bluuebunny/crossref_metadata_2025_split huggingface dataset:
1289. Knowledge, Attitudes and Barriers of Pre-exposure Prophylaxis for HIV Infection Among Resident Physicians in Rural, Eastern North Carolina
Authors: Morrison Arianne , Dortche Ciarra , Fadul Nada 
Published: November 2018

Abstract

Background
North Carolina bears a high burden of HIV and was ranked number 8 for the number of new infections in 2015. In 2014, the Centers for Disease Control and Prevention (CDC) published updated practice guidelines recommending the use of pre-exposure prophylaxis (PrEP) with daily oral dosing of tenofovir/emtricitabine to help prevent HIV infection in high-risk individuals. However, the use of PrEP in the primary care setting remains low and 1 in three primary care physicians is not aware of PrEP. The objective of our study was to evaluate PrEP knowledge among primary care resident physicians.

Methods
149 resident physicians were surveyed at East Carolina University from the following specialties; Internal Medicine, Medicine-Pediatrics, Obstetrics Gynecology and Family Medicine. We collected participants’ age, biological sex, current residency program, and current year within the residency program.

Results
Sixty out 149 residents completed the online survey. 20% of residents had never heard of PrEP. 17% of residents did not feel comfortable discussing sexual preferences with their patients. 15% of residents thought prescribing would increase risky sexual behaviors and 12% would not prescribe PrEP to patients with multiple sexual partners. Only 3% of residents identified potential side effects of PrEP (e.g., an increase in creatinine levels or decrease in mineral bone density) as a reason to not prescribe PrEP. One resident had ever prescribed PrEP. 83% of residents wanted more information on PrEP and 95% of residents would be willing to prescribe PrEP if educational workshops were offered.

Conclusion
PrEP is an underutilized tool among resident physicians in Eastern, NC. We identified lack of knowledge of PrEP and concern for increased risky sexual behaviors as barriers to prescribing. Resident physicians require more education on PrEP in order to prescribe it to their patients.

Disclosures
All authors: No reported disclosures.
1296. Potential use of Sexually Transmitted Infection (STI) Testing for Expanding HIV Pre-Exposure Prophylaxis (PrEP) at an Urban Hospital Center
Authors: Pitts Robert , Holzman Robert , Greene Richard , Lam Emily , Carmody Ellie , Braithwaite Scott 
Published: November 2018

Abstract

Background
Despite the high efficacy of PrEP, it continues to be underutilized. We examined the extent to which patients with a documented positive test for STIs were provided PrEP at an urban municipal medical center.

Methods
We reviewed data of all patients seen between January 1, 2014 and July 30, 2017 who were &gt; 18 years old and had an initial HIV negative test and ≥1 positive test for Chlamydia, Gonorrhea, or Syphilis. We examined PrEP prescription data by gender, race/ethnicity, and clinic location. Differences between groups were compared using Chi-squared analysis and logistic regression.

Results
Of 1,142 initially HIV− patients who were identified as having a positive STI result, 52% were female, 89% either Black or Hispanic, with a median age of 40 years (quartiles 30, 47). 58% had Medicare/Medicaid and 34% were self-pay or uninsured (Table 1). Only 25 (2.1%) of 1,142 patients who had ≥1 STI test positive were prescribed PrEP. No women received PrEP. Whites (aOR: 21.7 [95% CI:4.4, 107, P &lt; 0.001] and Hispanics (aOR:6.64 [95% CI:1.35, 32.8, P = 0.02] were both more likely to receive PrEP than Blacks, after adjusting for age, sex, marital status, and insurance. All PrEP prescriptions originated from the Medicine, Emergency, or HIV specialty clinics although most STI testing was obtained in Emergency and Obstetrical/Gynecological clinics (Table 2).

Conclusion
There were significant missed opportunities for HIV prevention among patients with STIs within the medical center, particularly among Hispanic and Black patients. Enrichment programs to educate providers and increase PrEP prescriptions may have a major impact on expanding HIV prevention, especially for women.

