bluuebunny/crossref_metadata_2025_split huggingface dataset:
1263. Managing an Influenza Outbreak Which Spilled Over to an Acute Care Hospital from a Behavioral Health Unit
Authors: Clay Colleen M , Girio-Herrera Leonardo , Younus Faheem 
Published: November 2018

Abstract

Background
Behavioral health units (BHU) have been implicated in influenza outbreaks due to group activities, low availability of alcohol-based hand gels and unique host factors. We describe the management of an unusual influenza outbreak, which started in the BHU and then spilled over to the acute care hospital (ACH).

Methods
University of Maryland Harford Memorial Hospital is a 95-bed ACH with a 14-bed closed-door adult BHU located on the fifth floor. Two cases each of hospital-acquired influenza were identified in our BHU during 2016 and 2017. In January 2018, however, hospital-acquired influenza cases in the BHU spilled over to the adjacent ACH to cause an outbreak. A case was defined as a patient with fever of &gt;100.4°F, presence of influenza-like illness, and a positive influenza test &gt;72 hours after admission. Outbreak control measures included twice daily fever screening, enhanced droplet precautions, visitor restrictions, discontinuing community activities, enforcing hand hygiene at all hospital entrances, and hospital-wide chemoprophylaxis with oseltamivir.

Results
On January 15, 2018, the index patient developed influenza in the BHU followed by a second case in BHU 4-days later. Over the next 10 days, five more patients on the third and fourth floors of ACH tested positive. Attack rate was 3% and average length of stay was 8.9 days. Chemoprophylaxis with oseltamivir 75 mg orally once a day was given to 71% of all eligible hospitalized patients for a week (at a cost of $17,000). All seven patients yielded influenza A, subtype H3N2 and were successfully treated with oseltamivir 75 mg orally twice a day for 7 days. The outbreak lasted 11 days. Figure 1 shows the epidemiologic curve.

Conclusion
Special attention should be paid to influenza prevention in the BHUs due to the risk of spillover effect to sicker patients in the adjacent ACH. A short, 7-day course of hospital-wide oseltamivir chemoprophylaxis, in addition to promptly implementing the infection prevention measures was effective in controlling the outbreak.

Disclosures
All authors: No reported disclosures.
1264. Healthcare-Acquired Influenza in Critical Ill Patients
Authors: Gutierrez Valentina , Cerda Jaime , Corre Nicole Le , Medina Rafael , Ferres Marcela 
Published: November 2018

Abstract

Background
Healthcare-associated infections (HAIs) increases morbidity and mortality. During 2014, at Hospital Clínico Red de Salud UC CHRISTUS (RS-UCCH), was estimated that 15% of viral respiratory infections were acquired during hospitalization, and influenza was the main etiologic agent. The aim of this study was to obtain clinical characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care units (chronic patients who need hospitalized nurse care).

Methods
Descriptive study of CCU and special care patients with hospital acquired influenza during 2014–2017. HAI due to influenza was defined as: symptoms onset and/or positive influenza PCR ≥48 hours after hospital admission, without previous respiratory symptoms or with negative PCR.

Results
22 patients with median age of 74 years old were identified, only three pediatric cases. The average time of acquired influenza was at 13th day of hospitalization. In 77% Influenza A was the only agent detected and 27% had respiratory co-infection. Thirteen (59%) were previously hospitalized in CCU, but only 2 (15%) due to respiratory problems. Nineteen patients (86%) presented comorbidity such as arterial hypertension (59%), chronic kidney disease (18%), and immunosuppression (18%). Half of them had a decompensation, mainly respiratory, associated to influenza infection. The observed lethality was 18%. Among all the influenza HAI, 59% occurred in unvaccinated patients, although 46% of them met criteria for vaccination recommendation.

Conclusion
HAI due to influenza occurred in chronic, older, and unvaccinated patients. Education about HAIs and continuing high vaccination coverage must be a priority.

