bluuebunny/crossref_metadata_2025_split huggingface dataset:
1292. HIV Pre-Exposure Prophylaxis (PrEP) Implementation at Silom Community Clinic in Bangkok, Thailand, 2016–2018
Authors: Kung Vanessa , Pattanasin Sarika , Ungsedhapand Chaiwat , Wimonsate Wipas , Thigpen Michael , Dunne Eileen 
Published: November 2018

Abstract

Background
Since 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent HIV among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand.

Methods
SCC staff routinely counseled MSM and TGW attending HIV voluntary counseling and testing about PrEP. If clients believed that they were at substantial risk of HIV and were interested in PrEP, they could receive PrEP after screening that included HIV and renal function testing. Eligible clients received a 30-day supply of daily oral tenofovir-emtricitabine costing 800 Baht (30 USD), and completed a baseline computer-assisted self-interview (CASI) on knowledge and behaviors. At every 3-month follow-up, PrEP clients had a CASI on adherence; if they were interested in discontinuation of PrEP, they completed a CASI that included reasons for discontinuation. We conducted a descriptive analysis of baseline and follow-up CASI results.

Results
From March 2016 to February 2018, 192 clients were prescribed PrEP, and 80 (42%) continued PrEP for at least 6 months. The median age of clients starting PrEP was 31 years (range, 17–67 years), and 98% were MSM. Overall, most (77%) reported at least 1 of four risk behaviors in the last 3 months; among the 148, 120 (81%) had a sex partner with unknown or positive HIV status, 99 (67%) had anal sex without a condom, 22 (15%) reported an STI, and 16 (11%) received money or goods in exchange for sex. Among the 166 clients who returned for at least one follow-up visit, 135 (81%) completed the CASI at the last follow-up visit; of those, 106 (78%) reported 100% adherence to daily PrEP in the last 7 days, and 126 (93%) reported ≥80% adherence in the last 30 days. Of the 36 clients who discontinued PrEP and completed CASI, 33% reported the reason for discontinuation was no current HIV risk (33%); most (69%) reported that they would consider PrEP in the future.

Conclusion
Most PrEP users reported adherence to daily PrEP, and almost one half of those starting PrEP continued through month six. PrEP use at SCC is dynamic, and commonly started and stopped based on self-assessed risk. Regular review of PrEP implementation, with a focus on client needs, will optimize use of this prevention approach.

Disclosures
All authors: No reported disclosures.
1295. Advancing the PrEP Continuum: A Novel Collaboration Between a Public Health Department and a Federally Qualified Healthcare Center in the Southern United States
Authors: Clement Meredith , Eagle Cedar , Taylor Destry , Goldstein Benjamin , Johnston Barbara , Sena Arlene 
Published: November 2018

Abstract

Background
While pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention, some high-risk persons have limited access to care, particularly Black and Latino men who have sex with men (MSM). Disparities also exist by region: the Southern United States accounts for over half of new HIV diagnoses but only a third of PrEP prescriptions. We evaluated a novel PrEP program based on a collaboration between a local department of public health (DPH) and a federally qualified health center (FQHC) providing care to underserved racial/ethnic minorities in Durham, North Carolina.

Methods
In May 2015, the Durham County DPH and Lincoln Community Health Center, an FQHC, developed a program to offer PrEP services using existing resources. The model included initial no-cost screening for sexually transmitted infections (STIs), hepatitis B/C, and HIV at the DPH STI clinic, followed by referral to the FQHC for PrEP services. We profiled the PrEP continuum for patients starting at program initiation until March 2018. For PrEP initiators and non-initiators, comparisons were made using Wilcoxon rank-sum test for continuous variables, and Chi-square or FisherÕs exact tests as indicated for categorical variables.

