bluuebunny/crossref_metadata_2025_split huggingface dataset:
856. Barriers to PrEP Implementation among Patient-Facing Staff in Three Urban Clinics
Authors: Shenoi Sheela , Sideleau Robert J , McKay Sharen E , Aoun-Barakat Lydia A 
Published: December 2021

Abstract

Background
PrEP implementation has lagged in the US. The role of multidisciplinary staff in PrEP rollout has been neglected. We sought to identify barriers to PrEP implementation among 3 urban federally qualified health centers (FQHCs) in Connecticut that provide HIV and PrEP services in order to inform development of staff training.

Methods
A link to an anonymous survey was emailed to patient-facing staff members or posted at the end of staff trainings October 2020-April 2021. The survey requested demographics, duration of employment, and using 4 and 5 point Likert scales, ascertained knowledge and beliefs toward PrEP based on established scales, and perceived individual and systemic barriers to PrEP uptake.

Results
Among 101 respondents, 40% were 36-54yo, 22% were male, 68% were non-prescribing clinicians, and median duration of employment was 6 years (IQR 2-14). Among 32 (31%) prescribers (physicians, PAs, APRNs), 97% felt comfortable discussing sexual risk with patients, though 15% were not familiar with PrEP efficacy and safety data, 28% responded that PrEP use would encourage risky behaviors, 34% were concerned about side effects, 53% responded that educational and behavioral interventions should be attempted prior to prescribing PrEP, and 59% identified lack of provider training as a barrier. Among 69 (68%) non-prescribers, barriers to PrEP uptake included: patients don’t ask for PrEP (43%), lack of insurance (47%), lack of clinic guidelines/protocol (42%), and staff time for counseling (31%).

Conclusion
Prescribers and non-prescribers identified distinct individual and systemic barriers to PrEP uptake at FQHCs. Among prescribers, uncertainty regarding indications for and safety of PrEP exist, which will be addressed with targeted training. Non-prescribers identified the need for patient outreach, financial assistance, and counseling as the top priorities. The input of clinic multidisciplinary team members is essential to addressing barriers to PrEP implementation.

Disclosures
Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.)
858. Impact of Using an Order Set on PrEP Prescribing and Laboratory Monitoring in Primary Care
Authors: Dao Linda T , Medders Kathryn , Hill Lucas 
Published: December 2021

Abstract

Background
CDC 2017 pre-exposure prophylaxis (PrEP) guideline recommends laboratory monitoring at baseline and follow-up and specifies that a PrEP prescription should be written for once daily dosing with a supply of 90 days or less to ensure patients repeat HIV testing every 3 months. This presents an opportunity to utilize order sets in the electronic health record to improve PrEP prescribing habits and prescriber adherence to laboratory monitoring recommendations. This study assessed the impact of using an order set on the accuracy of PrEP prescriptions and the appropriateness of laboratory monitoring in the primary care setting.

Methods
This was a retrospective, single-center, observational cohort study conducted at primary care clinics at a large academic health system. A total of 228 PrEP prescriptions from adults at least 18 years of age and that were written between April 1, 2018 through May 31, 2020 were assigned to the two comparator groups: 176 prescriptions ordered without an order set and 52 prescriptions ordered with an order set. The primary outcome was a composite of correct prescription details, defined as once daily dosing of PrEP for a 90-day supply or less. Secondary outcomes included the frequency of having an HIV antigen/antibody (Ag/Ab) test ordered within 3 months of the PrEP prescription, and the composite of appropriate baseline labs ordered for those newly starting PrEP.

Results
Baseline characteristics are shown in Table 1. The primary outcome of correct prescription details occurred in 100% of PrEP prescriptions ordered with an order set compared to 65.9% of those ordered without an order set (P&lt; 0.001). At least 1 HIV Ag/Ab test was appropriately repeated within 3 months for 65.4% of PrEP prescriptions ordered with an order set and 42.6% ordered without an order set (P=0.004). In those initiating PrEP, a composite of correct baseline labs ordered occurred with 14 (73.7%) new start prescriptions ordered with an order set versus 47 (42.7%) ordered without an order set (P=0.023).

Conclusion
When ordering PrEP, order set use significantly improved the accuracy of PrEP prescriptions and appropriateness of laboratory monitoring at baseline and at follow-up compared to no order set use at primary care clinics of a large academic health system.

