bluuebunny/crossref_metadata_2025_split huggingface dataset:
105. Null Effect of Financial Incentives or Social Media Support on Prep Adherence in a Randomized Controlled Trial of Young Men Who Have Sex with Men of Colour
Authors: Ware Chelsea , Sparks Andrew D , Levy Matthew E , Wolf Hilary , Siegel Marc O 
Published: January 2021

Abstract

Background
Pre-exposure prophylaxis (PrEP) using emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) effectively reduces HIV transmission, with efficacy being dependent on adherence. We evaluated the effect of either social media-based support or financial incentives on PrEP adherence among young MSM of color in Washington, DC

Methods
MSM aged 18–29 were randomized 1:1:1 to standard of care (SOC) PrEP (Control group), SOC PrEP + invitation to a bidirectional Facebook group supervised by two clinicians (Social Media group), or SOC PrEP + $50 gift card at each of two follow-up visits (Financial Incentive group). Participants were asked to return at 3 and 6 months. Adherence was monitored with predefined dried blood spots (DBS) TFVdp levels with &lt; 490, 490–979, 980–1749 and ≥1750 fmol/punch correlating with average of &lt; 2, 2–4, 4–6, and 7 doses per week

Results
We enrolled 53 MSM. Average age was 22.5 years and 72% of participants were Black. At enrollment, 96% had previously heard of PrEP, 17% had ever taken PrEP but none had taken PrEP in the prior 6 months. 92% of participants reported condomless anal sex in the prior 3 months, 36% with an HIV-positive man or man of unknown HIV status (Table 1). 81% of participants returned for their 3-month visit and 70% for their 6-month visit. Mean self-reported PrEP adherence over the previous 3 months was 78% with no difference in adherence between the three groups at either visit. Based on DBS TFVdp levels, protective PrEP adherence (≥4 doses/week) was measured in 46% of the Financial Incentive group and in 57% of the Social Media group compared to in 67% of the Control group (p=0.38). Only 16% of TFVdp levels corresponded to taking PrEP 7 days a week (Figure 1). There was no change in sexual risk activity over the course of the study. 38 sexually transmitted infections were diagnosed in 26 participants (Figure 2). No participant tested positive for HIV. 3 months after study completion, 9 participants were still taking PrEP
Table I. Sexual risk behaviors over the previous 3 months for study participants assessed at baseline visit, as well as 3 month and 6 month follow up visits

Figure 1. PrEP Adherence.

Figure 2. Number of sexually transmitted infections by specific etiology and site diagnosed

Conclusion
Our study showed no impact of either offering financial incentives or providing access to a supervised Facebook-based support group on PrEP adherence. Financial compensation based on level of PrEP adherence and using a more age-appropriate social media platform may have a greater impact on adherence

Disclosures
All Authors: No reported disclosures
106. META-INSTI: Metabolic Adverse Events Following Integrase Strand Transfer Inhibitor Administration in Spontaneous Adverse Event Reports
Authors: Murray Milena M , Harpe Spencer E 
Published: January 2021

Abstract

Background
Unexpected metabolic effects of integrase inhibitors (INSTIs) have been reported in the literature. The FDA Adverse Event Reporting System (FAERS) is a publicly available database that captures spontaneously reported adverse events. Analysis of these data allows for the determination of whether rare or unknown events represent a cause for concern. The objective of this study was to evaluate the relationship between INSTIs and metabolic adverse events using the FAERS database.

Methods
FAERS data were queried from quarter 4 2007 through quarter 4 2019 and limited to adults. The Standardized MedDRA Query (SMQ) for hyperglycemia/new onset diabetes mellitus (H/DM) was used to identify metabolic adverse events of interest. Weight gain was defined as increased weight or increased BMI and was analyzed as a separate event. Reporting odds ratios (ROR) and 95% Confidence Intervals (CIs) were calculated for the INSTI class and for individual agents.

Results
Over 10.1 million FAERS reports were identified. H/DM was noted in 732,591 reports (7.2%); 109,566 (1.1%) reported weight gain. Consumers (49%) and physicians (23%) were the most common reporters. The most frequent countries of occurrence were the US, Great Britain, and Japan. The mean (SD) age was 57 (17) years with 63% females. Any INSTI was mentioned as a primary and/or secondary suspect agent in 18,400 (0.18%) reports (bictegravir: 1,414 [0.01%]; dolutegravir: 7,840 [0.08%]; elvitegravir: 4,034 [0.04%]; raltegravir: 5,551 [0.05%]). RORs (95% CI) for H/DM and weight gain for any INSTI were 1.20 (1.15, 1.27) and 2.16 (1.96, 2.38). For individual agents, RORs (95% CI) for H/DM and weight gain were bictegravir: 1.23 (1.10, 1.37) and 6.82 (5.50, 8.41); dolutegravir: 1.28 (1.19, 1.39) and 1.86 (1.58, 2.18); elvitegravir: 0.76 (0.56, 1.02) and 1.63 (1.37, 1.92); raltegravir: 1.00 (0.90, 1.11) and 3.29 (2.77, 3.91). H/DM was noted in 159 bictegravir and 712 dolutegravir reports.