Disclosures
All authors: No reported disclosures.
1297. Characteristics for PrEP Uptake, Retention, and Discontinuation: Data From the ANCHOR Study
Authors: Mathur Poonam , Kattakuzhy Sarah , Nussdorf Laura , Hill Kristi , Silk Rachel , Gross Chloe , Akoth Elizabeth , Sidique Nadeera , Chaudhury Chloe , Sternberg David , Masur Henry , Kottilil Shyam , Rosenthal Elana 
Published: November 2018

Abstract

Background
People who inject drugs (PWID) have an increased risk for HIV, and HCV infection may foreshadow HIV acquisition in current epidemics. Studies of PWID have demonstrated a desire to obtain HCV treatment; however, use of pre-exposure prophylaxis (PrEP) in this population has not been well studied.

Methods
The ANCHOR study is an ongoing single-center study evaluating treatment of HCV in PWID. Enrolled patients have chronic HCV, opioid use disorder, and inject opioids. Patients are treated with sofosbuvir/velpatasvir and offered PrEP. Patients complete baseline community health worker (CHW)-administered surveys, physician assessment of PrEP eligibility, and are offered PrEP uptake.

Results
Of 89 enrolled patients, 49 (55%) met CDC criteria for PrEP, and 21 (24%) patients started PrEP. Reasons for not starting PrEP are in Figure 1. Though most patients are black (n = 82, 92.1%) and heterosexual (n = 81, 91%), these patients were less likely to start PrEP (P = 0.0068 and P = 0.0283, respectively). Baseline interest in starting PrEP was correlated with uptake (P = 0.0023), however, self-identifying as high-risk for HIV acquisition or meeting CDC criteria for PrEP were not. Though more patients endorsed sharing of injection equipment to a CHW than a physician (17% vs. 7%), endorsement to a physician rather than CHW was associated with starting PrEP (P = 0.0307). To date, 13 (62%) patients discontinued PrEP, 7 (54%) due to side effects.

Conclusion
Preliminary results of the ANCHOR study support that engagement in HCV care provides an opportunity for PWID to participate in PrEP intake; however, we found relatively low uptake in these patients, despite over half meeting CDC criteria. Our findings highlight the importance of counseling by physicians for initiation of PrEP, and suggest that improved communication between CHW and physician regarding risk behaviors could improve uptake. These data also reinforce that patients must be counseled and managed for side effects in order to retain them in care. Given the increasing opioid epidemic in the United States, more consideration needs to be given regarding how to incorporate PrEP into care, and how to effectively target and improve interest in PrEP for high-risk populations with poor uptake, including minorities and PWID.

Disclosures
C. Gross, Merck, Pfizer, Johnson and Johnson: Shareholder, stock. E. Rosenthal, Gilead Sciences, Merck: Grant Investigator, Grant recipient.
1305. Application of Standard Antibiotic Use Criteria to Evaluate Inpatient Antibiotic Use
Authors: Campion Maureen , Dionne Emily , Radigan Elizabeth , Scully Gail , Zoubi Moamen Al , Zivna Iva , Theodoropoulos Nicole 
Published: November 2018

Abstract

Background
It is estimated that 30–50% of antimicrobial agents prescribed inpatient are not optimal. Historically, antimicrobial evaluation has been based primarily upon expert opinion of ID trained individuals. Spivak and colleagues proposed standard terminology and definitions to assess antimicrobial prescribing practices. At UMass Memorial Medical Center we utilized Spivak’s criteria to measure antimicrobial use within point prevalence studies (PPS) and assessed the ability of Spivak’s criteria to provide consistent results between different evaluators.

Methods
A PPS was conducted in September 2017 (SEPT) by infectious disease (ID) attendings and ID trained pharmacists. A follow-up PPS was completed in November 2017 (NOV) by a pharmacy practice resident (PGY-1) and first year ID fellow. Patients were included if they were prescribed antibiotics at the time of review, greater than 18 years of age, and admitted to an inpatient unit. Patients only receiving antiretroviral therapy or antifungal prophylaxis were excluded from the study. Antibiotics, indications, days of therapy, and appropriateness or reason for inappropriateness, as defined by Spivak’s criteria, were collected.