Disclosures
All Authors: No reported disclosures
860. HIV Post-exposure Prophylaxis Availability at Small and Critical Access Hospitals in the Western Region
Authors: Castillo Alyssa Y , Bulger Peter , Lynch John B , Lynch John B , Pottinger Paul , Chu Carolyn , Chan Jeannie D , Jain Rupali , Naderi Mandana , Kassamali Zahra , Budak Jehan , Budak Jehan , Bryson-Cahn Chloe 
Published: December 2021

Abstract

Background
Post-exposure prophylaxis (PEP) is essential to minimize the risk of human immunodeficiency virus (HIV) acquisition following an occupational or nonoccupational exposure to potentially infectious body fluids. PEP is most effective when initiated as soon as possible after HIV exposure. Patients in rural areas may rely on small (&lt; 50 beds) and critical access (&lt; 25 beds) hospitals for access to PEP – especially after-hours and on holidays, when outpatient pharmacies are typically closed. However, PEP medications are costly to maintain on a hospital formulary due to unpredictable use and expiration. We hypothesized that PEP availability may be variable and limited at such hospitals.

Methods
The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals in Washington, Oregon, Arizona, Idaho, and Utah, most of which are rural and critical access. In August 2020, we surveyed UW-TASP participating hospitals and a convenience sample of other networked rural hospitals in Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported all antimicrobials on their hospital formulary and their hospital size. Data were reviewed by physicians and pharmacists trained in infectious diseases. Preferred PEP regimens, defined by the CDC, for adults and adolescents ≥ 13 years, included combination tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) and either raltegravir (RAL) or dolutegravir (DTG).

Results
Responses from 49 hospitals were received. Six were excluded – one was incomplete and five were excluded due to hospital size ( &gt; 50 beds) (Table 1). The majority of hospitals (40/43, 93.0%) were critical access. Half of the hospitals’ formularies (22/43, 51.2%) contained a preferred PEP regimen. One hospital reported a non-preferred regimen. Most hospitals with a preferred PEP regimen on formulary (18/22, 86.3%) offered TDF/FTC + RAL, and the remainder (4/22, 18.2%) offered TDF/FTC + DTG.

Conclusion
Many small and critical access hospital formularies do not include antiretroviral agents needed for HIV PEP. Improving urgent access to these critical medications in rural communities is an opportunity for HIV prevention.

Disclosures
Jehan Budak, MD, Nothing to disclose Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)
861. Impact of COVID-19 Mitigation Measures on PrEP Care at a Safety Net Health System in Atlanta
Authors: Cantos Valeria D , Ferencsik Kate , Prevot Jennifer , Reyna Kelly , Georgial Gabriela , Galaviz Karla I , Niles-Carnes Laris , Zheng Ziduo , Kundu Suprateek , Lora Meredith , Sheth Anandi N 
Published: December 2021

Abstract

Background
The Grady Health System pre-exposure prophylaxis (PrEP) program modified its care practices to accommodate COVID-19 mitigation measures. Changes enacted included: transition to telemedicine visits, medication mail delivery, and flexible timing of quarterly laboratory testing. These were implemented in March 2020 and remain in place presently. This study aimed to evaluate patients’ long-term acceptability of these modifications and to assess their impact on PrEP care.

Methods
This was a cross-sectional study in a convenience sample of PrEP patients, ages 18 and older, at an urban clinic in Atlanta. They were invited to complete a survey between December 2020 and April 2021. The survey assessed the impact of mitigation measures on overall PrEP care, follow up visits, medication access, and ability to complete laboratory testing. It also evaluated the usability, quality, satisfaction, and concerns with telemedicine. Data were examined using median and interquartile ranges, and proportions.

Results
Of 145 patients contacted, 61 completed the survey (median age 33 years, 72% Black, 75% cisgender men, 15% transgender women). Most participants did not report interruptions in their PrEP care (72%) or follow up visits (74%). Most found it easy to access medications (82%), as participants’ report of medication mail delivery usage increased from 57% (pre-pandemic) to 73% (in-pandemic period). Interruptions in completing quarterly labs were more frequently reported, as only 62% found this to be easy. Overall, 89% reported using telemedicine; telephone call was the most used method (78%). Telemedicine users’ ratings for quality, usability, and satisfaction of telemedicine was high (median score: 6/7) and nearly all users (97%) reported no concerns about its continued use for PrEP care. A few participants (5%) raised concerns about loss of telephone services due to financial issues, impacting their ability to complete telemedicine visits.

Conclusion
PrEP care at an urban clinic was well- maintained despite COVID-19 mitigation measures. Telemedicine was found to be acceptable and usable by surveyed participants. Future research on widescale implementation of telemedicine for PrEP care is needed

Disclosures
All Authors: No reported disclosures
862. A Survey of HIV PrEP Prescribing Practices at an Academic Medical Center in the Northwest United States
Authors: Nix Chad D , Bowden Sean , Babiarz Jane 
Published: December 2021

Abstract

Background
The prescribing of pre-exposure prophylaxis (PrEP) remains a major means of reducing the incidence of HIV infection in the United States. Many individuals are unaware of their HIV status until further symptom progression has ensued or continue to engage in high-risk behavior despite awareness of the risk of HIV transmission. Primary care providers are instrumental in identifying patients who are at high risk of HIV acquisition and prescribing PrEP with appropriate counseling and monitoring.

