bluuebunny/crossref_metadata_2025_split huggingface dataset:
1250. Don’t Turn Your Back on Fusion Surgical Site Infections (SSIs)
Authors: Mclain Jessica , Bender Sarah , Santana Brandy , Brown Sidonne , Kuhl Ann , Layell Jessica , Passaretti Catherine 
Published: October 2019

Abstract

Background
Spinal fusion surgical site infections (SSI) increase morbidity, length of stay, readmissions and cost compared with those who do not develop an SSI. Initiatives aimed at improving spinal fusion care and reducing SSI are essential.

Methods
In a large metropolitan teaching hospital that performs 1,352 fusions annually, a multidisciplinary team consisting of infection prevention (IP), neurosurgeons, a performance improvement specialist, administration, and postoperative nursing staff was convened to discuss fusion SSI prevention best practices. The SSI prevention team focused on improving chlorhexidine (CHG) bathing compliance in preoperative areas and appropriate alcohol containing skin preparation compliance, developing a postoperative power plan, implementing CHG bathing postoperatively and standardizing postoperative wound care. Compliance with CHG bathing and alcohol containing skin prep was monitored, dressing audits were completed and compliance with all process measures was fed back to the stakeholders. Rates of fusion SSI pre-intervention (January 2017 thru June 2018) were compared with postintervention (July thru December 2018)

Results
From July 2018 to December 2018, compliance with CHG bathing in the preoperative area increased from 81% to 92% and compliance with the use of alcohol containing skin preparation agent improved from 83% to 94%. Postoperative daily CHG bath x 10 days was implemented January 2018 with 72% compliance. With the efforts of the multidisciplinary team, Fusion SSI decreased from 1.43 to 0.75 per 100 fusion surgeries (Risk Ratio 0.52, 95% CI 0.18 -1.27, p-value 0.17) pre vs. post-intervention. This correlated to a Standardized Infection Ratio (SIR) decrease from 1.43 to 0.73. There was a concomitant trend toward decreased observed: expected (O: E) 30-day readmission (1.05 pre vs. 0.98 post) during the same time frame.

Conclusion
An interdisciplinary team developed spinal fusion bundle consisting of CHG bathing pre and postoperatively, alcohol containing skin preparation agent, and standardized postoperative dressing care resulted in a trend toward decreased fusion SSIs. Further data are needed to determine whether the improvement in process measures and outcomes is sustainable and significant.

Disclosures
All authors: No reported disclosures.
1253. Sex-on-Premise Venue (SOPV) Attendance Among Men Who Have Sex with Men (MSM) in Lima, Perú: Results From a Cross-Sectional Web-Based Survey
Authors: Lankowski Alexander , Sanchez Hugo , Hidalgo Jose , Cabello Robinson , Duerr Ann 
Published: October 2019

Abstract

Background
In Perú, where the HIV epidemic is concentrated among men who have sex with men (MSM), incidence has not changed appreciably over the last decade despite the rapid scale-up of free antiretroviral treatment (ART). New strategies for delivering effective HIV testing and prevention services to at-risk populations are greatly needed. Because most adult MSM in Perú live at home with family where it may be difficult to bring new sex partners, sex-on-premise venues (SOPVs)—such as saunas, sex clubs, and hourly hotels—might represent opportune sites at which to offer targeted HIV testing and prevention interventions.

Methods
From November 26, 2018 through April 15, 2019 we conducted a cross-sectional web-based survey using REDCap to assess the prevalence of SOPV attendance and associated sexual risk behaviors among MSM in Lima, Perú. SOPVs were defined as saunas, sex clubs, adult movie theaters, hotels, or bars/discos known to permit sex. We recruited participants by disseminating an anonymous survey link through local gay social media networks, with no monetary incentive to complete the survey. We asked participants how/where they met any sex partners from the prior 3 months, where they went for sex, and about HIV-associated sexual risk factors, including self-reported HIV status. We used the Pearson chi-squared test and Student’s t-test to assess whether the frequency of sexual risk behaviors differed based on SOPV attendance.

Results
Among n = 324 cis-gender MSM completing the survey, 16% identified as bisexual. Median age was 30 years, 62% lived at home with family, 50% had a university education or higher, and 29% reported being HIV+. 65% of respondents reported attending an SOPV to meet a partner and/or have sex in the prior 3 months. SOPV attendees were significantly more likely to report transactional sex, group sex, sex under the influence of alcohol, popper use, and have a higher number of sex partners (table).

