bluuebunny/crossref_metadata_2025_split huggingface dataset:
977. Bacterial STI Diagnoses as Missed Opportunities for HIV Pre-Exposure Prophylaxis
Authors: Reddy Archana K , Salazar Jorge , Waldman Sarah 
Published: January 2021

Abstract

Background
New HIV diagnoses in the United States have remained stagnant while the incidence has increased among certain groups; additional efforts towards HIV prevention are needed. Most adults who could benefit from HIV Pre-Exposure Prophylaxis (PrEP) in the United States are not receiving it. Many of these individuals present for healthcare visits for bacterial sexually transmitted infection (STI), an indication for PrEP in both men who have sex with men (MSM) and heterosexual individuals; we sought to characterize these visits and identify missed opportunities for PrEP prescription to inform future PrEP expansion efforts.

Methods
A retrospective chart review was conducted for all healthcare encounters of adult patients newly diagnosed with a bacterial STI within the UC Davis Health electronic medical record between January 1, 2017 and December 31, 2017. A bacterial STI was defined as a positive test result for gonorrhea, chlamydia, or syphilis. Patients were excluded if they had HIV, were pregnant or a prisoner, or if they were a woman or heterosexual man with a positive test result for chlamydia (not an indication for PrEP per CDC guidelines). Patient demographic, clinical, and visit-specific data were recorded; characteristics were described using frequencies for categorical variables, and median and quartiles for quantitative variables.

Results
205 encounters for bacterial STI were identified as potential opportunities for PrEP. The majority of PrEP candidates presented to the emergency department for their STI (44%), while 40% and 16% of encounters occurred in outpatient and inpatient settings, respectively. The majority of PrEP candidates were not offered PrEP within 6 months of their encounter for STI (86%). Of the 14% of PrEP candidates who were offered PrEP within 6 months of their STI diagnosis, the majority had presented to the outpatient setting for their STI (93%).

Conclusion
Visits to the emergency department for bacterial STI represent a disproportionate missed opportunity for PrEP discussion & prescription. Future PrEP expansion efforts should address emergency department visits as opportunities for linkage to PrEP and/or PrEP prescription.

Disclosures
All Authors: No reported disclosures
981. Extended Adherence and Persistence to HIV PrEP in a Multidisciplinary PrEP Clinic
Authors: Whelchel Kristen , Zuckerman Autumn , DeClercq Josh , Choi Leena , Rashid Shahristan , Kelly Sean 
Published: January 2021

Abstract

Background
Methods to identify and address barriers to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) persistence are needed to improve low PrEP persistence rates beyond 6 months. We evaluated PrEP adherence and persistence in a multidisciplinary clinic model with an integrated specialty pharmacist.

Methods
We conducted a single-center, retrospective, cohort study of patients initiating PrEP in the multidisciplinary Vanderbilt PrEP Clinic with prescriptions filled by Vanderbilt Specialty Pharmacy between 9/1/2016 and 3/31/2019. In this model, integrated clinical pharmacists manage PrEP access, affordability, and therapy monitoring. Clinical data were collected from the electronic health records and pharmacy claims data. Adherence was calculated from fill data using proportion of days covered (PDC). Persistence at 6, 12 and 18 months was measured using patient-reported discontinuation date or the date of the last fill plus the fill’s days’ supply for patients lost to follow-up. The Kaplan-Meier estimation method was used to estimate persistence probabilities.

Results
Most of the 63 patients included were male (97%), white (84%), commercially insured (94%) with a median age of 38 years, and men who have sex with men at high risk for acquiring HIV (97%); Table 1. The majority of patients with at least one follow-up visit (n=58) reported no adverse effects (78%), no missed doses (71%), and had a median PDC of 99% (IQR 97% – 100%). Persistence at 6, 12 and 18 months was 0.87 (95% confidence interval, CI, 0.80 – 0.96), 0.81 (95% CI 0.72 – 0.91), and 0.74 (95% CI 0.64 – 0.86), respectively; Figure 1. Of the 18 patients who discontinued PrEP, 9 discontinued due to perceived lack of risk for acquiring HIV, 6 were lost to follow up, 1 moved, transferring PrEP care to a new provider, 1 had worsening depression, and 1 had renal function decline.
Table 1 Patient Characteristics

Figure 1 Persistence on HIV PrEP

Conclusion
Patients receiving PrEP treatment in a multidisciplinary clinic with an integrated clinical pharmacist had high rates of adherence and persistence up to 18 months. Patients reported few side effects and reasons for therapy discontinuation were appropriate. Efforts to incorporate pharmacy support in managing PrEP patients could be beneficial in increasing patient adherence and persistence.