Conclusion
Overall, H/DM was associated with bictegravir and dolutegravir; weight gain was associated with all INSTIs. Clinicians should be aware of the potential relationship with INSTIs and concerning metabolic effects and institute appropriate monitoring. Future clinical studies to evaluate these findings are warranted.

Disclosures
Milena M. Murray, PharmD, MSc, BCIDP, AAHIVP, Merck (Speaker’s Bureau)
107. Impact of Switching to an Antiretroviral Regimen Containing Tenofovir Alafenamide on Weight Gain and Development of Metabolic Side Effects
Authors: Darnell Julia , Karris Maile , Qin Huifang , Hill Lucas 
Published: January 2021

Abstract

Background
Tenofovir is a common backbone of many antiretroviral (ARV) regimens for the treatment of HIV. Although limited, data has shown that tenofovir alafenamide (TAF) may contribute to weight gain. Our study evaluated the impact on weight gain and metabolic effects of people living with HIV (PLWH) who were switched to ARV regimens containing TAF in the real-world setting.

Methods
Single center retrospective cohort study. Included were PLWH who were on an ARV regimen not containing TAF, who were switched to a TAF containing regimen between January 1, 2016 and September 30, 2018. The control group contained patients on a TAF free ARV regimen throughout the study period. The primary outcome was change in weight from baseline at 12 months post switch. Secondary outcomes were change in BMI, development of new diabetes, hypertension, and/or hypercholesteremia.

Results
A total of 446 patients were switched to a TAF containing regimen during the study period, and included as cases. Controls (n=162) consisted of patients who continued a regimen containing abacavir/lamivudine/dolutegravir during the study period. The control group was older (54 vs. 49 years, p&lt; 0.0001), had a higher proportion of black patients (17.9% vs 11.4%, p=0.04), had a higher mean VACS score (27 vs 18, p&lt; 0.0001), and had fewer patients with reported physical activity (21.6% vs 30%, p=0.04), although this was driven by a higher proportion of patients in the controls with unknown physical activity. Cases showed significantly more weight gain compared to controls at 12 months (2.01kg vs 0.77kg, p=0.001). There was a higher percentage of increase in BMI class in the cases compared to control at 12 months (18.2% vs 9.9%, p=0.01). Increase in weight at 12 months varied dependent on the rest of the antiretroviral regimen (Table 1). Cases had a significant increase in the number of patients with hypertension (35.9% pre vs 43.7% post, p=0.02) and hyperlipidemia after the switch (7.8% pre and 18.4% post, p&lt; 0.00001), while controls only had a significant increase in hyperlipidemia (50.0% pre vs 67.9% post, p=0.01).

Conclusion
Patients switched to an ARV regimen containing TAF gained significantly more weight, and had higher rates of increase in BMI category than those who stayed on a non TAF containing regimen throughout the study period.

Disclosures
All Authors: No reported disclosures
110. Bone Mineral Density Screening in Veterans Living with HIV
Authors: Khanjee Naveed , Turin Christie G , Breaux Katharine , Armamento-Villareal Reina , Barradas Maria Rodriguez- , Clark Eva 
Published: January 2021

Abstract

Background
Low bone mineral density (BMD) is more prevalent in people living with HIV (PLWH) than in the general population. Although no consensus exists regarding when to start screening for BMD loss in PLWH, the Infectious Diseases Society of America (IDSA) recommends dual x-ray absorptiometry (DXA) for men aged ≥50 years, postmenopausal women, and patients with a history of fragility fracture, chronic glucocorticoid treatment, or at high fall risk. The objective of this study is to evaluate how well this guideline is being carried out in a population of veterans living with HIV (VLWH).

Methods
We retrospectively identified VLWH seen at the Veterans Affairs Medical Center (VAMC) in Houston, TX, between 2014–2018 via the VAMC HIV Registry. We extracted demographic, laboratory, and clinical variables, as well as DXA results via this registry database and subsequent chart review.