Results
Of 196 unique patients evaluated in the STI clinic and referred to the FQHC, 117 (60%) persons attended their initial PrEP appointments. Among these, 84 (43%) filled a PrEP prescription, 69 (35%) persisted in care for at least three months, and 58 (30%) reported &gt;90% adherence at follow-up (see figure). Among those presenting for initial appointments (n = 117), more than half were Black (n = 62, 53%) and 21 (18%) were Latino. Most were MSM (n = 95, 81%) and 9 were transgender. Almost half (n = 55, 47%) were uninsured. We found statistically significant differences between PrEP initiators vs. noninitiators based on race/ethnicity (P = 0.02), insurance status (P = 0.05), and history of sex work (P = 0.05).

Conclusion
A collaborative model of PrEP care between a DPH and an FQHC in the Southern United States was able to reach predominantly Black and Latino MSM at high-risk for HIV. Although this program is sustainable, efforts to improve steps along the PrEP care continuum are still needed in this population.

Disclosures
A. Sena, Gilead: Grant Investigator, Research grant.
1302. Antibiotic Prescribing Knowledge: A Brief Survey of Providers and Staff at an Ambulatory Cancer Center During Antibiotic Awareness Week 2017
Authors: Stohs Erica , Krantz Elizabeth M , Sweet Ania , Zier Jacqlynn , Paleologos Maria , Pergam Steven A , Liu Catherine 
Published: November 2018

Abstract

Background
Antibiotics have contributed significantly to advances in cancer therapy and hematopoietic cell transplantation, but rising antibiotic resistance threatens this progress. Little is known about knowledge and perceptions surrounding antibiotic use and resistance among staff at cancer centers.

Methods
We conducted a brief cross-sectional survey of healthcare professionals (HCP) at a large ambulatory cancer center to assess knowledge of antibiotic prescribing and resistance during Antibiotic Awareness Week, November 13–19, 2017. A convenience sample of providers and staff who participated in one of two 2-hour Antimicrobial Stewardship Program “open house” events was used. Questions evaluated knowledge about antibiotic use for upper respiratory tract infections (URIs).

Results
There were 179 respondents. The proportion of correct responses to each question by employee type is displayed in Table 1. There was a statistically significant decreasing trend in the proportion correctly answering all four questions by employee type from providers, to pharmacists, to nurses, to others (P &lt;0.001) (Figure 1).

Conclusion
Providers were more likely to correctly answer questions pertaining to antibiotic use compared with other HCP. Due to the multidisciplinary nature of cancer care, patients often encounter a variety of HCP over the course of treatment. Opportunities exist to improve antibiotic stewardship education across the spectrum of HCP at our cancer center, including pharmacists, nurses, and other staff.

Disclosures
All authors: No reported disclosures.
1307. Emerging Treatments in Ongoing Battle Against Community-Acquired Bacterial Pneumonia (CABP): The Positive Impact of Online Education
Authors: Hurst Simi , Smith Susan 
Published: November 2018

Abstract

Background
The leading infectious cause of hospitalization and infection-related mortality, pneumonia imparts a significant, but often underappreciated, burden. Agents in the antibiotic pipeline have the potential to improve both individual and public health, as well as support antibiotic stewardship programs

Methods
To address knowledge gaps among ID specialists, a CME/CE-certified, 30-minute, video-based, multidisciplinary panel discussion was developed and posted online on March 27, 2018. Featuring four expert faculty, the activity addressed: The evolving etiology of CABP; Emerging antibiotics for CABP treatment; and Antibiotic stewardship
Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to multiple-choice, knowledge questions and a self-efficacy confidence question were analyzed. A chi-squared test assessed changes pre- to post-assessment. P values &lt;0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (&lt;0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; &gt;0.26 extensive effect). Data were collected through April 23, 2017.

Results
A total of 6,146 healthcare providers, including 2,936 physicians have participated in the activity. Data from ID specialists (n = 130) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P = 0.024; V = 0.080) and in several specific areas of assessment (figure). Following activity participation, 34% of ID specialists indicated increased confidence in assessing key attributes of emerging agents and 79% of ID specialists indicated a commitment to incorporate one or more changes into practice. Lastly, the findings uncovered educational needs that require further educational intervention.

