gierlach Michael , Werner Sandra L , Bar-Shain David S , Avery Ann 
Published: October 2019

Abstract

Background
In 2016, MetroHealth System (MHS) launched the FOCUS (Frontlines of Communities in the United States) project to routinize HIV testing in the emergency department (ED). Before 2016, clinical decision support (CDS) for HIV testing was not in place, nor was there a policy to support the importance of opt-out, nontargeted screening. The purpose of this study was to outline the progress of HIV testing after the integration of CDS, as well as describe the implementation challenges, and how certain events impacted HIV testing.

Methods
HIV testing data from MHS EDs were collected from October 1, 2015 to March 31, 2019 and graphed into a run chart. The dataset was mapped with the following events: project start date, ED testing begins (without CDS), CDS implementation, the staffing of the ED Testing Coordinator (EDTC), and optimization of CDS (Figure 1). To determine whether observed variation in the dataset is due to random or special cause variation, these run chart rules were applied: Run, Shift (Figure 2), and Trend.

Results
There were 42 data points and 4 runs. With 42 points, the lower limit of runs was 16 and the upper limit of runs was 28. This signals that one or more special cause variations were present. A total of three distinct shifts were observed indicating special cause variation. The run chart did not include any downward or upward trends. Testing increased as much as 3971% (7 tests in October 2015 vs. 285 tests in March 2018).

Conclusion
HIV testing increased from 7 tests to 86 tests (Shift 1). This coincided with establishment of an ED testing policy in April 2016. Testing increased to 266 tests in October 2016 (Shift 2). This directly related to implementation of CDS in the ED. December 2017 displayed the lowest testing with 117 tests. This was due to lack of policy awareness, and to the rarely-visited location of the HIV screening tool during the triage process. Staff was re-educated and the HIV screening tool was moved to a more visible location. This resulted in 227 tests in February 2018, and was followed by the highest testing month with 285 tests (Shift 3). Continued challenges prohibit sustained upward trends in ED testing. A control chart may be the appropriate next step to identify new control limits

Disclosures
All authors: No reported disclosures.
1303. Impact of Pharmacy Type on HIV Viral Suppression at a University-Based HIV Clinic in the Midwest
Authors: Havens Josh , New-Aaron Moses , Gao Yangyang , He Qingfeng , Nada Fadul , Bares Sara H 
Published: October 2019

Abstract

Background
People with HIV (PWH) utilize various pharmacy types beyond the traditional local pharmacy including mail order and specialty pharmacies. Some pharmacies often provide additional adherence services such as refill reminders, expedited delivery, and adherence packaging. Limited data are available describing the relationship between pharmacy type and HIV viral suppression (VS). We evaluated the impact of pharmacy type on VS.

Methods
We conducted a single-center, retrospective cohort study of PWH (≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2018, and December 31, 2018, with at least 1 HIV RNA reading during the study period. We collected sociodemographic information, ART regimen, adherence (PDC—percentage of days covered), and clinical characteristics. Patients were stratified by pharmacy type: local (traditional pharmacy without adherence services), local specialty (traditional pharmacy with adherence services and same-day, couriered delivery), and mail order (mail order pharmacy with or without adherence services). Pearson Chi-squared tests and binary logistic regression were used to examine the effect of pharmacy type on VS (HIV viral load ≤50 copies/mL).

Results
A total of 1014 patients met study criteria; 164 (16%) utilized a local, 720 (71%) local specialty, and 130 (13%) mail order. VS rates were similar between pharmacy types: local (91%), semi-specialty local (88%), and mail order (96%). After adjusting for sociodemographic characteristics, ART regimen, ART adherence and other clinical characteristics, there was no association between pharmacy type and VS when comparing local and mail to local specialty pharmacy types (local—aOR: 0.98, 95% CI, 0.46–2.12; mail—aOR: 1.65, 95% CI, 0.46–6.0). Factors found to be negatively associated with VS were single marital status (aOR: 0.49; 95% CI, 0.24–0.95), current or historical opportunistic infection (aOR: 0.51; 95% CI, 0.26–0.99), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI, 0.16–0.98).

Conclusion
Despite additional services offered by some pharmacies, no differences were observed in HIV VS between pharmacy types.

Disclosures
All authors: No reported disclosures.
1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV
Authors: Du Ping , Zurlo John , Eshak Tarek , Crook Tonya , Whitener Cynthia 
Published: October 2019

Abstract

Background
Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH.

Methods
YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study.

Results
92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%).

Conclusion
Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations.

Disclosures
All authors: No reported disclosures.
1330. Evaluation of Multiple Host Response-Based Strategies to Classify Acute Respiratory Illness
Authors: Ross Melissa H , Henao Ricardo , Burke Thomas W , McClain Micah T , Ginsburg Geoffrey S , Woods Chris W , Tsalik Ephraim L , Tsalik Ephraim L 
Published: October 2019

Abstract

Background
Host response-based diagnostics are an alternative to pathogen-based tests. Host response strategies include proteomic and transcriptomic approaches. Here, we compare three host response strategies for ARI diagnosis: Procalcitonin (PCT), a 3-protein panel, and an mRNA panel.

