bluuebunny/crossref_metadata_2025_split huggingface dataset:
1278. Assessing Statewide HIV Pre-exposure Prophylaxis Implementation Using an All Payer Claims Database
Authors: Nocka Kristen , Raifman Julia , Crowley Christina , Galárraga Omar , Wilson Ira , Tao Jun , Chan Philip , Chan Philip 
Published: October 2019

Abstract

Background
Pre-exposure prophylaxis (PrEP) in the form of daily tenofovir disoproxil fumarate (TDF/FTC) is a potentially transformative tool to prevent HIV infection. However, PrEP scale-up in the United States has been slow and difficult to evaluate comprehensively. All payer claims databases (APCDs) are large datasets that contain information on medical and pharmaceutical claims from most public and private payers in each state, and provide an unusual opportunity to evaluate statewide PrEP implementation efforts.

Methods
We used 2012–2017 data from Rhode Island’s APCD and developed an algorithm to identify individuals prescribed TDF/FTC for PrEP. We compared APCD PrEP data to electronic medical record (EMR) data at the largest dedicated PrEP program in the state, and to other comprehensive pharmaceutical claims data (AIDSVu.org). We calculated the PrEP-to-Need ratio (PnR) based on annual HIV incidence, and used multivariable logistic regression to predict ZIP code-level PrEP use, and specialty of prescribing provider (primary care vs. infectious disease).

Results
The Rhode Island APCD included insurance claims for 917,633 individuals (87% of the Rhode Island population). PrEP use increased substantially in Rhode Island over the 5-year period, from 13 to 331 prescriptions between 2012 and 2017, with 546 total users during this time period. Users were predominantly male (89%) and privately insured (69.1%), and concentrated in Providence County (71.5%). The PnR ratio increased from 0.2 to 4.0 from 2012–2017. Compared with AIDSVu and EMR Data, the APCD underestimated the number of PrEP users in Rhode Island, but improved over time in documenting users. Infectious diseases specialists had 8.4 times the odds (95% CI: 5.4 to 12.9) of being a PrEP prescriber compared with primary care providers. A total of 2.6% of infectious disease specialists were PrEP prescribers compared with 0.33% of PCPs. The proportion of Black or Hispanic individuals in a ZIP-code was not a significant predictor of PrEP use.

Conclusion
APCDs offer an innovative approach to evaluate statewide PrEP implementation comprehensively. Engaging PCPs in PrEP implementation is critical to improve overall uptake among populations most at-risk.

Disclosures
All authors: No reported disclosures.
1279. Barriers to Acquiring Pre-Exposure Prophylaxis (PrEP), Risk Factors for HIV and Health Determinants in Adult Transgender Individuals
Authors: Sanchez Daniel , Conklin Jessica , Borrego Matthew , Newsome Cheyenne , Mercier Renee C 
Published: October 2019

Abstract

Background
Transgender women face many health disparities including higher rates of acquiring Human Immunodeficiency Virus (HIV). The prevalence of HIV in the transgender population is 14.1% with 31% of this population engaging in sex work. PrEP is an effective method to prevent HIV acquisition. With transgender women among the highest risk in acquiring HIV, this study aimed to describe the transgender population while identifying risk factors for acquiring HIV and barriers transgender females face in acquiring PrEP.

Methods
An IRB approved, cross-sectional study utilized an electronic questionnaire administered to 54 people at a community resource center who specializes in the care for transgender individuals between January and April 2019. Using a pre-questionnaire survey, participants were eligible for inclusion if they were deemed at high risk for acquiring HIV. A second survey was given to those who were deemed high risk and met the inclusion criteria ( ≥18 years old). Survey questions inquired about the individuals’ high-risk behaviors, social determinants of health and knowledge about PrEP. Descriptive statistics were used for data analysis.

Results
Of the 54 participants, 51 individuals met inclusion for enrollment. Two of the enrolled people were excluded due to incomplete surveys. Of the 49 individuals who completed the study, 43 of the participants had a gender identity other than their assigned sex. Nearly half of the people in this study were American Indian. Over 60% of the cohort had sex for money or other goods. Depression was reported by 71% of participants while homelessness by 59%. Approximately 69% were aware of PrEP however 70.8% had never taken PrEP. When asked about HIV risk, 41.7% felt that they were not at risk for HIV and chose not to take PrEP. Lack of self-awareness of HIV risk factors was the predominant barrier to PrEP.