Disclosures
All authors: No reported disclosures.
1275. Will an App-Optimized HIV Self-testing Strategy Work for South Africans? Results From a Large Cohort Study
Authors: Pai Nitika Pant , Esmail Ali , Marathe Gayatri , Oelofse Suzette , Pretorius Marietjie , Smallwood Megan , Daher Jana , Janssen Ricky , Saha-Chaudhuri Paramita , Engel Nora , Dheda Keertan 
Published: November 2018

Abstract

Background
HIV self-testing (HIVST) offers a potential for expanded test access; challenges remain in operationalizing rapid personalized linkages and referrals to care. We investigated if an app-optimized personalized HIVST strategy improved referrals, detected new infections and expedited linkages to care and treatment.

Methods
In an ongoing cohort study (n = 2,000) based in South Africa, from November 2016 to January 2018, to participants presenting to self-test at community township based clinics, we offered a choice of the following strategies: (a) unsupervised HIVST; (b) supervised HIVST. We also observed participants opting for conventional HIV testing (ConvHT) in geographically separated clinics. We observed outcomes (i.e., linkage initiation, referrals, disease detection) and compared it between the two (HIVST vs. ConvHT) for the same duration.

Results
Of 2,000 participants, 1,000 participants were on HIVST, 599 (59.9%) chose unsupervised HIVST, 401 (40.1%) on supervised HIVST; compared with 1,000 participants on ConvHT. Participants in HIVST vs. ConvHT were comparable young (mean age 27.7 [SD = 9.0] vs. 29.5 [SD = 8.4]); female (64.0% vs. 74.7%); poor monthly income &lt;3,000 RAND ($253 USD) (79.9% vs. 76.4%). With HIV ST (vs. ConvHT), many more referrals (17.4% [15.1–19.9] vs. 2.6% [1.7–3.8]; RR 6.69 [95% CI: 4.47–10.01]), and many new infections (86 (8.6% (6.9–10.5)) vs. 57 (5.7% (4.3–7.3)); Odds Ratio 1.55 [95% CI 1.1–2.2]) were noted. Break up: 45 infections in supervised HIVST 45 (52.3%); 41 infections in unsupervised HIVST (47.6%)]. Preference for HIVST was at 91.6%. With an app-optimized HIVST strategy, linkages to care were operationalized within a day in all participants (99.7% (HIVST) vs. 99.2% (ConvHT); RR 1.005 [95% CI: 0.99–1.01]); 99.8% supervised HIVST, 99.7% unsupervised HIVST.

Conclusion
Our app-optimized HIVST strategy successfully increased test referrals, detected new infections, and operationalized linkages within a day. This innovative, patient preferred strategy holds promise for a global scale up in digitally literate populations worldwide.

Disclosures
All authors: No reported disclosures.
1276. Human Immunodeficiency Virus (HIV) Diagnostic Limbo: A Retrospective Review of Discordant HIV Test Results in a Large, Academic Health Center Over a 10-Year Period to Guide Clinicians in Distinguishing False-Positive vs. Acute HIV Infection
Authors: Commanday Alexander , Rose Stacey R , Hemmige Vagish S , Rubin Jack , Giordano Thomas P 
Published: November 2018

Abstract

Background
The Centers for Disease Control and Prevention (CDC) recommends universal HIV screening with a fourth-generation HIV-1/2 antigen–antibody immunoassay followed by an HIV-1/-2 antibody differentiation immunoassay. Discordant results require nucleic acid testing (NAT) to distinguish acute HIV from false positives. In practice, NAT can be delayed, leaving clinicians and patients in limbo. Better understanding of factors associated with acute HIV vs. false positivity among discordant HIV tests is needed.

Methods
From 2014 to 2018, positive fourth-generation HIV-1/-2 enzyme-linked immunosorbent assay (ELISA) tests were retrospectively analyzed across centers in the Harris Health system in Houston, Texas. Discordant results were defined as a positive fourthgeneration HIV-1/2 ELISA with a negative HIV-1/-2 antibody confirmation test and were resolved via NAT (if possible). Duplicate results and patients with a previously positive HIV-1 viral load were excluded. Results were analyzed (Fisher’s exact test or Chi square) by year, setting (clinic/hospital), sex, age, race, and comorbid conditions (pregnancy, rheumatoid arthritis, lupus, hepatitis B and syphilis [rapid plasma reagin, or RPR&gt;1:4] for associations with acute HIV vs. false positivity).