Conclusion
SOPV attendance is common among MSM in Lima and associated with higher levels of several sexual behavioral risk factors. In light of this, SOPVs warrant further consideration as potential sites of outreach to offer HIV testing and prevention interventions designed to reach MSM at high risk for HIV infection.

Disclosures
All authors: No reported disclosures.
1255. Comparison in AIDS-Related Mortality Between African Americans and Whites with Human Immunodeficiency Virus During the HAART Era
Authors: Cihlar Jennifer , Fichtenbaum Carl 
Published: October 2019

Abstract

Background
Higher death rates have been reported in African American (AA) compared with non-Hispanic whites with HIV infection. However, there are no published studies of attributable mortality by racial and ethnic groups. We evaluated differences in attributable mortality between AA and whites.

Methods
We conducted a retrospective review of all persons with HIV infection who received care at the University of Cincinnati Medical Center whose deaths were between 1996 and 2017. We abstracted chart data using a standard data tool and identified all deaths reported to the social security national database. Probable cause of death was assigned using the EuroSida CoDe methodology. Primary endpoint was to compare AIDS vs. non-AIDS-related deaths between AA and whites.

Results
Initial analysis of 588 deaths are reported through 2007 (44% AA and 53% white). The median age at the time of HIV diagnosis was 37 years for AA patients and 36 years for white patients, while median age at the time of death was 43 years for AA and 42 years for whites (P = ns). 16.9% of AA were women, 2.6% were transgender; 10.3% of whites were women and 1% were transgender (P < 0.02). Risk factors for HIV acquisition included: MSM, 61.3% of whites vs. 46.0% AA; heterosexual contact, 11.7% of whites vs. 13.4% for AA; and injection drug use 16.9% white vs. 18.3% AA (P < 0.0001). African Americans had both lower median CD4 counts at the time of diagnosis and within 3–6 months prior to death (167 and 68 cells/mm3, respectively) as compared with whites (214 and 103 cells/mm3, respectively) (P < 0.0001 for both). There was no statistical significance of having AIDS at entry into the practice between AA and whites (P = 0.79). AIDS-related deaths accounted for a larger percentage of overall deaths within white patients (51%) compared with AA patients (40%) (P = 0.03).

Conclusion
Our data show that while a greater percent of AIDS-related deaths were found in whites vs. AA in the early HAART era, AA patients typically have lower CD4 counts at the time of diagnosis and within 3–6 months prior to death. Future analyses will examine specific attributable mortality, HIV viremia and changes in causes of death over later HAART era. Understanding factors associated with mortality may inform care models to prevent or delay future deaths.

Disclosures
All authors: No reported disclosures.
1258. The Pregnancy Factor: Differences in the Prevalence of Depression Among Pregnant and Nonpregnant Sub-Saharan African Women Living with HIV
Authors: Jones Milissa U , Esber Allahna L , Reed Domonique , Kiweewa Francis , Maswai Jonah , Owuoth John , Bahemana Emmanuel , Iroezindu Michael , Crowell Trevor A , Polyak Christina , Ake Julie A , Hickey Patrick 
Published: October 2019

Abstract

Background
In Sub-Saharan African (SSA) women living with HIV, pregnancy creates unique stressors that may induce or exacerbate depression. We described the prevalence of depression during the perinatal period among women living with HIV that became pregnant (P-WLWH) as compared with those that did not (NP-WLWH).

Methods
We analyzed data from WLWH, age < 45 years, across 11 HIV clinics in Kenya, Nigeria, Uganda, and Tanzania, within the African Cohort Study (AFRICOS). Depression screening was performed via the Center for Epidemiological Studies-Depression (CESD) scale at enrollment and every 6 months in the study. For these analyses, the CESD score was assessed during three periods in time. For P-WLWH, these periods were: (1) enrollment, (2) during pregnancy and (3) the study visit following delivery. For NP-WLWH, three sequential evaluations were analyzed, with visit 1 being enrollment. We compared the prevalence of depression between groups at each period using χ 2 analysis and calculated adjusted odds ratios (OR) using logistic regression for variables associated with positive depression screening (CESD score ≥16).