Results
We identified 1,306 VLWH who received care between 2014–2018; 197 turned 50 years old during this time period. Of those, only 32 (16.2%) underwent DXA (2 women, 30 men). DXA revealed normal BMD in 17 (53.1%), osteopenia in 12 (37.5%), and osteoporosis in 3 (9.4%), as defined by traditional DXA T-score cutoffs. Average CD4 count at time of DXA was 698 cells/mm3 (n=30) (average CD4 for those with normal DXA was 654 [n=16] and for those with osteopenia/osteoporosis it was 749 [n=14]; t-test p = 0.47). Thirty had HIV viral load (VL) &lt; 100 copies/mL; the remaining 2 had VLs of 11,200 and 2,980, both with normal DXAs. Vitamin D (VD) levels were available for 1,005 (77%) VLWH in the study cohort. Of those, 278 (27.7%) were VD deficient (25-hydroxy VD level of &lt; 20 ng/mL). VD levels were available for 31 of the 32 VLWH who had DXA after turning 50 years old; the average VD level was 22.76 (24.61 [n=16] for those with normal BMD and 20.78 [n=15] for those with osteoporosis/osteopenia; t-test p = 0.30).

Conclusion
Our results indicate that adherence to IDSA BMD screening guidelines in VLWH can be improved. Given that nearly half of the screened patients showed evidence of BMD loss on their initial DXA, efforts should be made to increase awareness and screening in this vulnerable population. Prevention, earlier diagnosis, and treatment of BMD loss in VLWH would likely lead to decreased morbidity associated with fractures due to low BMD in this population.

Disclosures
All Authors: No reported disclosures
112. A Quality Management Project of a Midwestern Academic HIV Clinic Operation During COVID-19: Implementation Strategy and Preliminary Outcomes
Authors: Fadul Nada 
Published: January 2021

Abstract

Background
During the COVID-19 pandemic, HIV clinics had to transform care delivery in order to ensure retention in care (RIC) for people with HIV (PWH). The objective of this quality management project is to maintain high rates of RIC and viral load suppression (VLS) during the pandemic for PWH receiving services at an academic HIV clinic in the Midwest.

Methods
We developed a multifaceted implementation strategy for clinic operation using a combination of telehealth and in-person visits. The strategy included: 1) assess for readiness and identify barriers and facilitators, 2) identify and prepare champions, 3) organize clinician implementation meetings, and 4) staff training. As a result, we developed an implementation blue print with criteria for telehealth vs. office visits, criteria for rescheduling patients, conducted staff training on telehealth and personal protective equipment, and changed the clinic structure to accommodate in-person visits for patients who did not meet telehealth criteria and walk-ins. We monitored VLS (defined as HIV RNA &lt; 200 copies per mL) and RIC as measured by medical visit frequency (MVF, defined as percentage of patients who had one visit in each 6 months of the preceding 24 months with at least 60 days between visits); and gap in care (GiC, defined as no visit in the preceding 6 months).

Results
As of June 14, 2020, there were 1140 active PWH receiving care at the clinic. By February 29, 2020 there were 34 patients lost to care as (defined as no visit within the preceding 12 months). Between March 1 and June 14, 2020 we conducted a total 943 visits, out of which 642 (68%) were in person and 301 (32%) were telephone visits. By end of May 2020, there were 47 patients lost to care. MVF decreased to 40% compared to 69% for FY2020, and GiC increased to 25% compared to 14% for FY2020. VLS rate remained unchanged at 91%.

Conclusion
The COVID-19 pandemic resulted in a decrease in MVF and an increase in GiC for PWH. However, VLS remained high at 91%. Our implementation strategy facilitated quick adoption of telemedicine, which helped us provide clinical care to a third of PWH during the pandemic. Telemedicine provided a great tool for ensuring patients remain VLS. Evaluation of implementation outcomes including fidelity and reach remains ongoing.

Disclosures
All Authors: No reported disclosures
113. Advanced HIV Disease Among Adults in the African Cohort Study (AFRICOS)
Authors: Oboho Ikwo , Esber Allahna L , Dear Nicole , Paulin Heather , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Owuoth John , Maswai Jonah , Crowell Trevor A , Ake Julie A , Polyak Christina 
Published: January 2021

Abstract

Background
In the “test and treat” era, early ART may decrease the prevalence of advanced HIV disease (AHD), defined as having a CD4 cell count &lt; 200 cells/µL or World Health Organization (WHO) clinical stage III or IV disease. We assessed trends in AHD and ART coverage and describe factors associated with AHD among adults living with HIV (LWH) across four countries before and during the “test and treat” era.