Disclosures
All Authors: No reported disclosures
989. Pre-exposure Prophylaxis (PrEP) Short-Term Retention Among Heavy Alcohol Users in Rural South Africa
Authors: Grammatico Megan A , Choi Koeun , Moll Anthony , Shenoi Sheela 
Published: January 2021

Abstract

Background
Despite widespread access to HIV testing and antiretroviral therapy (ART), men, and especially young men, remain difficult to engage in HIV services. Alcohol use disorder (AUD) further complicates engagement. Congregate alcohol venues, known as shebeens, are an ideal place to engage with young men for HIV testing, treatment, and prevention services, including pre-exposure prophylaxis (PrEP). Here we report on one-month retention in care in eligible patrons recruited from shebeens into a community-based model of PrEP delivery.

Methods
An all-male field team offered HIV testing at mobile clinics outside shebeens in rural Msinga sub-district of Kwazulu-Natal (KZN) province. Eligible participants were offered enrollment into a community-based model of PrEP delivery. PrEP initiators completed the AUDIT scale, with hazardous alcohol use defined as score &gt; 6 for women and &gt; 8 for men, and had dried blood spot (DBS) analysis for phosphatidylethanol (PEth). Loss to follow up was defined as not attending the 1 month follow up appointment, non-response to 3 separate phone calls on three separate days, and unsuccessful tracing at least once at participant’s home address.

Results
Between February and May 2020, 16 eligible shebeen patrons initiated PrEP, a median of 14.5 days (IQR 12.5 – 19) after initial screening. Among initiators, 93.8% were male, median age was 29.5 years (IQR 22.25 - 37), 31.2% were employed, 56.3% had running water, and 68.8% were hazardous alcohol users. One-month follow-up visits were completed with 68.8% (11/16) participants. Of those retained in care, 90.9% reported at least one sexual partner in the last month, and 54.5% reported more than one sexual partner. All sexually active participants reported inconsistent condom use. In the prior 7 days, 63.7 % of participants reported taking “all of my medication” and 36.4% reported taking “most of my medication,” verified by pill count. Hazardous alcohol use and PEth results did not predict one-month retention in this small sample

Conclusion
Young men engaging in risky behavior were interested and willing to engage in PrEP through a community-based PrEP model. The majority were retained in care, and all reported good adherence to PrEP, suggesting the value of differentiated service delivery to engage men in HIV prevention.

Disclosures
All Authors: No reported disclosures
990. Prophylaxis against spontaneous bacterial peritonitis: too much or too little?
Authors: Dhanani Muhammad , Gupta Kalpana , Strymish Judith 
Published: January 2021

Abstract

Background
Prophylaxis against spontaneous bacterial peritonitis (SBP) is a guideline-recommended strategy; there are limited data on rates of concordance with guideline recommendations. We sought to evaluate rates of concordance, hypothesizing that antibiotics would overprescribed for prophylaxis against SBP.

Methods
This retrospective cohort study included all patients at the Boston Veterans Affairs Medical Center who underwent paracentesis between 1/1/2014 and 12/31/2018. Exclusion criteria included absence of cirrhosis and hepatic transplantation, either prior to enrollment or during the study period. Manual review was used to capture demographic data, guideline concordance, microbiology results and healthcare utilization within one year of enrollment. Descriptive and analytical statistics were performed.

Results
Of 259 patients eligible for analysis, 181 (70%) met inclusion criteria; 65 patients (25%) were excluded as cirrhosis was not confirmed. Small numbers of other patients were excluded for other reasons [Figure 1].
Incorrect antibiotic utilization was noted in 80 patients (44%) [Figure 2]. Among 93 patients meriting antibiotics, 65 (70%) did not receive them. Conversely, among 90 who did not have an indication for antibiotic prophylaxis, 15 (17%) received it (p = 0.03, chi-squared test).
Receipt of SBP prophylaxis was not correlated with gastroenterologist involvement, infection by antibiotic-resistant bacteria or development of illness due to Clostridioides difficile. No difference in hospital readmission rates was observed between groups receiving guideline-concordant and guideline-discordant prophylaxis.
Figure 1

Figure 2

Conclusion
We expected to find overprescription of SBP prophylaxis. In fact, we found that the largest error in prescribing was underprescribing, which may be equally as harmful as inappropriate use of antibiotics. SBP prophylaxis may be an important target for antibiotic stewardship and education.