Conclusion
Participation in this online educational intervention significantly improved ID specialists’ knowledge with regard to the key similarities and differences between agents in the CABP antibiotic pipeline and the potential role of these agents in patient care. These findings highlight the positive impact of well-designed online education.

Disclosures
All Authors. Nabriva Therapeutics: Independent Medical Education, Educational grant.
1308. Predictors of Career Interest in Infectious Diseases Among US Pharmacy Students
Authors: Jeffres Meghan , Biehle Lauren , Macdougall Conan 
Published: November 2018

Abstract

Background
Pharmacists have a central role in infectious diseases (ID) and antibiotic stewardship efforts across multiple healthcare settings. The demand for pharmacist to fill ID and stewardship-related careers will likely increase as institutions create antibiotic stewardship programs in response to the 2016 Joint Commission standard. The objective of this study was to compare students’ perceptions of their school’s ID curriculum between students interested in an ID career and those who are not.

Methods
A cross-sectional survey study of students graduating from US pharmacy schools was conducted in September 2017. Students received the survey link from the ID faculty at participating schools.

Results
Five hundred thirty-seven students from 28 pharmacy schools completed surveys. Quality of ID didactic education was rated as Very Good by 220 (41%), Good by 219 (40%), Acceptable by 76 (14%), and Poor by 22 (4%) respondents. The most common career interests were ambulatory care (44%), community practice (38%), and infectious diseases (29%). The most common preferred practice settings for students with an interest in ID (n = 157) were inpatient/hospital (86%), inpatient stewardship (70%), and inpatient ID consult service (66%). Differences in responses about didactic ID education between students interested in an ID career and those not interested included: perception of education as Very Good (52% vs. 37%, P = 0.005), faculty providing handouts and/or worksheets (89% vs. 82%, P = 0.009), and the desire for more time allocated to antibiotic stewardship (47% vs. 31%, P &lt; 0.001). Multivariate logistic regression found variables to be predictive of pharmacy student interest in an ID career including: pharmacy school curriculum (OR 2.5, 95% CI 1.5–4.0), perception of a Very Good didactic ID education (OR 1.5, 95% CI 1.0–2.3), and faculty mentor(s) (OR 1.8, 95% CI 1.2–2.7).

Conclusion
Pharmacy students expressing interest in ID as a career had positive views of their didactic ID education, were more likely to report faculty mentorship, and desired more time for antibiotic stewardship in the curriculum. These results can inform efforts to encourage pharmacy students to pursue careers in ID.

Disclosures
All authors: No reported disclosures.
1315. Mind the Gap: Medical Trainees Require Training in Hepatitis C, Drug Use and Mental Health to Help Address the Opioid Crisis
Authors: Corace Kimberly , Ares Isabelle , Schubert Nicholas , Altenberg Jason , Willows Melanie , Kaluzienski Mark , Garber Gary 
Published: November 2018

Abstract

Background
Dramatic increases in acute hepatitis C (HCV) incidence is linked to the opioid epidemic and increased injection drug use. Over 50% of people with HCV also have a mental illness. IDSA/HIVMA calls for the integration of infectious diseases, addiction medicine, and mental health as key to addressing the opioid epidemic. Barriers identified include limited physician education and stigma. This study examined medical trainees’ gaps in training and attitudes toward HCV, drug use, and mental illness.

Methods
Medical students and residents (N = 98) at a large Canadian University completed questionnaires assessing stigma, attitudes, knowledge, and training related to HCV, drug use, and mental illness.