Methods
In order to identify existing barriers to prescribing HIV PrEP at a single academic medical center, a voluntary 14-question de-identified survey was administered electronically to ambulatory care providers in the following departments: family medicine, internal medicine and geriatrics, adolescent and young adult health, student health, and women’s health clinics.

Results
Following survey dissemination, the response rate was 28% (82/286). The results are displayed in Tables 1-3. Notably, though 74% of survey respondents reported being familiar with CDC 2017 and USTPF 2019 clinical practice guidelines for PrEP prescribing, only 36% (22/61) were able to correctly identify the clinical scenarios in the survey whereby an individual is eligible for HIV PrEP. 57% (47/82) reported that they discuss HIV PrEP with less than 25% of eligible patients.

Conclusion
A significant proportion of healthcare providers at a major regional academic medical center are either not familiar with HIV PrEP prescribing clinical practice guidelines or are unable to appropriately identify situations whereby an individual meets eligibility for PrEP. In addition, a significant proportion do not discuss HIV PrEP with eligible patients. As such, data from the conducted survey will be used to inform the creation of clinical decision support tool to identify risk factors for HIV acquisition in patients, educate providers on guideline-based indications, and provide the option of a telePrEP referral service. Downstream effects anticipated from this intervention include increased HIV/STI testing, case identification, and increased rates of PrEP counseling and prescribing.

Disclosures
All Authors: No reported disclosures
863. Pre-Exposure Prophylaxis (PrEP) Prescriptions among Individuals at High Risk for HIV in the United States, 2012-2018
Authors: Zhou Mo , Song Yan , Gao Emily , Whiteside Yohance , Billmyer Emma , Signorovitch James 
Published: December 2021

Abstract

Background
To describe trends in emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) PrEP uptake in 2012-2018 and characterize high risk individuals who use PrEP.

Methods
The study identified individuals aged ≥ 15 years old with claims suggesting high risk for HIV infection in the IBM MarketScan® Commercial Claims and Multi-state Medicaid Databases. High risk was defined using ICD codes indicating high risk sexual behavior or rectal/repeated bacterial sexually transmitted infection (STI). The index date was defined as the earliest of the first high risk sexual behavior diagnosis, the first rectal bacterial STI diagnosis, or the second non-rectal bacterial STI diagnosis within 12 months. Individuals were considered PrEP users if they had at least one FTC/TDF PrEP prescription within 12 months of index date. Individuals with evidence of HIV prior to or within 30 days after PrEP initiation/index date were excluded. Comorbidities were assessed using a modified Charlson Comorbidity Index that excluded HIV/AIDS.

Results
FTC/TDF PrEP uptake increased from 0.1% to 7.3% among commercially insured individuals between 2012-2018, and from 0.01% to 0.5% among Medicaid insured individuals between 2012-2017. Individuals ≥ 35 years old had the largest increase in PrEP uptake (0.1% to 13.0%), while those 16-25 years old had the smallest increase (0.03% to 2.3%). The largest proportion of PrEP users across all years were aged 25-34 while the largest proportion of non-PrEP users were aged 18-24. Compared to PrEP users, a larger proportion of PrEP non-users were female (62.9% vs. 1.4%, p &lt; 0.05) and blacks/African American (49.1% vs. 40.3%, p &lt; 0.05). A larger proportion of PrEP users had a risk status of homosexual (46.6% vs. 1.5%, p &lt; 0.05) or bisexual (3.9% vs. 0.8%, p &lt; 0.05) behavior than non-PrEP users. PrEP users also had more comorbidities than non-users among individuals with Medicaid and were less likely to have fee-for-service insurance plans overall (p &lt; 0.05).
Table 1. Characteristics of people at high-risk for HIV who do vs. do not use FTC/TDF PrEP measured during the follow-up period

Conclusion
Despite an increase in FTC/TDF PrEP initiations, uptake was low, especially among young adults, women, heterosexuals and blacks/African Americans. Low initiation rates in these groups may illustrate that FTC/TDF PrEP is not meeting the needs of all high-risk individuals.