Disclosures
All Authors: No reported disclosures
991. Psychosocial Factors and HIV Risk among Transgender Women Living in Miami
Authors: Rodriguez Jornan , Salguero Douglas , Abbamonte John M , Botero Patricia Raccamarich; Valeria , Montgomerie Emily K , Savita Pahwa , Martinez Claudia , Rodriguez Allan , Alcaide Maria L , Raccamarich Patricia , Solorzano Dalhila 
Published: January 2021

Abstract

Background
Transgender (TG) women are disproportionately affected by HIV infection and have poor health outcomes when compared to cisgender women. This study evaluates psychosocial factors, and HIV risk among transgender women with and without HIV infection living in Miami, the city with the highest incidence of HIV in the US.

Methods
Adults who identified themselves as TG living in Miami were recruited from the community and local clinics. Self-reported HIV status, sociodemographic, behavioral data (HIV risk behaviors, sexual partners, illicit substance and alcohol use), and psychosocial factors (depression, violence or abuse events, and HIV stigma) were collected with questionnaires into RedCap.

Results
A total of 22 participants completed assessments. Ten (45.5%) indicated being HIV uninfected (HIV-) and 12 (54.5%) had been diagnosed with HIV (HIV+). A total of 15 (68%) participants reported use of feminizing hormones and 11 (50%) had undergone feminizing surgeries. Median age was 55 (20, 69); 15 (69%) were white and 5 (23%) Black; 15 (69%) were of Hispanic ethnicity; Level of education 11 (12; 1.8) 12(55%) had completed at least high school; 2 (9%) were employed. 16 (73%) reported being sexually active in the previous month; median number of partners in the last month was 1.5 (1; 2.13); only 13 (60%) reported consistent condom use in the last sexual encounter; 14 (64%) engaged in receptive anal sex; 9 (41%) reported ever engaging in sex for money. Violence or abuse events were common, and participants had experienced an average of 3.9 lifetime events (Median = 3; SD = 3.45). Depression measured by the BSI-18 scale revealed low depression scores (Mean = 1.77; SD = 0.82). HIV infected participants were more likely to be black (p=0.05) and unemployed. We did not find significant differences by HIV status in other variables, including depression and violence or abuse. Among HIV+ participants, HIV stigma measured by the ‘Stigma Scale’ was low (Mean = 1.71; SD = 0.41).

Conclusion
We identified high rates of events of violence or abuse, that did not differ by HIV status. HIV infection was more common among black TG women.Further research is necessary to identify potential targets for HIV prevention and care in the vulnerable population of TG women. Study funded by the Miami CFAR (P30AI073961)

Disclosures
All Authors: No reported disclosures
993. Risk Factors for Periconception Non-Suppression Among Women Living with HIV in Kisumu, Kenya
Authors: Fisseha Ephrat , Hampanda Karen , Oyaro Patrick , Brown Evelyn , Mukui Irene , Odeny Beryne , Patel Rena , Abuogi Lisa 
Published: January 2021

Abstract

Background
Pregnant and postpartum women living with HIV (WLHIV) are a priority population for virologic monitoring and efforts to ensure viral suppression to reduce the risk for vertical-transmission and poor maternal health outcomes. Few studies have examined the role of parity on viral suppression during periconception in WLHIV.

Methods
We present data from the ongoing Opt4Mamas study which enrolled pregnant women with HIV on antiretroviral therapy between March and November 2019 attending antenatal care in five public health facilities in Kisumu County, Kenya. We evaluated associations between various sociodemographic and psychosocial factors and periconception viral suppression (&lt; 40 copies/mL) within 12 months of study enrollment. We conducted univariate and multivariate logistic regressions, calculating odds ratios (OR) and 95% confidence intervals (CI).