Conclusion
This is, to the best of our knowledge, the first study to describe a significant proportion of transgender individuals of American Indian heritage who are at high-risk for HIV. Participants were aware of PrEP however despite high-risk behaviors they underestimated their risks and few took PrEP. Negative health determinants were reported in the majority of participants.

Disclosures
All authors: No reported disclosures.
1285. PrEP Acceptability, Uptake, and Adherence Among Young Men Who Have Sex with Men and Transgender Women in PrEP Demonstration Project, Chiang Mai, Thailand
Authors: Kaewpoowat Quanhathai , Saokhieo Pongpun , Songsupa Radchanok , Supindham Taweewat , Chariyalertsak Suwat 
Published: October 2019

Abstract

Background
Young men who have sex with men (YMSM) and transgender women (YTGW) are at high risk for HIV acquisition. In attempt to end the HIV epidemic, the comprehensive HIV prevention packages should be offered. However, the PrEP persistent among this population in western studies was low. The acceptability, uptake and persistent among Thai YMSM/YTGW PrEP clients were explored.

Methods
This is a sub-study of PrEP implementation project in Chiang Mai Thailand which was conducted during December 2015–February 2017. In the main study, PrEP@PIMAN, 105 participants who were 18 years and older, able to read and write in Thai, creatinine clearance ≥60 mL/minute, negative urine protein, and HBs-Ag-negative YMSM/YTGW were enrolled. Twelve months of PrEP along with quarterly visit and comprehensive HIV prevention package were offered. The data were collected through interview and computer-assisted self-interview. Each participant voluntary made their own decision about PrEP uptake.

Results
Sixty participants (57% of the main study) were youth, aged 16–24 years old. Of those, 82% were gay men and 12% were TGW (self-identified). Mean age was 21 years old and 80% were university/college students. At baseline, median partner in past 3 month was 3 (range 0–52). Approximately one-fourth of the participants reported history of sexually transmitted diseases (STDs) and 8% has positive TPHA at baseline. Majority (72%) initiated PrEP with 70% at the enrollment 2% during the study. PrEP was discontinued in 25% (10/42) due to nonserious side effects, participant preference or lost to follow-up (see Figure 1). The retention rate at 12 month were 70%. PrEP use was not consistent (see Figure 2). Only 30% reported adherence ≥60% (or equivalent to ≥4 pills/ week) throughout the study period. There was no seroconversion during 49 person-year of follow-up with 5 confirmed new STDs (incidence of 10/100 person-year).

Conclusion
This project demonstrated a good uptake with varying PrEP adherence rate among Thai YMSM and YTGW. The PrEP persistent was persistence could be improved. Further interventions and strategies should be explored to enhance PrEP adherence among this population.

Disclosures
All authors: No reported disclosures.
1295. Mortality of Patients with HIV Infection Admitted to the Intensive Care Unit: A 16-Year Experience
Authors: Rosso Fernando , Marcela Martínez-Ruiz Diana , Castro Andres , Parra-Lara Luis Gabriel , Andrés Hoyos Jorge , Tovar Daniela , Granados Marcela 
Published: October 2019

Abstract

Background
The life expectancy of HIV patients has increased with antiretroviral therapy which has reduced the incidence of AIDS-associated illnesses. Longer life expectancy increases noncommunicable diseases cases and the demand for intensive care unit (ICU) care. ICU mortality is higher among HIV patients. Information about mortality and other relevant outcomes among HIV patients from developing countries is paramount for benchmarking purposes. This study aimed to evaluate the mortality of patients with HIV/AIDS admitted to the ICU during the years 1999 to 2015.

Methods
An observational retrospective study was conducted based on episodes of patients admitted to the ICU of the Fundación Valle del Lili from December 1998 to October 2015. The Cochran-Armitage test was used to evaluate the trend of HIV mortality by 4-year periods, considering sex and age groups ( <50 vs. >50 years). The Z test compared the mortality between HIV patients with non-HIV patients in the ICU; also it compared the mortality in HIV patients by sex and age group.