Results
Of 7,077 positive fourth-generation HIV-1/2 ELISA tests, 488 (13%) discordant cases were identified. Eighty-six (18%) represented acute HIV while 322 (66%) were false positives; 80 remained unresolved (no NAT performed). Median time to resolution via NAT was 21 days. Clinic setting, female sex, older age, non-Black race, and negative RPR status were associated with significantly higher rates of false positivity vs. acute HIV (P &lt; 0.02 for all associations).

Conclusion
In this large HIV testing program in a multicenter metropolitan health system, 66% of discordant fourth-generation HIV tests represented false positives. Several clinical factors correlated with a higher rate of false positivity, likely reflecting the impact of disease prevalence on the positive predictive value of any diagnostic test. Clinicians may consider these factors when counseling their patients during the limbo period. Efforts to expedite NAT to resolve discordant cases is paramount to reducing diagnostic uncertainty.

Disclosures
All authors: No reported disclosures.
1280. Geospatial Spread of HIV in the Cologne-Bonn Region, Germany: From 2001 to 2016
Authors: Stecher Melanie , Hoenigl Martin , Eis-Huebinger Anna-Maria , Lehmann Clara , Fätkenheuer Gerd , Wasmuth Jan-Christian , Knops Elena , Metha Sanjay , Vehreschild Janne , Chaillon Antoine 
Published: November 2018

Abstract

Background
Geographical targeting of interventions of hotspots of HIV transmission increases the impact of HIV intervention. We combined molecular epidemiology and geospatial analyses to provide insights into the drivers of HIV transmission and the contribution of geographical hot spots to the rapidly evolving local HIV epidemic of Cologne-Bonn.

Methods
We included 714 HIV-1-infected ART naïve individuals, followed at the University Hospitals Cologne and Bonn between 2001 and 2016. Phylogenetic and network analyses were performed to infer putative relationships. Assortativity index (AI, i.e., shared attributes) and characteristics of genetically linked individuals were analyzed. The geospatial diffusion of the local epidemic (i.e., viral gene flow) was evaluated using a Slatkin-Maddison approach. Geospatial dispersal of local HIV transmission was determined by calculating the average distance between genetically linked individuals (centroids of 3-digit zip code of residency, ArcGIS®).

Results
Of 714 sequences, 217 (30.4%) had a putative linkage with at least one other sequence, forming 77 clusters (size range: 2–8). Genetically linked individuals were significantly more likely to live in suburban areas (P = 0.035), &lt;30 years of age (P = 0.013), infected with HIV-1 subtype B (P = 0.002). AI for concurrent area of residency showed that individuals were nonassortative in the network (−0.0026, P = 0.046), indicating that clustering individuals tended to cluster with individuals living in a different zip code. Geospatial analyses revealed that the median distance between genetically linked individuals was 23.4 km, significantly lower than expected (median 39.68 km; P &lt; 0.001) (Figure 1A). Slatkin Maddison analyses revealed increased gene flow originating from Central Cologne toward the surrounding areas (P &lt; 0.001, Figure 1B).

Conclusion
Phylogeographic analysis suggests that central Cologne may be a significant driver of the regional epidemic. While clustering individuals lived closer than unlinked individuals, they were less likely to be linked to others from their same zip code. This may reflect individuals reaching out of their neighborhoods and social circles to meet new partners.

Disclosures
All authors: No reported disclosures.
1283. Pretreatment HIV-1 Drug Resistance in Transmission Clusters of the Cologne-Bonn Region, Germany
Authors: Stecher Melanie , Hoenigl Martin , Eis-Huebinger Anna-Maria , Lehmann Clara , Fätkenheuer Gerd , Wasmuth Jan-Christian , Knops Elena , Metha Sanjay , Vehreschild Janne , Chaillon Antoine 
Published: November 2018

Abstract

Background
In Germany, previous reports have demonstrated transmitted HIV-1 drug resistance mutations (DRM) in 10% of newly diagnosed individuals, affecting treatment failure and the choice of antiretroviral therapy (ART). Here, we sought to understand the molecular epidemiology of HIV DRM transmission throughout the Cologne-Bonn region, an area with one of the highest rate of new HIV infections in Europe (13.7 per 100,000 habitants).