Results
Most participants were medical residents (71%). Within-subjects ANOVAs showed that trainees worked with more patients with mental illness (71%) than drug use (55%) or HCV (21%) (P’s &lt; 0.001). Trainees reported less positive experiences with patients with drug use (34%) and HCV (36%) compared with those with mental illness (55%) (p’s &lt; 0.05). They reported that injection drug use (68%), prescription opioids (66%), and heroin use (59%) were the most challenging substance use problems to treat (P &lt; 0.001). They were less satisfied working with patients with drug use (40%) or HCV (40%) than mental illness (59%) (P’s &lt; 0.01). Trainees reported they were more able to help patients with mental illness (83%) than HCV (65%) or drug use (73%) (P’s &lt; 0.01). Only 34% saw HCV treatment as central to their professional role. Their training better prepared them to treat mental illness (58%) than drug use (41%) or HCV (19%) (P’s &lt; 0.001). They were more interested in training in drug use (76%) and mental health (71%) than HCV (62%) (P’s &lt; 0.01).

Conclusion
Medical trainees report being ill-equipped to treat patients with HCV and drug use (specifically opioids) and are less satisfied with this work. Many report attitudes that may be viewed by patients as stigmatizing. There is a large knowledge gap related to the effectiveness of HCV treatment. Addressing the opioid crisis requires a physician workforce that is prepared to integrate treatment for HCV, drug use, and mental illness. Infectious disease specialists can take a leadership role in building capacity to foster integration.

Disclosures
All authors: No reported disclosures.
1316. An Integrative Approach to Teaching History of Medicine in Medical School
Authors: Slosar-Cheah Magdalena , Nosanchuk Joshua , Pirofski Liise-Anne 
Published: November 2018

Abstract

Background
Medical history plays a foundational role in shaping the characters and habits of thought of developing physicians. Specifically, it cultivates an ability to assess the quality and durability of current knowledge and contributes to the growth of resilience, humility and intellectual curiosity. Especially for Infectious Diseases, knowledge of its history fosters an appreciation for our evolving understanding of the field and an opportunity to spark interest in a future career. Nevertheless, it is hard to find the space for this content amidst competing priorities in the medical school curriculum. An integrative approach has been described as a way to introduce history as a longitudinal component of the existing curriculum. Our aim, using this approach, was to pilot the incorporation of history modules into the Microbiology and Infectious Diseases (Micro/ID) course at Albert Einstein College of Medicine.

Methods
Students participating in Micro/ID were shown four history modules integrated into the existing course. The first was embedded within the introductory lecture and the remaining three were prerecorded videos available through the virtual learning environment. The modules offered context to course material and introduced principles of medical history, such as the potential pitfalls of retrospective diagnosis and changing definitions of disease over time. Comprehension and retention were assessed via two questions on each of two exams. Students had the opportunity to evaluate the course material in both their examination and end-of-course evaluations.

Results
On the first examination, 99% and 68% of students answered correctly. On the second examination, 92% and 54% answered correctly. Student evaluation of the content was positive overall with 91% rating the content satisfactory, very good or excellent. However, some questioned the value of the material while others requested expansion of the modules to include topics such as history of research ethics (Tuskegee and syphilis) and more recent history (the HIV epidemic).

Conclusion
An integrative approach to teaching medical history is largely well-received by students and offers a way to introduce historical topics to an entire class. Comments from students serve as a guide to topics of interest for future iterations of the course.

Disclosures
All authors: No reported disclosures.
1325. HIV, Aging, and Comorbid Conditions: Case-Based, Online Education Improves HIV/ID Specialists’ Management Strategies
Authors: Hurst Simi , Smith Susan 
Published: November 2018

Abstract

Background
Over half of people living with HIV are over 50 years of age. Clinicians must balance HIV care with the management of age-related comorbidities such as, cardiovascular disease, diabetes, liver and kidney disease, and cancer.