Results
A total of 53,798 episodes of ICU admissions were analyzed, 0.76% (414) were HIV patients, and of this 78.5% were men. Twenty-three percent were over 50 years old. Overall mortality in the ICU was 9.13%, and the mortality in HIV patients was 22.03%, which was higher when compared with a non-HIV group (9%, P < 0.001). Mortality due to HIV had a statistically significant decreasing trend (P < 0.001), going from 40% between 1999 and 2003 to 18.04% between 2012–2015, this trend was observed among men with HIV (P < 0.001) starting with 43. 5% and ending at 20%, but among women the decreasing trend was not statistically significant (P = 0.62). Mortality for HIV decreased, in the <50 years group: it went from 38. 3% to 18. 6% (P = 0.0003). Furthermore, in patients 50 years and older group mortality went from 50% to 17.9% (P = 0.025). During period 2008–2011, patients 50 years and older had more mortality compared with <50 years group (P = 0.019), but there were no differences by sex in any period.

Conclusion
This study found a statistically significant trend for mortality decrease over a 16-year period among HIV patients admitted to an ICU from a developing country.

Disclosures
All authors: No reported disclosures.
1307. Virologic Failure in HIV-Infected Men Who Have Sex with Men and Transgender Women Treated in a Community-Based Model vs. a Hospital-based Model
Authors: Brito Maximo O , Khosla Shaveta , Mehta Supriya D , Novak Richard M 
Published: October 2019

Abstract

Background
Men who have sex with men (MSM) and transgender women are disproportionately affected by HIV, especially those that belong to minority groups and lower socioeconomic status. The purpose of this study was to compare virologic failure in MSM and transgender women receiving HIV care at a community-based model (CBM) to a hospital-based model (HBM) of care.

Methods
This was a retrospective cohort study. We extracted data from electronic medical records of HIV-infected MSM and transgender women treated at one of the six community clinics or at a hospital-based clinic in Chicago between 2010 to 2014. The outcome was cumulative probability of virologic failure (i.e., viral load ≥200 copies/mL), measured in each semester of observation. We used multivariable Cox Proportional Hazards model to determine the association between CBM and HBM with virologic failure, adjusted for confounding variables.

Results
The sample consisted of 290 patients; of whom, 20 (7%) were transgender. Approximately half (49%) of the sample received care via CBM. Compared with patients receiving care at the HBM, CBM patients were more likely to be African American (72% vs. 61%), uninsured (50% vs. 39%) and with a history of substance abuse (38% vs. 24%). There was no difference in virologic failure between the two care models (57% in CBM vs. 52% in HBM; HRadj = 1.1; 95% CI: 0.8–1.6). Younger individuals (HRadj = 4.0; 95% CI: 2.3–7.1), alcohol users (HRadj = 1.6; 95% CI: 1.1–2.2) and patients without insurance (HRadj = 1.7; 95% CI: 1.1–2.6) were more likely to have virologic failure.

Conclusion
The CBM was as effective as a traditional HBM in providing care to MSM and transgender women despite their more marginalized status. Intensive outreach and targeted case management likely contributed to the effectiveness of this model and need further study.

Disclosures
All authors: No reported disclosures.
1310. The Impact of Recent Incarceration on Post-Release HIV Linkage to Care and Risk-Taking Behaviors in the Setting of Enhanced Linkage to Care Policies in Florida
Authors: Teo Greg Matthew E , Nagaraj Suraj , Sunku Nisha , Aslam Sadaf , Mhaskar Rahul , Chen Liwei , Zhou Zhi , Cook Robert L , Morano Jamie P , Somboonwit Charurut 
Published: October 2019

Abstract

Background
The United States has the largest incarcerated population in the world with 6.61 million adults in 2016.1 While incarceration is a known risk factor for difficulties in linkage to care2–3 and adverse health outcomes4–6, little is published on post-release incarcerated persons living with HIV (PLWH) in Florida.

Methods
Data were acquired from the Florida Cohort, an ongoing, longitudinal, cross-sectional study of PLWH recruited across HIV clinics in the state of Florida, from 2014 to 2018. Chi-square and multiple regression analyses correlated recent incarceration (within last 12 months) with demographics, HIV care adherence, perceived barriers to care, and self-reported high-risk behaviors.