Methods
We analyzed 714 HIV-1 ART naïve infected individuals diagnosed at the University Hospitals Cologne and Bonn between 2001 and 2016. Screening for DRM was performed according to the Stanford University Genotypic Resistance Interpretation. Shared DRM were defined as any DRM present in genetically linked individuals (&lt;1.5% genetic distance). Phylogenetic and network analyses were performed to infer putative relationships and shared DRMs.

Results
We detected 123 DRMs in our study population (17.2% of all sequences). Prevalence of any DRM was comparable among risk groups and was highest among people from an endemic area (i.e., country with HIV prevalence &gt;1%) (11/51, 21.6%). Nucleoside-and non-nucleoside reverse transcriptase inhibitor (NRTI/NNNRTI) resistance mutations were detected in 49 (7%) and 97 (13.6%) individuals, with the E138A in 29 (4.1%) and K103N in 11 (1.5%) being the most frequent. Frequency of DRM was comparable in clustering and not clustering individuals (17.1% vs. 17.5%). Transmission network analysis indicated that the frequency of DRM in clustering individuals was the highest in PWID (3/7, 42.9%) (Figure 1A). Genetically linked individuals harboring shared DRMs were more likely to live in suburban areas than in Central Cologne (18.8% vs. 8% of clustering sequences with DRM; Figure 1B).

Conclusion
The rate of DRMs was exceptionally high in the Cologne/Bonn area. Network analysis elucidated frequent cases of shared DRMs among genetically linked individuals, revealing the potential spread of DRMs and the need to prevent onward transmission of DRM in the Cologne-Bonn area.

Disclosures
M. Hoenigl, Gilead, Basilea, Merck: Speaker’s Bureau, Research grant and Speaker honorarium.
1285. Impact of an Educational Program on Knowledge, Attitude and Practice to Prevent HIV Infection Among HIV-Negative Heterosexual Partners of HIV-Infected Patients
Authors: Khawcharoenporn Thana , Srirach Chanika , Chunloy Krongtip 
Published: November 2018

Abstract

Background
Data on knowledge, attitudes, and practices to prevent HIV transmission are limited and effective strategies to improve such knowledge, change attitudes, and reduce risk behaviors are unknown among serodiscordant couples.

Methods
A quasi-experimental study was conducted among HIV-negative adult heterosexual partners of HIV-infected patients. The intervention was an educational program consisting of a 1-hour educational session on knowledge about HIV infection and transmission prevention, a condom use teaching session, group discussion and experience sharing, and free HIV testing. Self-administered survey was conducted pre- and post-intervention on the same day to assess effectiveness of the program in improving HIV knowledge and changing attitudes toward HIV prevention. The participants were invited to participate in the program again 6 months later to assess retention of the knowledge and positive attitudes and practices to prevent HIV.

Results
A total of 88 participants were enrolled. The median age was 39 years and 49 (56%) were male. The median number of correct answers to the 30 statements about HIV infection and transmission prevention was significantly higher after the program compared with before the program (28 vs. 21; P &lt; 0.001). After the program, higher proportions of the participants would encourage treatment of their HIV-infected partners (77% vs. 58%), use pre-exposure prophylaxis (59% vs. 38%), have a regular HIV blood test every 6 months (94% vs. 81%) and think that they and their partners can have a baby together safely with the current HIV transmission prevention strategies (48% vs. 17%) compared with before the program (all P &lt; 0.05). Among the 35 participants who participated in the educational program twice, most of the knowledge and positive attitudes were retained. The rates of regular HIV testing every 6 months and consistent condom use had increased from baseline to 6 months later (29% to 74% and 71% to 91%, respectively). None of the participants acquired HIV from their partners.

Conclusion
The educational program was shown to be effective in improving HIV knowledge, attitudes, and practices toward HIV prevention among the seronegative partners.

Disclosures
All authors: No reported disclosures.
1286. Evaluating Strategies to Reduce Risk of HIV Infection in the US Blood Supply
Authors: Goldstein Robert , Sacks Chana , Walensky Rochelle 
Published: November 2018

Abstract

Background
Due to risk of HIV transmission, the FDA recommends a ban on blood donation from men who have sex with men (MSM). Revised in 2015, the current restriction applies to men who have had sex with a man in the year before donation. Given advances in HIV testing and the option of risk-based screening, the current approach may not represent the optimal strategy for ensuring a safe blood supply.