Results
Four hundred five patients in SEPT and 475 patients in NOV were reviewed. Baseline characteristics between SEPT and NOV, including sex, age, average length of hospital stay (LOS) at time of review were similar between groups, (SEPT vs. NOV: male sex: 53.2% vs. 51.1%; age: 60.4 vs. 61.7; LOS:8.55 vs. 8.36 days). Number of antibiotics per patient was different between PPS (SEPT 1.69 vs. NOV 1.28). For non-intensive care unit (ICU) patients, 64.9% of use was considered appropriate in SEPT vs. 69.3% in NOV. The top reasons for inappropriate use in non-ICU patients in both PPS were no indication and excess length of therapy. Within the ICU, 89.4% of use was considered appropriate in SEPT, with 75% of use considered appropriate in NOV. The top reason for inappropriate use in ICU patients in both PPS was overly broad therapy.

Conclusion
Application of standard antibiotic evaluation criteria can assist healthcare professionals with different levels of ID training to assess antibiotic use in non-ICU patients. Further evaluation should be considered for critically ill patients.

Disclosures
All authors: No reported disclosures.
1314. From Book to Bedside: Theoretical and Applied Knowledge on the Topic of Healthcare-Associated Infections in Second-Year Nursing Students from a Croatian University
Authors: Mestrovic Tomislav , Kozina Goran , Neuberg Marijana , Ribic Rosana 
Published: November 2018

Abstract

Background
Adequate training of health workers is pivotal in the prevention of healthcare-associated infections (HAI). Our aim was to assess the theoretical and applied knowledge about the risk factors and effective measures of HAI prevention (most notably the use of standard precautions and hand hygiene practices) in second year undergraduate university nursing students that have already completed obligatory courses in microbiology, infectious diseases and epidemiology.

Methods
This study included a whole generation of second year undergraduate nursing students, comprised of 161 female and 25 male participants (186 in total), from a public university in Croatia (University Centre Varaždin, University North). They were given an anonymous questionnaire (developed on the model used by Tavolacci et al. in 2008) covering three domains: General Knowledge of HAI, Standard Precautions (SP) and Hand Hygiene (HH). The acceptable score overall (max. 30) and for each area (max. 10) was arbitrarily set at ≥ 20 and ≥ 7, respectively (in accordance with prior research).

Results
The age range of surveyed students was 19–37 (mean: 21.97, median: 21, mod: 20). An accurate definition of nosocomial infections was provided by 98.92% students (with 60.75% of them defining it as the infection occurring 48 hours after hospital admission). The overall score was 21.5, which indicates sufficient level of applied knowledge of healthcare-associated infections. Very high level of knowledge was observed for the SP area (total score of 9.5); however, the level of knowledge in HAI and HH domains was inadequate (5.9 and 6.1, respectively). There was no statistically significant difference in the overall or specific scores between male and female students (P &gt; 0.05). Formal teaching during the curriculum was students’ primary source of information (60.22%), followed by practical learning in the ward during work (23.65%), formal teaching in the ward (9.68%) and self-learning (6.45%).

Conclusion
Periodical checking of nursing students’ knowledge on HAI and corresponding curriculum modifications in obligatory courses tackling this topic are advised in order to fill the knowledge gaps, improve training, reduce infection rates and increase compliance with prevention measures.

Disclosures
All authors: No reported disclosures.
1320. Continuing Education Improves HIV Screening and Use of PrEP in High-Risk Patients
Authors: Robinson Katie , Dietze Derek , Esgro Robert , Elion Richard 
Published: November 2018

Abstract

Background
Since approval in 2012, the uptake of PrEP in high-risk patients remains low, especially among primary care providers (PCPs) who lack knowledge and confidence regarding its use. Continuing education (CE) has been extensively used to address such knowledge and practice gaps, yet little evidence exists supporting the impact of these initiatives on direct patient care and cost.

Methods
Vindico Medical Education partnered with Improve CME to assess the impact of seven CE programs targeted to PCPs from 2015 to 2017 regarding the use of PrEP in high-risk patients. An outcomes analysis model was used and designed to estimate (1) patients newly identified as HIV+ or HIV−, (2) patients newly on PrEP or HIV treatment, and (3) associated costs of care due to the CE.