Results
There were 764 WLWH selected for analysis, including 164 P-WLWH and 600 NP-WLWH. At enrollment, P-WLWH tended to be younger than NP-WLWH (mean age=30 vs. 34, P < 0.01). Neither group differed significantly with respect to marital status, employment, education, viral load, or duration of HIV. The crude prevalence of depression during periods 1 thru 3 for P-WLWH and NP-WLWH was: 20% (in both groups, P = 0.99), 10% and 13% (P = 0.26), and 4% and 10% (P = 0.01), respectively (figure). P-WLWH had 74% lower odds [OR = 0.26 [0.09–0.75], P = 0.01] of positive depression screening during period 3 than NP-WLWH, when controlling for age, marital status, educational level, viral load, and duration of HIV.

Conclusion
Surprisingly, our analyses demonstrate P-WLWH were less likely to have positive screening for depression following their pregnancies. These findings may highlight the strength of comprehensive maternal health initiatives in SSA. Additionally, these women will be followed further longitudinally to evaluate patterns of depression in the months following pregnancy.

Disclosures
All authors: No reported disclosures.
1274. The PrEP Care Continuum Among an Uninsured Patient Population
Authors: Jones Trahern Wallace , De La Cruz Cinthya N , Spivak Adam , Keeshin Susana 
Published: October 2019

Abstract

Background
Despite the clear preventive benefits of HIV Pre-Exposure Prophylaxis (PrEP), uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care. In March 2018 we opened a free PrEP clinic for those without insurance. We provide HIV prevention services, following the CDC guidelines, with PrEP case manager navigation, medical management, and medication for at-risk individuals free of charge.

Methods
Half-day clinics were organized on a twice-monthly basis with supervision provided by two infectious disease specialists and several other licensed providers/fellows, with supporting case managers and medical assistants. Medical students were enlisted to help organize and manage patient visits. All patient visits were preceded by discussion with case managers to document insurance status, followed by a sexual history and general physical examination by medical students and supervisory licensed providers. We performed all laboratory testing, diagnostics, and follow-up visits per CDC guidelines.

Results
From March 2018 to 2019, 193 self-identified at-risk patients scheduled an appointment; 157 unique patients were seen and all deemed eligible for PrEP per CDC guidelines. Of those eligible for PrEP, 140 (89%) received a prescription and started emtricitabine/tenofovir and 115 (73%) remain in care with ≥2 visits completed. Of the 25 no longer in care at our clinic, 6 have insurance or Medicaid (2 continue to be seen in our insured PrEP Clinic), 1 reports no HIV risk factors, and 1 is over-income for pharmacy patient assistance. Patients enrolled in clinic are largely male (145, 92%); 74% age ≤ 34, a disproportionate fraction belonging to a minority racial/ethnic group (67, 43%), with a majority Latinx (60, 38%). A total of 48 STI cases were identified, mostly rectal chlamydia, rectal and pharyngeal gonorrhea 39 (81%), and 9 (19%) cases of syphilis, and no new HIV or HCV infections. At the first visit, 17% of our patients have an STI and at subsequent visits 22% have a new STI.

Conclusion
Implementation of a free PrEP clinic for uninsured patients is a feasible and effective strategy to reach key populations at risk for HIV. STI rates are high in our population and increased after starting PrEP.

Disclosures
All authors: No reported disclosures.
1277. Retention Among Adolescents with Mental Health Diagnoses on Pre-Exposure Prophylaxis (RAMP) Study
Authors: Mayer Christopher M , Siddiqui Ramail D , Ellen Adams Mary , Strauss Brooke , Mathur Aneesh , Tristram Debra A , Santos Roberto P 
Published: October 2019

Abstract

Background
The CDC reported in 2017 that 21% of new HIV diagnoses were composed of persons 13–24 years old. New York State (NYS) is addressing this with the Ending the Epidemic initiative, started in 2014, which emphasized pre-exposure prophylaxis (PrEP) for persons at risk of acquiring HIV. Though PrEP can effectively prevent HIV transmission, NYS minors were only granted capacity to accept PrEP in 2017. The Adolescent Medicine Trials Network found clinicians had varying perceptions on whether mental health diagnoses (MHD) were a barrier to adolescent PrEP utilization. This study aims to test the hypothesis that patients with MHD do not differ in PrEP retention length when compared with adolescents without MHD.