Results
Among 497 women enrolled, mean age 29.9 years, 301 (61%) had viral load results available within 12 months of study enrollment. Viral loads were available a median of 18 days from conception (interquartile range 71 days before to 90 days after conception), and 237 women (79%) were virally suppressed. The majority (90%) of women were on a non-nucleoside reverse transcriptase inhibitor and 23 (9%) were on a protease inhibitor-containing regimen. In univariate analysis, women younger than 25 and primigravida women were less likely to be virally suppressed (OR 0.31, 95% CI [0.16 - 0.60] and OR 0.25, 95% CI [0.11 - 0.61] respectively; Table 1). The relationship between primigravida and periconception viral suppression is modified by age and duration on ART. Primigravida women who were younger than 25 years or who had less than 1 year of ART had significantly reduced odds of achieving viral suppression in the past year compared to primigravida women who were older or who had more experience taking ART (OR 0.09, 95%CI [0.03-0.31] and OR 0.09, 95%CI [0.02-0.48] respectively; Table 2).
Table 1: Comparison of Pregnant Women with HIV by Periconception Viral Suppression

Table 2: Interaction Effects with Primigravida Status

Conclusion
Risk factors for non-suppression around the time of conception in WLHIV include primigravida status, which is modified by age and duration on ART. Interventions targeting viral suppression among WLHIV leading up to their first pregnancy are needed, particularly among those who are newly initiated onto ART or younger age.

Disclosures
All Authors: No reported disclosures
73. Improving Cephalosporin Utilization in the Emergency Department for Penicillin Allergic Patients
Authors: Mattappallil Arun , Chew Debra , Magan Alyssa M , Zaeem Maryam , Scalgione Jaclyn , Sackey Joachim D 
Published: January 2021

Abstract

Background
Penicillin (PCN) allergies impact acute-care antibiotic prescribing practices, limit the use of first-line antibiotic agents and are associated with poor patient outcomes. Cephalosporins (CPN) are inconsistently prescribed to patients reporting PCN allergies despite reported low allergy cross-reactivity. The purpose of this study is to assess the impact of an education intervention on prescribing practices for CPN use in PCN allergic patients in the emergency department (ED).

Methods
This is a retrospective study evaluating all PCN allergic patients receiving a CPN in the ED from 07/01/2018 to 07/31/2019. The education intervention (consisting of circulating a locally developed guideline directing ED physicians to optimal CPN use given a designated PCN allergy along with lectures on suitable use of the guideline in recurring in-person sessions) occurred during 01/2019. We compared patient characteristics, CPN use, PCN allergy notation and adverse reactions between the “pre” (07/01/2018 – 12/31/2018) and “post” (02/01/2019 – 07/31/2019) groups.
Antibiotic Allergy Cross Reactivity/Sensitivity Chart

Results
A total of 123 patients are included (53 “pre” vs. 70 “post”). Patient characteristics are similar (Table 1). 31 (12.1% vs. 13%, P = 0.5) received previous treatment with CPN with the most common choices being cefazolin (14, 11.3%), ceftriaxone (18, 14.6%) and cefepime (9, 7.3%). 14 (11.3%) received pretreatment prior to CPN use. CPN given to patients in the ED include cefazolin (6 vs. 7), cephalexin (4 vs. 3), ceftriaxone (32 vs. 45) and cefepime (11 vs. 11). Common indications for CPN use include “empiric therapy” (38, 30.8%), “UTI” (17, 13.8%) and “pelvic region infection” (15, 12.1%). CPN administration routes include oral (10, 8.1%), intravenous (91, 73.9%) and intramuscular (22, 17.8%). 80 patients (65%) received a single dose of a CPN (37 vs. 43). No significant difference is noted in CPN use between groups (P = 0.1). Increased PCN allergy notation on tolerance to CPN after CPN use is noted, but later use of CPN use did not increase after notation (Table 2). No adverse events occurred from any CPN use.

Conclusion
Education interventions on CPN use in PCN allergic patients require support with other strategies and tools. This intervention provides groundwork to initiate efforts to further improve CPN use in PCN allergic patients.

Disclosures
All Authors: No reported disclosures
997. The Purview Paradox: PrEP Utilization at a Major Southern California County Teaching Hospital and Affiliated Clinics
Authors: Clavijo Stephanie , Herrmann Matthew , Corado Katya 
Published: January 2021

Abstract

Background
According to the Centers for Disease Control (CDC), PrEP coverage in the United States was approximately 18% in 2018 and 21.9% in California. We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics within Los Angeles County Department of Health Services.

Methods
A retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted infections (STIs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of sexual behavior risk reduction counseling, PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Descriptive statistics and analysis were completed in STATA Version 16.1, StataCorp LLC.