Methods
To improve HIV/ID specialists’ ability to develop a comprehensive care strategy for aging men and women living with HIV, a CME/CE/CPE-certified educational intervention comprising two patient case scenarios was developed. It launched on a website dedicated to continuous professional development on March 23, 2018. The interactive, text-based, “test and teach” approach elicited cognitive dissonance; clinicians were presented with multiple-choice questions to evaluate their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to teach. Educational effectiveness was assessed with a repeated pairs pre-/post-assessment study design, in which each individual served as his/her own control. Responses to three multiple-choice, knowledge questions, and one self-efficacy confidence question were evaluated. A chi-squared test assessed changes pre- to post-assessment. P values of &lt;0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (&lt;0.05 modest; 0.06–0.15 noticeable effect; 0.16–0.26 considerable effect; &gt;0.26 extensive effect). Data were collected through April 27, 2018.

Results
4,130 HCPs, including 795 physicians, participated in the activity. Data from HIV/ID specialists (n = 76) who answered all pre-/post-assessment questions during the study period were analyzed. Significant improvements were observed overall (P &lt; 0.0001; V = 0.496) and in several specific areas of assessment (figure). Following activity participation, the % of ID specialists who answered all assessment questions correctly increased dramatically: 9% (pre) vs. 88% (post). Additionally, 77% of HIV/ID specialists indicated a commitment to incorporate one or more changes into practice.

Conclusion
Participation in this online, interactive, case-based educational intervention significantly improved ID specialists’ ability to care for aging patients living with HIV. These findings highlight the positive impact of well-designed online education.

Disclosures
S. Hurst, ViiV Healthcare: Independent Medical Education, Educational grant. S. Smith, ViiV Healthcare: Independent Medical Education, Educational grant.
1329. Beyond Reporting: Using an Accreditation Council for Graduate Medical Education (ACGME) Milestone-Linked Evaluation System to Improve Clinical Infectious Diseases Rotations for Baylor College of Medicine Internal Medicine (BCM IM) Residents
Authors: Herrera Lauren Nicholas , Hamill Richard J , Rose Stacey R 
Published: November 2018

Abstract

Background
ACGME requires reporting of trainee performance on specialty-specific “milestones.” Online evaluation platforms facilitate reporting by linking evaluation questions to these milestones. Whether a milestone-linked evaluation system can be used to identify educational strengths and weaknesses within a training program has not been reported.

Methods
In 2016, the BCM IM residency program implemented a milestone-linked evaluation system to increase transparency to residents regarding educational goals and streamline milestone reporting. Residents are evaluated on rotation-specific educational objectives; scores range from 1 to 5 (Figure 1), or “not observed” if the skill was not observed during the rotation. Evaluation data from residents on infectious diseases (ID) rotations between 2016 and 2018 were analyzed to compare performance by post-graduate year (PGY) and to assess curricular strengths and deficiencies.

Results
Two hundred five inpatient and 43 ambulatory ID rotation evaluations were analyzed. In the inpatient setting, mean scores for PGY-1, -2, and -3 trainees were 2.62, 3.06, and 3.88. Residents scored highly on communicating consult recommendations and collecting data from the health record. Residents received lower scores on identifying infections associated with immune deficiencies and in knowledge of antimicrobial spectrum/indications. In the ambulatory setting, mean scores for PGY-2 and -3 trainees were 3.44 and 3.61. Relative to the inpatient setting, more objectives on ambulatory rotations were rated as “not observed.” Objectives with high rates of “not observed” ratings included managing infections in returning travelers (70%); testing/treating latent tuberculosis (63%); interpreting viral hepatitis studies (31%); and managing sexually transmitted infections (25%).

Conclusion
Data from a milestone-linked evaluation system identified educational strengths and weaknesses of clinical ID experiences for internal medicine residents. Objectives with consistently low or “not observed” ratings may be judged as educational deficiencies, and should prompt modifications to the curriculum to provide increased clinical exposure and/or dedicated didactics to help residents develop these important skills.

Disclosures
All authors: No reported disclosures.