Methods
This is a retrospective single-center study analyzing self-reported visit data for adolescent enrolled on PrEP (n = 27) in the Capital District, NY. MHD were confirmed with clinician notes and retention to PrEP was defined as attending appointments. Between-group differences were compared using Fisher’s Exact Test (FET). Kaplan–Meier curves were compared using the log-rank test.

Results
Of the 27 adolescents enrolled on PrEP between Sep 2015-March 2019, most self-identified as males (93%), MSM (85%), white (74%), and 13 (48%) had a MH diagnosis. Anxiety was the most common MHD (69%), followed by depression (38%). The mean age was 20.3 years (16–24). The average PrEP retention for patients with and without MHD were 262±136 and 292±138 days, respectively (P = 0.575). For patients with MHD, follow-up at 1-month, 3-months and 1-year was 10 (77%), 8 (62%), and 5 (39%), respectively. For patients without MHD, follow-up at 1-month, 3-months, and 1-year was 11 (79%), 10 (71%), 5 (36%), respectively. Follow-up between adolescents with and without MHD was compared at 1-month (P = 0.086, FET), 3-months (P = 0.695, FET), and 1-year (P = 1.0, FET). Adolescents’ retention on PrEP was depicted on Kaplan–Meier curves (Figure 1). Log-rank test indicated that PrEP retention is not significantly associated with MHD (χ2(1) = 0.1, P = 0.727).

Conclusion
Adolescents with and without MHD did not significantly differ in PrEP retention outcomes. The RAMP study elucidates a potentially incorrect provider bias regarding PrEP retention and MHD. Future investigation should be done prospectively with larger sample size.

Disclosures
All authors: No reported disclosures.
1283. Attitudes and Practices Regarding HIV Post-Exposure Prophylaxis
Authors: Sherrerd-Smith William , O’Connell Katie , Gill Shanedeep , Kisteneff Alice , Derber Catherine , Salts Laila , Lo Bruce 
Published: October 2019

Abstract

Background
Research suggests nonoccupational Post Exposure Prophylaxis (nPEP) is underprescribed when indicated in the Emergency Department (ED). This study is an assessment of ED providers’ attitudes and practices regarding administration of HIV nPEP.

Methods
This was an anonymous survey based on literature review and modified Delphi technique. We approached 153 ED providers at work over a 4-month period from 5 hospital-based and 2 freestanding EDs with an annual census between 35,000 and 75,000 patients. The EDs are a combination of urban, suburban, and rural EDs. There were 152 completed surveys: 80 attendings, 27 residents, and 44 physician assistants.

Results
The majority of surveyed providers (133/149, 89.3%) believe it is their responsibility as an emergency provider to provide HIV nPEP in the emergency department (Figure 1). Although 91% (138/151) and 87% (132/151) of respondents are willing to prescribe nPEP to a patient in the ED for IV drug use and unprotected sex, respectively, only 40% (61/152) of participants felt they could confidently prescribe the appropriate regimen. Ultimately, only 25% (37/151) of participants prescribed nPEP in the last year. Number of years in practice, age, and gender did not result in a significant difference in nPEP administration. Respondents noted time (27%), access to follow-up care (26%), cost to patients (23%), patients’ perceived interest in HIV counseling (15%), and concern for ongoing risky behaviors (9%) as barriers to prescribing nPEP (Figure 2). 64% (95/149) of respondents feel that it is their responsibility as an ED provider to refer patients at risk of nonoccupational exposures for risk-reduction counseling.

Conclusion
This study identified an opportunity for HIV prevention in the emergency department. The majority of participants had not prescribed nPEP in the past 12 months. Although most were willing to prescribe nPEP and felt it was their responsibility, the majority of participants were not confident in prescribing it. Future interventions to increase the use of nPEP in the ED should target provider education, cost, access to follow-up care and counseling.

Disclosures
All authors: No reported disclosures.
1288. Bone Safety Outcomes with F/TAF vs. F/TDF for PrEP in the DISCOVER Trial
Authors: Wohl David , Ruane Peter , Hosek Sybil , Creticos Catherine , Morris Sheldon , Phoenix John , Ramgopal Moti , Brinson Cynthia , Tremblay Cecile , Carter Christoph C , Wong Pamela , Brainard Diana M , McCallister Scott , Das Moupali , Thompson Melanie A 
Published: October 2019

Abstract

Background
In the DISCOVER PrEP trial, emtricitabine/tenofovir alafenamide (F/TAF) was noninferior to emtricitabine/tenofovir disoproxil fumarate (F/TDF) for HIV prevention. Here we report the bone safety outcomes of F/TAF and F/TDF.