Disclosures
Mo Zhou, PhD, Merck & Co., Inc. (Consultant) Yan Song, PhD, Merck & Co., Inc. (Consultant) Emily Gao, MS, MPH, Merck & Co., Inc. (Consultant) Yohance Whiteside, PhD, MSPH, Merck & Co., Inc. (Employee) Emma Billmyer, BA, Merck & Co., Inc. (Consultant) James Signorovitch, PhD, Merck & Co., Inc. (Consultant)
864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center
Authors: Allen Genevieve , Riddell Jamie 
Published: December 2021

Abstract

Background
HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center.

Methods
We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey.

Results
138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p &lt; 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p &lt; 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate).

Conclusion
Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing.

Disclosures
All Authors: No reported disclosures
106. Risk Classification to Differentiate Autoimmune from Viral Encephalitis
Authors: Granillo Alejandro , Hansen Michael , Samannodi Mohammed S , Hasbun Rodrigo , Hasbun Rodrigo 
Published: December 2021

Abstract

Background
Autoimmune encephalitis is an urgent treatable etiology that needs to be differentiated from viral encephalitis. Prompt recognition and therapy is of utmost importance.

Methods
We performed a retrospective cohort of encephalitis cases in 16 hospitals in Houston, Texas, between January 2005 and December 2019.

Results
A total of 1,310 adult (age ≥18 years) inpatient hospital admissions were identified by the presence of an encephalitis-related discharge diagnosis per the International Classification of Disease 9th edition codes. Of these, only 279 cases met the 2013 International Encephalitis Consortium criteria for probable encephalitis. A laboratory confirmed diagnosis of autoimmune encephalitis or viral encephalitis was identified in 36 (12.9%) and 88 (31.5%) cases, respectively. There were 155 cases (55.5%) that had no identifiable cause and were considered idiopathic.
As compared to viral encephalitis, patients with autoimmune encephalitis were more likely to be younger (&lt; 60 years old), have a subacute (6-30 days) or chronic ( &gt;30 days) presentation, have seizures, and have psychiatric and/or memory complaints (P&lt; 0.001). Furthermore, patients with autoimmune encephalitis were less likely to be febrile and to lack inflammatory cerebrospinal fluid (CSF) (defined as white blood cells &lt; 50 per microliter or protein &lt; 50 milligrams per deciliter) [See Table 1]. In the multivariable logistic regression model, subacute/chronic presentation, psychiatric and/or memory complaints, and lack of inflammatory CSF were significantly associated with autoimmune encephalitis. Using these 3 variables, patients were classified into 3 risk categories for autoimmune encephalitis: low risk (0-1 variables); 0%; intermediate risk (2 variables); 16%; and high risk (3 variables); 83% (P value &lt; 0.001).

Conclusion
Adults with encephalitis can be accurately stratified for the risk of having autoimmune encephalitis using clinical variables available upon presentation.

Disclosures
Rodrigo Hasbun, MD, MPH, Biofire (Speaker's Bureau) Rodrigo Hasbun, MD, MPH, Biofire (Individual(s) Involved: Self): Consultant, Research Grant or Support
867. Telehealth and HIV Care During the COVID-19 Pandemic
Authors: Gudipati Smitha , Lee Monica , Brar Indira , Markowitz Norman 
Published: December 2021

Abstract

Background
The COVID-19 Pandemic led to many restrictions in health care services, and as a consequence, an expansion of telehealth capabilities. In order to meet the needs of PLWH along the Care Continuum, we developed a process to promote the use of our MyChart app. This HIPAA-compliant app allows patients to view their medical records, communicate with their providers, make appointments, and have video visits on their smart devices. This report describes our preliminary findings.

Methods
PLWH enrolled in the Ryan White Program, in the Infectious Diseases Clinic at Henry Ford Hospital who had not used telehealth services were asked to sign up for our MyChart (electronic medical record software) initiative. A telehealth Navigator interviewed and taught PLWH how to download and use MyChart, and supplied pre-loaded phones, as needed, to make virtual visits accessible. We collected demographic and clinical information and reasons for not using telehealth services.

Results
From October 2020 to May 2021, 209 PLWH were enrolled into our pilot program (Table 1). Of these: 48% were 45-64 years old (yo), while 21% were &gt;/+ 60 yo and 3% &lt; 25 yo; 75% were male, 85% Black; 48% MSM, and 84% virally suppressed (HIV RNA &lt; 200 copies/mm3). When asked why they were not using telehealth services, 29% reported a lack of technology or capability to install MyChart on their phones, 27% needed further education, and 18% and had not prioritized installation of the application.

Conclusion
The crises created by the COVID-19 pandemic revealed a new role for telehealth services. Although available to all PLWH in our RW program, many had never used telehealth services. Over half lacked compatible devices or needed help to download or use the app. Compared to younger PLWH, older individuals were more likely to need assistance. Further work is needed to understand and promote digital parity.

Disclosures
All Authors: No reported disclosures