Results
Prescribing providers (n = 4,550) who each see an average of 16.8 patients at high-risk for HIV infection per month, participated. Prior to learning only 44% of participants reported that they frequently offer HIV testing to high-risk patients; and only 13% frequently use PrEP clinical guidelines. Six-month post-education, however, 83% and 68% of providers reported using HIV testing and PrEP guidelines, respectively. We then used evidence-based parameters to project the number of high-risk patients who, based on our pool of patients directly impacted by the education, would be willing to accept an HIV test, those who would be HIV+ vs. HIV−, and those who would be willing to accept and adhere to either HIV treatment or PrEP. The model estimated that over the course of 1 year, 135,941 high-risk patients would be newly offered an HIV test. Of those accepting the test (n = 54,376), 163 would be newly identified as HIV+. Of the 54,213 newly identified as HIV−, at least 3,914 would be placed on PrEP. Using accepted values for direct cost of care, this translates to $1.26 million per year for patients newly treated for HIV and $92.4 million per year for those patients newly on PrEP.

Conclusion
Targeted CE to PCPs increased screening rates for HIV infection in high-risk patients, increased awareness and use of PrEP, and linked patients with appropriate care. These findings validate the need for ongoing CE programs to address persisting unmet needs and show that modeling can be used to estimate patient outcomes from CE programs.

Disclosures
R. Elion, gilead: Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. ViiV: Consultant, Consulting fee.
1322. Impact of Hospital Medicine on Trends in Infectious Diseases and Other Subspecialty Fellowship Applications
Authors: Santhosh Lekshmi , Babik Jennifer 
Published: November 2018

Abstract

Background
Over the last decade, the rapid growth of hospital medicine has raised concerns that fewer graduating internal medicine (IM) residents might be pursuing fellowship,1 including in ID.2 We analyzed national trends in applications to subspecialty fellowships over the last 10 years to examine the potential impact of hospital medicine on resident career choice.

Methods
We examined 2009–2018 data from the National Resident Matching Program Specialties Matching Service3 for applicants to eight IM subspecialties. The number of third year residents (R3s) was obtained from the American Board of Internal Medicine Resident Workforce Data.4

Results
The number of matched applicants increased significantly over the last 10 years from 2,889 to 3,640 (P &lt; 0.0001) and was highly correlated with the increase in number of R3s (r2 = 0.93, P &lt; 0.001). All subspecialties saw a significant increase in matched applicants over time except ID and nephrology, which both saw initial decreases that reversed after converting to an “all-in” match. In 2018, ID had its highest number of matched applicants in the last 10 years.

Conclusion
Despite concerns that the growth in hospital medicine would lead to fewer IM residents pursuing subspecialty fellowship, the number of matched applicants to subspecialty fellowships has actually increased over the last 10 years, and has kept pace with the growth in R3s over this time. Initial decreases in the number of matched applicants in ID have now reversed after conversion to the “all-in” match, and the next few years will be critical to determine whether this trend continues.
References
1. Santhosh L, Babik J, Looney MR, Hollander H. Whither the pulmonary ward attending? Preserving subspecialty exposure in United States IM residency training. Ann Am Thorac Soc. 2017;14(4):565–568.
2. Bonura EM, Armstrong WS. Increasing subspecialization in the field of infectious diseases: Evaluating challenges and strategies to move forward. J Infect Dis 2017;216(Suppl 5):S594–S599.
3. National Resident Matching Program. Results and Data: Specialties Matching Service 2009–2018 Appointment Years. National Resident Matching Program, Washington, DC. 2009–2018.
4. American Board of Internal Medicine. Resident and Fellow Workforce Data, 2018.

Disclosures
All authors: No reported disclosures.
1323. Implementation and Effectiveness of the Asia Pacific HIV Practice Course: Building Capacity of Healthcare Workers in the Region
Authors: Michaels Jessica , Olszyna Dariusz , Banerjee Sumita , McGill Scott , Lin Jing Yi , Law Hwa Lin , Yong Joy , Wong Nicole , Lee Cheng Chuan , Archuleta Sophia 
Published: November 2018

Abstract

Background
Building the capacity of healthcare workers (HCW) can positively influence service quality and patient care. Given the limited HIV training opportunities in the Asia Pacific Region, the Asia Pacific HIV Practice Course (APHPC) aims to improve knowledge and skills and encourage patient-centered practice.