Methods
Men who have sex with men (MSM) and transgender women (TGW) at risk of HIV were randomized 1:1 to receive blinded F/TDF or F/TAF, taken once daily. Those on PrEP with F/TDF were eligible to enroll. Bone densitometry (DXA) of the hip and spine were performed in a subset of participants (BMD subset). Fracture events were compared in all study participants. Week 48 data are presented.

Results
5387 participants were enrolled in the main study, with 383 included in the BMD subset. In the BMD subset, the median age was 37 (IQR 29, 46); 0.8% were TGW, 9.4% were black, and 20.6% were Hispanic or Latinx. Fifty-three BMD subset participants were on baseline F/TDF PrEP at enrollment, 26 of whom were randomized to F/TAF. F/TAF was associated with more favorable changes in hip and spine BMD compared with F/TDF (Table 1); these differences were similar when participants on baseline PrEP were excluded. Participants age <35 on F/TAF gained BMD, whereas those on F/TDF lost BMD (Table 1). BMD decreases of ≥3% were less frequent in the F/TAF group than the F/TDF group at the hip (3.8% vs. 18.4%, P < 0.001) and spine (10.1% vs. 26.9%, P < 0.001). Osteopenia was more frequently diagnosed in the spine in participants on F/TDF compared with F/TAF (Figure 1, P = 0.007); but not in the hip. Fracture event frequency was the same (53 [2.0%] per group, P = 1.00). One pathological fracture was reported in the F/TAF group compared with two in the F/TDF group (P = 0.57). In participants on baseline F/TDF PrEP, those randomized to F/TAF had significantly improved hip BMD compared with baseline (median percent change 1.13 [IQR −0.86, 3.47], P = 0.027), while spine BMD was unchanged.

Conclusion
Through 48 weeks, DXA subset participants taking F/TAF for PrEP had significantly less change in BMD than those taking F/TDF, and were less likely to develop spine osteopenia. The incidence of fracture was similar, and pathological fractures were rare. F/TAF for PrEP is effective and has a superior bone safety profile compared with F/TDF.

Disclosures
All authors: No reported disclosures.
1293. Bundled HIV/Hep C testing 4 Years of Implementation at 9 Emergency Departments in the Houston Metropolitan Area
Authors: Rodriguez Gilhen , Prater Samuel , Heresi Gloria , Murphy James , Wanger Audrey , Murphy Daniel , Del Bianco Gabriela P , Aguilera Elizabeth A , McCarthy James 
Published: October 2019

Abstract

Background
Individuals living with HIV infection and/or Hep C infection and unaware of their infected status are at risk of significant morbidity and a risk to public health. It has been recommended that all conscious adults presenting to Emergency Departments (EDs) be tested for HIV and increasingly testing for Hep C. Testing of all arrivals is important because a majority of both infections may not present signature signs or symptoms associated with the reason for the ED visit. For these reasons, the implementation of a bundled HIV/HepC testing protocol is reported here.

Methods
Data from 4 years of HIV/Hep C screening of patients 18 to 64 years old made in 9 EDs in the Houston Metropolitan Area are reviewed. Screening for HIV was using HIV fourth-generation ADVIA Centaur™ Ag/Ab COMBO (Siemens) and Hep C was tested for using Gilead Hep C Ab testing.

Results
During January 2013 until October 2016, 3,976 HIV/Hep C test bundles were performed. There were 40 (1.0%) HIV+ and 407 (10.2%) Hep C positive detected. Nine (0.2%) of these individuals were positive for both HIV and Hep C. A 22.5% of HIV-positive patients were co-infected with Hep C. The population had a median age of 53 years, comprising an equal number of males and females.

Conclusion
A significant prevalence of Hep C (10%) and HIV (1%) was found in patients presenting for any cause of major EDs in the Houston region. Bundled HIV/Hep C testing of all arrivals to EDs is an effective way to identify individuals that need to be directed to antiviral and linkage to care.

Disclosures
All authors: No reported disclosures.