Methods
Using a decision tree, we compared three strategies: (1) the current standard: a deferral for MSM followed by fourth-generation HIV antibody/antigen (Ab/Ag) and viral load (VL) testing of all donated units; (2) test-only: no deferral, with Ab/Ag and VL testing; (3) risk-based: deferral for all male donors who report condomless anal intercourse in the past 6 weeks, followed by Ab/Ag and VL testing. The primary outcome was the expected number of accepted HIV+ donations per million units of donated blood. Key input parameters include MSM prevalence (3.6%), HIV testing sensitivity for chronic (99.96%) and acute (75%) infection, and false negative rate of the current MSM deferral question and the risk-based screening question (2.6% for each). In sensitivity analyses, we assessed the impact of variation in these parameters.

Results
In the base case, the current strategy resulted in 5.39 HIV+ accepted blood donations per million; the testing only strategy resulted in 7.10 HIV+ accepted blood donations per million; and the risk-based strategy resulted in 2.54 HIV+ accepted blood donations per million. In sensitivity analyses, the risk-based strategy was superior across plausible ranges of HIV test sensitivity and MSM prevalence. The risk-based strategy was superior when the false negative rate generated by the risk-based screening question was &lt;10.4%; at higher rates, the current strategy was superior. The current strategy was superior when the MSM deferral question yielded &lt;0.8% false negative rate; at higher rates, the risk-based strategy is superior. Compared with the current standard, a risk-based strategy could add 5 million low-risk MSM to the potential donor supply.

Conclusion
A risk-based screening question, combined with Ab/Ag and VL testing, may be more effective than the current strategy. The quality and ability of screening questions to accurately assess risk is key to any pre-donation screening strategy.

Disclosures
All authors: No reported disclosures.
1291. Assessing Uptake of HIV Pre-Exposure Prophylaxis (PrEP) Among High-risk Demographics in a Community-Based Clinic in Brooklyn
Authors: Marryshow Terry , Ojeda-Martinez Hector , Stefanov Dimitre 
Published: November 2018

Abstract

Background
PrEP is a proven, effective means of preventing HIV. Uptake in groups at highest risk of HIV, such as Black men who have sex with men (MSM) and Hispanics, has been disproportionately low nationwide. We analyzed the demographics of PrEP patients in the STAR Health Center in East Flatbush, Brooklyn (BK) to assess our effectiveness in PrEP uptake and retention among at-risk groups.

Methods
We performed a retrospective analysis of 134 consecutive patients who enrolled in our clinic for PrEP between June 2016 and December 2017. We assessed risk factors, demographics, insurance status, location, and retention in care. Retention was defined as completing medical visits within 3 months of prior visit. We compared demographics, sexual practices, and locations of our patients to those among new HIV diagnoses in BK, as reported by NYC Department of Health’s 2016 surveillance report. Fisher’s exact test was used to detect differences in gender, race, and sexual practices.

Results
Only 11.94% of those enrolled in our clinic and prescribed PrEP were women, compared with 27.19% of BK new HIV diagnoses (P &lt; 0.005). There was no statistically significant difference in race, and distributions were similar between the two groups. There was a higher proportion of MSM among those prescribed PrEP (71.64%) compared with BK new HIV diagnoses (46.64%) (P &lt; 0.005). Retention rates were low, with female gender (6/16, 37.5%) and White race (12/32, 37.5%) having the lowest retention in care, compared with Hispanic patients (13/21, 61.90%) who had highest retention. 41.04% of PrEP patients were uninsured. ZIP codes with highest HIV incidence per NYC Department of Health surveillance report were well represented in our clinic for PrEP.

Conclusion
In STAR, PrEP uptake was similar across race and location when compared with people who newly acquired HIV. There was a larger proportion of individuals known to be MSM among those prescribed PrEP. This study shows that STAR’s efforts at targeting at-risk groups are reaching the appropriate demographics. However, there was a detectable disparity in PrEP uptake in women. Research into further interventions to increase PrEP access for women and improve retention overall is needed. Nevertheless, STAR’s program presents a model to follow for other areas with disparities in PrEP uptake among at-risk groups.

Disclosures
All authors: No reported disclosures.