Results
The sample included 250 individual patients, all with indications for PrEP. Of those, 47.2% identified as Latinx and 27.2% Black. Table 1 shows 74% of patients identified as heterosexual whereas 9.2% identified as gay, and 4.4% bisexual. Of the 250 individual patients, 87 (34.8%) returned for a 2nd visit, 35 (14.0%) for a third, and 9 (3.6%) for a 4th visit, for a total of 381 encounters. Of the total encounters, 49.3% had sexual behavior risk reduction counseling, 7.3% had discussions about PrEP with their provider, and only 2.1% were newly prescribed PrEP (Table 2). Of the 2.1% new PrEP prescriptions, 1.8% were prescribed by family medicine providers with no new prescriptions by OB/GYN or acute care providers. Only 25% of new PrEP prescriptions were female patients. A positive test for an STI occurred in 45.1% of total encounters while high risk sexual behavior was identified in 54.9% of encounters (Table 3).
Table 1: First Encounter Demographics (N=250 Individual Patients)

Table 2: Primary Outcomes by Specialty (N=381 Total Encounters)

Table 3: Sexually Transmitted Infections Frequency (N=381 Total Encounters)

Conclusion
Our findings demonstrate that the percent of individuals newly prescribed PrEP (2.1%) at HUMC and affiliated clinics is less than that reported nationally and in California. This suggests that municipal health systems fall short in PrEP usage, notably for structurally vulnerable populations such as racial minorities as well as heterosexual females. Ending racial/ethnic disparities in HIV and in PrEP coverage not only requires educating specialty providers on PrEP, but also addressing structural racism and identifying structural barriers to care in vulnerable communities.

Disclosures
All Authors: No reported disclosures
998. Understanding Retention in PrEP Care in the South: Insights from an Academic HIV Prevention Clinic
Authors: Burns Charles , Borges Monica , Frye Justin , Keicher Kathryn V , Elliott Scotty , Schwartz Sheila K , Shipp Kenneth W , Okeke Nwora L , McKellar Mehri , McKellar Mehri 
Published: January 2021

Abstract

Background
Daily emtricitabine-tenofovir disoproxil fumarate has emerged as one of the most effective tools to prevent HIV transmission. However, it remains poorly utilized in the South. We report on PrEP retention in care and sexually transmitted infections (STIs) in a large academic PrEP clinic in Durham, North Carolina.

Methods
We conducted a retrospective chart review of patients in the Duke University PrEP Clinic from Jan. 1, 2015 through Oct. 15, 2019. Short-term retention in care was completion of a 3 month (mo) follow up as per CDC guidelines. Long-term retention was defined as completion of a 3 mo visit and an additional visit between 8 and 12 mo. Baseline STI was defined as a diagnosis at or within 1 year prior to initial PrEP visit. STI diagnosis while on PrEP was any subsequent diagnosis while retained in care. Odds ratios (OR) were generated using multivariable logistic regression. Kaplan-Meier curves were generated for retention in care and compared using the log rank test.

Results
A total of 255 patients attended at least one PrEP clinic encounter; 89% were men, 37% were Black, and 73% identified as men who have sex with men (MSM); 153 (60%) returned for at least one follow-up visit. Short and long term retention in care were met by 130/237 (55%) and 80/217 (37%) patients respectively. OR for retention are reported in Table 1. MSM are more likely to be retained in the short-term (OR 5.22 [95% confidence interval (CI) 1.57-17.32]). Self-referred patients were more likely to be retained in the long-term (OR 2.18 [95% CI 1.12-4.23]). Patients without insurance were less likely to attain long-term retention in care outcomes (OR 0.32 [95% CI 0.11-0.91]). STI diagnoses include 30 (12%) patients for a total of 42 unique infections at baseline and 44 (17%) for a total of 69 unique infections at follow up. Two new HIV diagnoses were made at first PrEP clinic encounter with no new diagnoses made at follow-up. Baseline STI was not associated with retention in care over time with disengagement defined as 6 mo post last visit (Figure 1).
Table 1) Odds Ratios of Retention in Care at 3 and 12 Months

Figure 1) Retention in Care for Patients with Baseline STI Diagnosis.

Conclusion
Our PrEP clinic shows a decline in patient retention over time. STIs were also prevalent, reinforcing that frequent STI testing and counseling should be part of each PrEP encounter. Further investigations into how to increase and improve PrEP utilization for HIV prevention are needed.

Disclosures
All Authors: No reported disclosures