Results
Of 936 participants, 6.4% (n = 60) reported recent incarceration within the last 12 months. Those recently incarcerated were more likely to report missing at least one appointment in the last 6 months (46.7% vs. 22.2%; P < 0.0001), to have an excessively long travel time ( >60 minutes) to a HIV provider (34.5% vs. 16.6%, P = 0.002; OR 2.66 [95% CI: 1.20–5.92]), and to lack reliable transportation (70% vs. 47.5%, P = 0.0007; OR 1.70 [95% CI: 0.82–3.52]) Those not recently incarcerated reported having completed a high school education (OR: 0.69 [95% CI: 0.5–0.97]) and stated they “never missed an appointment” (OR: 0.42 [95% CI: 0.22–0.81]). Recently incarcerated PLWH also had higher occurrence of high-risk behaviors such as receiving (40.4% vs. 8.7%; P = 0.001) or providing (30.4% vs. 10.4%; P = 0.000) money or drugs for sex, having used IV drugs (15% vs. 4%; P = 0.001), and not using condoms during exchange of drugs for sex (OR: 9.43 [95% CI: 3.78–23.52]).

Conclusion
Recently incarcerated PLWH continue to have significant geographical and logistical barriers to care and self-report more high-risk behaviors than nonincarcerated peers. Enhanced case management and telehealth services may be useful in linkage to care when PLWH transition from correctional to community healthcare systems in the Florida setting.

Disclosures
All authors: No reported disclosures.
1317. Comparison of Access and Linkage to Care Among People Living with Human Immunodeficiency Virus When Enrolled in Florida AIDS Drug Assistance Program (ADAP)
Authors: Teo Greg Matthew E , Sunku Nisha , Nagaraj Suraj , Aslam Sadaf , Mhaskar Rahul , Chen Liwei , Zhou Zhi , Cook Robert L , Morano Jamie P , Somboonwit Charurut 
Published: October 2019

Abstract

Background
The Southeast region of the United States contains nine out of the 10 states with the most severe syndemic of poverty and HIV infection.1 The Florida AIDS Drug Assistance Program (FL-ADAP) and Ryan White network are crucial for linkage to care services. Data from FL-ADAP are available but seldom published; thus this study quantifies this program’s impact on Florida PLWH access and linkage to care.

Methods
Data were obtained from the Florida Cohort, an ongoing cross-sectional survey among health clinics across the State of Florida from 2015 to 2018. Chi-square and binomial multivariate logistic regression analyses correlated anti-retroviral therapy (ART) access and linkage to care stratified by insurance status (ADAP vs. non-ADAP), demographics, and sexual orientation

Results
Of the total 934 PLWH, n = 418 (44.8%) self-reported ADAP participation. Of these, 68.4% were male, 79.7% were non-Hispanic, and 55.5% were African American. FL ADAP participants did not significantly differ by race, ethnicity, marital or education status, transportation barriers, nor the actual number of missed appointments. However, ADAP participants were slightly more likely to have same-sex relationships [OR 1.41 (CI 1.02 to 1.96)] or to be bisexual [OR 2.05 (1.21 to 3.47)]. ADAP enrollees reported greater adherence to antiretroviral therapy (ART) (94.2% vs. 87.1%; P < 0.001) and to have a case manager (83.8% vs. 75.4%; P = 0.008). Likewise, PLWH with a case manager were more likely to have ADAP [OR 2.04; (CI 1.32 to 3.17)]. However, ADAP enrollees were more likely to report barriers to care for a missed appointment (28.9% vs. 22.2%; P = 0.02).

Conclusion
The Florida ADAP program is successful in providing ART access, facilitating linkage to care, and improving adherence through embedded case management services. However, more resources are needed to improve ART and medical appointment adherence as well as to decrease socioeconomic barriers to care.

Disclosures
All authors: No reported disclosures.
1320. HIV Care Continuum Outcomes Among Newly Diagnosed PLWH in Washington, DC
Authors: Jaurretche Maria J , Byrne Morgan , Powers Happ Lindsey J , Levy Matthew E , Horberg Michael A , Greenberg Alan E , Castel Amanda , Monroe Anne K 
Published: October 2019

Abstract

Background
In 2019, the US Administration announced the Ending the HIV Epidemic plan to decrease new infections. A key component is the Test and Treat plan to diagnose early, treat rapidly and achieve viral suppression (VS) among persons living with HIV (PLWH). We assessed retention in care (RIC), antiretroviral therapy (ART) initiation and VS among newly diagnosed PLWH in Washington, DC.