Methods
PCT, a 3-protein panel (CRP, IP-10, TRAIL), and a host gene expression mRNA panel were measured in a cohort of 286 participants presenting to one of the four Emergency Departments with ARI due to bacterial (n = 47), viral (n = 162), or noninfectious (n = 77) etiologies. Multinomial logistic regression and leave-one-out cross-validation were used to train and evaluate the protein and mRNA panels. Performance characteristics were calculated for each method, and their combination, for the ability to discriminate bacterial vs. non-bacterial infection and viral vs. nonviral infection. PCT was not evaluated for viral vs. nonviral discrimination since it does not discriminate viral and noninfectious etiologies. McNemar’s test was used to compare overall accuracy of mRNA and protein panels.

Results
For discriminating bacterial vs. non-bacterial etiologies, the mRNA panel had an AUC of 0.93 vs. 0.83 for both the protein panel and PCT. A model utilizing all three strategies was the same as mRNA alone. Using previously established cutoffs, overall accuracy was similar between mRNA and protein panels, but the protein panel had widely discordant sensitivity (43%) and specificity (92%). When selecting an optimal cutoff for the protein panel that balanced the two (82% and 73%, respectively), the mRNA panel had a significantly greater overall accuracy (P < 0.001). Similar results were found when discriminating viral vs. non-viral subjects: the mRNA panel (AUC = 0.93) outperformed the protein panel (AUC = 0.84). Combining the mRNA and protein panels was equivalent to the mRNA panel alone.

Conclusion
A host-based gene expression signature is the most effective platform for classifying subjects with bacterial, viral, or noninfectious ARI. A gene expression approach, when translated to a clinically available platform, may facilitate diagnosis and clinical management of acute infectious diseases, mitigating antibiotic overuse.

Disclosures
Ephraim L. Tsalik, MD, MHS, PhD, Immunexpress: Consultant; Predigen, Inc.: Officer or Board Member, Research Grant.
1335. A Translational Nephrotoxicity Model to Probe Acute Kidney Injury with Vancomycin and Piperacillin–Tazobactam
Authors: Pais Gwendolyn M , Liu Jiajun , Avedissian Sean N , Hiner Danielle , Xanthos Theodoros , Chalkias Athanasios , d’Aloja Ernesto , Locci Emanuela , Gilchrist Annette , Prozialeck Walter , Rhodes Nathaniel J , Lodise Thomas , Fitzgerald Julie , Downes Kevin J , Downes Kevin J , Zuppa Athena , H. Scheetz Marc 
Published: October 2019

Abstract

Background
Vancomycin and piperacillin–tazobactam (VAN+TZP) are two of the most commonly utilized antibiotics in the hospital setting and are reported in clinical studies to increase acute kidney injury (AKI). However, no clinical study has demonstrated that synergistic AKI occurs, only that serum creatinine increases with VAN+TZP. Previous preclinical work demonstrated that novel urinary biomarkers and histopathologic scores were not increased in the VAN+TZP group compared with VAN alone. The purpose of this study was to assess changes in urinary output and plasma creatinine between VAN, TZP, and VAN+TZP treatments.

Methods
Male Sprague–Dawley rats (n = 32) received either saline, VAN 150 mg/kg/day intravenously, TZP 1,400 mg/kg/day intraperitoneally, or VAN+TZP for 3 days. Animals were placed in metabolic cages pre-study and on drug dosing days 1–3. Urinary output, plasma creatinine, urinary biomarkers were compared daily and kidney histopathology was compared at the end of therapy between the groups. Mixed-effects, repeated-measures models were employed to assess differences between the groups.

Results
In the VAN-treated rats, urinary output was increased on days 1, 2 and 3 compared with baseline and saline (P < 0.01 for all), whereas it increased later for VAN+TZP (i.e., day 2 and 3 compared with saline, P < 0.001). No changes in urinary output were observed with saline and TZP alone. Plasma creatinine rose for VAN on days 1, 2, and 3 from baseline and VAN+TZP on day 3 (P < 0.02 for all), but no treatment group was different from saline. In the VAN-treated rats, urinary KIM-1 and clusterin were increased on days 1, 2, and 3 compared with controls (P < 0.001). Elevations were seen only after 3 days of treatment with VAN+TZP (P < 0.001 KIM-1, P < 0.05 clusterin). No changes in urinary biomarkers output were observed with saline and TZP alone. Histopathology was only elevated in the VAN group compared with saline (P < 0.002). No histopathology changes were noted with VAN+TZP.

Conclusion
All groups with VAN demonstrated kidney injury; however, VAN+TZP did not cause more kidney injury than VAN alone in a rat model of VIKI when using plasma creatinine, urinary output, or urinary biomarkers as outcomes. Histopathology data suggest that adding TZP did not worsen VAN-induced AKI and may even be protective.

Disclosures
Kevin J. Downes, MD, Merck: Grant/Research Support, Research Grant; Pfizer: Grant/Research Support.