Methods
The African Cohort Study (AFRICOS) is a prospective cohort enrolling adults at risk for HIV or LWH from 12 facilities in Uganda, Kenya, Tanzania and Nigeria. Clinical history review and laboratory testing were performed at enrollment and every 6 months. Serum cryptococcal antigen screening (CrAg) was performed in a subset with CD4 &lt; 200 at enrollment. Logistic regression was used to estimate odds ratios for factors associated with CD4 &lt; 200.

Results
From January 2013–December 2019, 2934 adults LWH were enrolled (median age 38 years [interquartile range, 31–46 years], 41.5% men). Of 2903 with CD4 results at enrollment, 567 (19.5%) had CD4 &lt; 200. Despite consistent increases in ART coverage since 2016, across all countries the prevalence of AHD did not decline below levels observed in 2013 until 2019. The prevalence of CD4 &lt; 200 did not significantly decline from 11.9% (range 9.1–25.0%) in 2013 to 10.3% (range 0–16%) in 2019, p=0.7, while ART coverage increased from 74.7% (range 68.3–93.8%) in 2013 to 97.5% (range 86–100%) in 2019, p= &lt; 0.01 (Figure 1). Factors associated with a higher risk of CD4 &lt; 200 at enrollment were being enrolled in Tanzania, male sex, age &gt;29 years, having a primary or some secondary education or above, and WHO stage II disease or higher. Factors associated with a lower risk of CD4 &lt; 200 were &gt;1 year since HIV diagnosis and being on ART for at least 6 months (Table 1). Among those with CD4 &lt; 200 at enrollment, the most commonly reported comorbidities included HIV wasting syndrome (9.3%) and tuberculosis (TB) (2.3%); 19 (3.4%) of 564 adults screened were CrAg positive.
Figure 1: Trends in Percentage of Participants with CD4 &lt;200 and ART coverage at Study Enrollment by Country and Year

Table 1: Factors associated with CD4 &lt;200 cells/mm3 at Study Enrollment

Conclusion
Despite the scale-up of ART in the era of “test and treat”, AHD prevalence has only recently trended downward. Continued efforts towards early HIV diagnosis and timely ART initiation are needed to reduce the risk for CD4&lt; 200. Strategies to increase TB screening, prophylaxis, and treatment are essential to reduce morbidity.

Disclosures
All Authors: No reported disclosures
114. HIV Prevalence and Associated Factors Among Persons Experiencing Homelessness (PEH) During a Multi-shelter Tuberculosis (TB) Outbreak in Atlanta, Georgia (2008 – 2018)
Authors: Onwubiko Udodirim 
Published: January 2021

Abstract

Background
Jointly and independently, HIV and homelessness are strong risk factors for acquiring tuberculosis (TB) in the United States (US). However, public health programs geared towards addressing TB among persons experiencing homelessness (PEH) are often not used as prime opportunities to also actively address HIV among PEH. Here, we describe the prevalence and risk factors associated with HIV among PEH who were screened during a city-wide TB screening program among PEH initiated in response to a multi-shelter TB outbreak in Atlanta, Georgia.

Methods
Retrospective analysis of data on 18,605 PEH screened for TB between 2008 and 2018 was done. HIV status was either self-reported (SR) or laboratory-confirmed (LC). Modified Poisson regression models with robust error variances were used to assess associations between socio-demographic characteristics and being HIV-positive.

Results
Of 18,605 PEH screened for TB, 9,308 (53%) had a known HIV status. Of these, 38% (n=3,559) received a HIV test while 62% (n=5,749) were only SR HIV status. The prevalence of HIV positivity among all PEH who SR a HIV status (n=7,404) was 4.0% (296/7404) while the prevalence of LC HIV infection was 3.6% (129/3559). Among PEH with LC HIV results, gender (male, transgender), year of screening (2008–2010, 2011–2013) and location of screening (onsite) were independently associated with higher HIV prevalence (p&lt; 0.05). Adjusted analysis showed statistically significant interaction between gender and age [Adjusted prevalence ratio for men vs. women: young PEH (0–29 years) 8.47 (5.13, 14.00), p&lt; 0.0001]. Year of screening and shelter of residence also remained significant in the adjusted model.

Conclusion
The prevalence of HIV among PEH in Atlanta is more than four times higher than the prevalence in the general Atlanta population (0.86%). In addition to essential TB control measures needed in congregate settings like homeless shelters, strong efforts to concurrently increase access to HIV prevention and care at homeless shelters may also help reduce both HIV transmission and TB acquisition in this at-risk population in the South and move the South closer to achieving the US End TB and Ending the HIV Epidemic goals.