Methods
The APHPC is organized by an interprofessional organizing committee. The course was developed based on a needs assessment of HCWs in the region and is run over 4 days. Using didactic and interactive learning approaches, the course covers psychosocial, biomedical and service delivery topics. One hundred HCWs, predominantly nurses, social workers/counselors and, pharmacists have attended the course over 2 years (2016 and 2017). Participants have attended from Singapore, Sri Lanka, Indonesia, Malaysia, Philippines, Bangladesh, Papua New Guinea, Myanmar, and Vietnam. Pre- and post-course evaluations were completed, as well as daily session evaluations and a 3-month post-course evaluation. Participants rated their confidence from 1 to 5 (not confident–very confident). A paired-samples t-test was conducted to compare mean (M) confidence levels pre- and post-course in the various topics covered.

Results
There was significant improvement in mean confidence scores pre-course (M = 3.40, SD 0.27) and post-course (M = 4.09, SD = 0.13); t(11)= 13.1958, P &lt; 0.0001. This was seen across all topics (figure) with the most marked improvement found in models of care and barriers to care, topics that are not routinely or explicitly covered in the same detail or frequency as HIV basics, testing, treatment and prevention. In the 3-month post-course survey, participants shared the changes they have made to their local practice since attending the APHPC. Changes include, additional staff training, revisions to counseling models and services and the implementation of monitoring and evaluation structures.

Conclusion
The APHPC has proven to be an impactful and highly evaluated course. To ensure the course continues to influence and improve practice, the content of the course can be expanded to cover nonstandard topics, and further interactive learning experiences can be incorporated.

Disclosures
All authors: No reported disclosures.
1324. Development of HIV-ASSIST, an Online, Educational, Clinical Decision Support Tool to Guide Patient-Centered ARV Regimen Selection
Authors: Maddali Manoj , Li Jonathan , Shah Maunank 
Published: November 2018

Abstract

Background
Multiple antiretroviral (ARV) regimens are effective at achieving HIV viral suppression but differ in pill burden, resistance profile, side effects, and impact on comorbidities. Current guidelines advocate for an individualized, patient-centric approach to ARV regimen selection, including simplification of ARV regimens in patients with stable viral suppression. Synthesizing these modifying factors is necessary for effective care but is a complex and time-consuming process for infectious disease and primary care practitioners.

Methods
We sought to develop an online, interactive tool for ARV decision support that incorporates patient, viral, and therapeutic factors to provide evidence-based recommendations for individualized ARV regimen selection. We additionally incorporated educational materials within the tool to enhance provider learning while simultaneously improving real-time clinical care. Our goal is to optimize ARV regimen selection to provide personalized HIV care that improves patient outcomes, minimizes adverse effects, and enriches clinician knowledge of antiretrovirals.

Results
We developed HIV-ASSIST (https://www.hivassist.com) as a freely available, online resource to support clinicians caring for HIV patients. Our tool utilizes decision-analysis principles based on current guidelines, scientific literature, and expert opinions to deliver tailored recommendations on ARV regimen selection specific to each patient encounter. Decision algorithms were optimized in an iterative fashion using feedback on complex case scenarios from regional HIV experts. HIV-ASSIST evaluates and “ranks” all possible multi-drug ARV regimens across a variety of domains, including common laboratory markers (viral load, genotype, etc.) and patient-specific characteristics (medical comorbidities and drug interactions, treatment history, adherence, etc.). Through a user-friendly interface, clinicians are shown the impact of these modifying factors on ARV regimens and dosing, along with supporting clinical trial evidence.

Conclusion
HIV-ASSIST is a patient-centric tool to improve patient outcomes through real-time ARV decision support and enhance knowledge of evidence-based HIV care guidelines.

Disclosures
All authors: No reported disclosures.