Methods
We conducted a cross-sectional analysis using data from the DC Cohort, an observational longitudinal cohort of PLWH in care in 14 clinics in DC. We included participants enrolled from 2011 to 2016 whose HIV diagnosis was within 1 year of enrollment and with at least 12 months follow-up. RIC was defined as ≥2 visits or HIV lab results 90 days apart in the first year of follow-up. ART initiation was defined as being prescribed ART, VS was defined as HIV RNA <200 copies/mL, and both these outcomes were assessed at 2 time points: by 3 and 12 months. Adjusted multivariable logistic regression was used to identify clinical and sociodemographic factors associated with RIC, ART initiation and VS.

Results
Among the 455 newly diagnosed participants (6% of all enrollees), median age was 33 years (IQR 25, 45), 69% were Black, 79% male, 60% MSM. Median duration of HIV at enrollment was 4.9 months (IQR 2.3, 7.7). Median nadir CD4 count was 346 cells/μL (IQR 224, 494). Of the 455, 38% had a history of AIDS, 92% were RIC, 65% initiated ART by 3 months and 17% had VS by 3 months. There were no differences by sex or race for RIC, ART initiation and VS. An AIDS diagnosis at enrollment was associated with RIC (aOR 2.28; 1.01–5.15), ART initiation by 3 months (aOR 2.41; 1.54–3.76), and VS by 12 months (aOR 1.92; 1.06–3.46). Lower nadir CD4 (aOR 0.89 per 50 cell increase; 0.84–0.94) and younger age (aOR 0.747 per 10-year increase; 0.584–0.995) were associated with ART initiation by 12 months.

Conclusion
Although the majority of newly diagnosed PLWH were RIC, fewer started ART or achieved VS. With a large proportion of our sample having an AIDS diagnosis at enrollment, we illustrate the ongoing challenge of late HIV diagnosis in DC. Those with AIDS at diagnosis were more likely to initiate ART within the first 3 months. As same-day ART initiation is scaled up in DC, future research can evaluate if all PLWH, regardless of AIDS status, will achieve this milestone earlier.

Disclosures
All authors: No reported disclosures.
1340. The Effect of Continuous Renal Replacement Therapy on Body Temperature in Patients with and without Infection
Authors: Challener Douglas W , Kashani Kianoush , O’Horo John C 
Published: October 2019

Abstract

Background
Sepsis frequently leads to acute kidney injury. In severe cases, patients may require continuous renal replacement therapy (CRRT) which involves placement of a dialysis catheter and an extracorporeal blood filtration circuit. CRRT is commonly considered to “mask” fever, though this phenomenon has not been investigated.

Methods
We queried an institutional database of all patients on CRRT from 2007 to 2015 for inpatient temperature data and antibiotic administration records. Receipts of piperacillin–tazobactam, a carbapenem, or a third or fourth-generation cephalosporin, indicating a serious infection, were considered intervention arm. We analyzed temperatures recorded in the intensive care unit before, during, and after CRRT. Patients were divided into groups that did not receive antibiotics as well as those who did. Temperature data were Winsorized to correct for outliers. We also performed descriptive statistics for each group.

Results
There were 237,988 temperature readings for 1,568 ICU patients on CRRT. 1,153 patients received broad-spectrum antibiotics in ICU. In patients who received antibiotics in ICU and were presumed to have an infection, the mean temperature was 37.2°C prior to initiation of CRRT, 36.8°C while on CRRT, and 37.2°C following discontinuation of CRRT. In the 415 patients who did not receive IV antibiotics, the mean temperature was 36.9°C prior to initiation of CRRT, 36.6°C while on CRRT, and 37.0°C following discontinuation of CRRT. During each of the periods before, during, and after CRRT, patients who received antibiotics had significantly higher temperatures than those who did not (P < 0.001). Patients receiving antibiotics were generally younger (mean 60 years vs. 64 years, P < 0.001), had longer ICU stays (mean 29 days vs. 12 days, P < 0.001) and spent more time being ventilated (mean 23 days vs. 7 days, P < 0.001). The mean SOFA score on day one was similar (mean 11.1 in the antibiotic group and 10.5 in the other group).

Conclusion
This investigation suggests that patients have slightly lower temperatures while on CRRT, by on average less than half a degree. A similar effect is seen in both patients with infections as well as those without. Further work will be needed to determine what constitutes a true febrile response in this population.

Disclosures
All authors: No reported disclosures.