Disclosures
All Authors: No reported disclosures
118. Eliminating Blood Culture Contamination with an Initial-specimen Diversion Device
Authors: Tompkins Lucy S , Madison Alexandra , Schaffner Tammy , Tran Jenny , Ang Pablito 
Published: January 2021

Abstract

Background
Blood samples obtained via traditional venipuncture can become contaminated by superficial and deeply embedded skin flora. We evaluated the hospital-wide use of an initial-specimen diversion device (ISDD) designed to shunt these microorganisms away from the culture bottle to reduce blood culture contamination (BCC) and sequelae: false-positive central line-associated bloodstream infections (CLABSIs), repeat blood culture draws, inappropriate antibiotic usage, increased patient length-of-stay and misdiagnosis. The study aimed to show the proportion of blood cultures containing contaminants drawn by phlebotomy staff using the ISDD versus those drawn using traditional methods. Nursing staff continued to use traditional methods to draw blood cultures in the emergency department (ED) and from inpatients.

Methods
Over a four-month trial at Stanford Health Care (SHC), 4,462 blood cultures were drawn by phlebotomy staff using the ISDD (Steripath Gen2, Magnolia Medical Technologies) in the ED and from inpatients; 922 blood cultures were obtained by phlebotomy staff using standard methods. Additionally, 1,413 blood cultures were drawn by nursing staff using standard methods. The number of matched sets (2 bottles [aerobic/anaerobic] plus 2 bottles [aerobic/anaerobic], with total volume 40 ml) obtained through traditional methods and by the ISDD were recorded. Contaminants were defined by the National Healthcare Safety Network (NHSN). In addition, sets in which 1 out of 4 bottles contained vancomycin-resistant Enterococcus (VRE) or Candida sp. were also recorded, even though these are not considered contaminants by the NHSN.

Results
Of 4,462 blood cultures obtained using the ISDD there were zero contaminants found (BCC rate 0%) versus 29 contaminated sets using traditional methods (BCC rate 3.15%). Twenty-eight contaminants were observed from nursing staff blood culture draws (BCC rate 1.98%). Zero false-positive CLABSIs were associated with use of the ISDD for the trial period. No matched sets containing 1 of 4 bottles with VRE or Candida sp. were observed.
Table Stanford Health Care blood culture collection methods and contamination events (March 15, 2019 - July 21, 2019)

Conclusion
The trial results encourage adoption of the ISDD as standard practice for blood culture at SHC.

Disclosures
All Authors: No reported disclosures
124. Six-year Longitudinal Analysis of an Inpatient Infectious Diseases Telemedicine Service at a Community Hospital
Authors: Gupta Nupur , Sanghvi Adit B , Mellors John , Abdel-Massih Rima 
Published: January 2021

Abstract

Background
Telemedicine (TM) has emerged as a viable solution to extend infectious disease (ID) expertise to communities without access to this specialty.1 TM allows clinicians in rural settings to connect with specialists at distant sites and provide the best care for their patients, often eliminating the need for hospital transfers. Here, we describe the experience from one of the longest standing inpatient Tele-ID consult services using live audio-video (AV) visits with the assistance of a telepresenter.

Methods
Longitudinal data were collected from a 126-bed rural hospital in Pennsylvania that had no access to ID consultation before 2014. Live AV consults during business hours began in 2014 and telephonic physician to physician consults were made available 24/7. All ID consult data were extracted from the hospital electronic health record between 2014 to 2019. Key outcomes assessed included the number of consult encounters, total hospital length of stay (LOS), discharges to home, transfer to tertiary care centers, and readmission rates at 30 days.

Results
Most consulted patients were Caucasians, and females with an average age of 64.7 years (Table 1). The number of unique consult encounters increased annually from 111 in 2014 to 469 in 2019 (Table 1). The Charlson Comorbidity Score and Elixhauser Comorbidity Index also increased each year beginning in 2016 (Table 1). By contrast, LOS decreased each year as did the 30-day readmission rate (Table 2). Most patients were not transferred (average 89.4% over 6 years) to tertiary care centers and more than half were discharged to home each year (Table 2).

Conclusion
This longitudinal 6-year observation study of an inpatient TM ID service at a rural hospital showed remarkable annual growth in consult encounters (total growth &gt;400%). Despite increasing patient acuity, overall hospital LOS decreased over time (10.2 to 8.2 days). Patient transfers to tertiary care centers remained low (average 10.5% over 6 years) as did 30-day readmissions (average 16.3% over 6 years). The majority of patients were discharged to home (average 61.3% over 6 years). These findings show that a rural inpatient TM ID consult service can expand over time and is an effective alternative for hospitals without access to ID expertise.

Disclosures
John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)