bluuebunny/crossref_metadata_2025_split huggingface dataset:
1850. Association between social vulnerability and Streptococcus pneumoniae antimicrobial resistance in US adults
Authors: Mohanty Salini , Ye Gang , Sheets Charles , Cossrow Nicole , Yu Kalvin , White Meghan , Klinker Kenneth P , Gupta Vikas 
Published: November 2023

Abstract

Background
Antibiotic resistant infections affect more than 2.8 million people in the US each year and disproportionately impact those who are socially vulnerable. The objective of this study was to evaluate the association between Streptococcus pneumoniae (SP) antimicrobial resistance (AMR) and the CDC/ATSDR Social Vulnerability Index (SVI) in the US.

Methods
Adult patients (≥ 18 years) with 30-day nonduplicate SP isolates from ambulatory/hospital settings from January 2011–December 2022 who had zip codes of residence reported were evaluated across 177 facilities in the BD Insights Research Database (Becton, Dickinson & Co., Franklin Lakes, NJ). Isolates were identified as SP AMR if they were intermediate or resistant to ≥ 1 macrolide, tetracycline, extended-spectrum cephalosporin, or penicillin. Isolates from adult patients with zip code of residence reported were matched with county-level CDC SVI data, and associations between SVI score (overall and by each theme) and SP AMR were evaluated using generalized estimating equations with repeated measurements within county to account for within-cluster correlations (Figure 1, Table 1).

Results
Of the 8,008 unique SP isolates linked to 574 US counties, the overall rate of SP AMR was 49.9%. A significant association between the socioeconomic status (SES) theme and SP AMR was detected with higher SVI scores (indicating greater social vulnerability) associated with greater risk of AMR. On average, a single decile increase in SES theme ranking score was observed to be associated with a 1.28% increased risk of AMR (95% confidence interval [CI], 0.61%, 1.95%; P=0.0002; Table 1). Similarly, a single decile increase in household characteristic theme ranking score was observed to be associated with a 0.81% increased risk in SP AMR (95% CI,0.13%, 1.49%; P=0.0197). However, no association between the racial and ethnic minority status theme, the housing type and transportation theme, and overall SVI score and SP AMR were observed.

Conclusion
Higher SES and household characteristic ranking scores (indicating greater social vulnerability) were observed to be associated with higher risk of SP AMR. These results contribute to evidence linking AMR to health disparities and inequities and suggest that AMR is impacted by social determinants of health.

Disclosures
Salini Mohanty, DrPH, MPH, Employee of Merck & Co., Inc.: Stocks/Bonds Gang Ye, PhD, Becton Dickinson and Company: employee Charles Sheets, MS, Becton Dickinson: Data Analysis Nicole Cossrow, PhD, Merck: Stocks/Bonds Kalvin Yu, MD, FIDSA, BD: Stocks/Bonds Meghan White, PharmD, Merck: Employee|Merck: Stocks/Bonds Kenneth P. Klinker, PharmD, Merck & Co., Inc: Employee|Merck & Co., Inc: Stocks/Bonds Vikas Gupta, PharmD, Becton, Dickinson and Company (BD): Employee of BD|Becton, Dickinson and Company (BD): Stocks/Bonds
1852. Harnessing the Power of Artificial Intelligence to Mitigate the HIV/STI Epidemic: Identifying Free Resources for Prevention and Treatment
Authors: Patel Premalkumar M , Prieto Freddie , Singh Yavani , Tuda Claudio , Rivera Cynthia 
Published: November 2023

Abstract

Background
According to the CDC, 1.2 million people in the US have contracted HIV, with 13% of them being unaware of their diagnosis and treatment options. Only 25% of the eligible population is using PrEP. At any given time, 1 in 5 people in the US have STIs, but many do not seek medical attention due to the associated stigma and discrimination. Advanced technologies, such as AI, are being utilized to enhance healthcare delivery and address disparities in accessing health services. AI algorithms can help reduce the spread of HIV and STIs and prevent long-term complications.
HIV/STI free clinic information for providers/patients
HIV/STI free resources information generated by ChatGPT
HIV/STI free clinic information near Miami generated by ChatGPT

Methods
To access ChatBot in ChatGPT for finding resources, we followed these steps:

Results
The Chatbot was utilized by the ChatGPT application and conducted an extensive search for HIV/STI testing and treatment resources in the US. The search involved identifying potential resources from numerous sources, such as Planned Parenthood clinics, community health centers, care resources, AHF and the National HIV and STD Testing Resources websites. The search was focused on determining whether insurance was required, the type of services provided, and contact information for the potential resources. Screenshots attached as images.

Conclusion
In conclusion, the utilization of artificial intelligence in finding free resources for HIV/STI prevention and treatment can be a game-changer in addressing the HIV epidemic. With its ability to identify available resources and high-risk populations, AI can greatly aid in allocating resources more efficiently towards reducing barriers that impede access to HIV/STI prevention and treatment.Further research is needed to explore how best AI can enhance these findings but undoubtedly it could be valuable if applied correctly. Overall, the implementation of AI-based solutions may hold significant promise for addressing public health challenges posed by STIs/HIV infections on a global scale.

Disclosures
All Authors: No reported disclosures
1862. Understanding Care Experiences Amongst Immigrant and Refugee Clients in a Ryan-White Funded HIV Clinic: Insights to Improve Culturally Competent Care
Authors: Zhang Sirey , Altomare Antonia , Zuckerman Richard A 
Published: November 2023

Abstract

Background
Immigrants and refugees receiving HIV care may have challenges accessing effective care due to their unique social determinants of health. In this pilot project, we gathered client and caregiver experiences to improve care systems for our immigrant and refugee clients.

Methods
Participant observation and standardized ethnographic interviews were conducted with 18 clients and 4 caregivers in the HIV clinics at Dartmouth Health. Community support was determined by asking clients if there are family or other members of their immigrant community involved in supporting their care. Clients received gift cards for their time. The study was funded through the IDSA G.E.R.M. grant.

Results
Clients encompassed the spectrum of documentation status and length of residence. Overall, clients seemed satisfied with their care; however, in addition to concerns of how their diagnoses impact documentation and employment status, clients cited fears about the impact on their community standing, with some clients refusing interpreters for fears of being identified. Seven of the 18 total clients reported poor community support. This group included the 2 clients who required more follow-up visits (9 and 4 visits per year) and the only client with an unsuppressed viral load. Congruently, caregivers perceived better adherence and participation when they were able to incorporate family and community support into the client’s care. Clients also expressed that it was important for them to incorporate their sense of self and community within the context of the predominant American culture.

Conclusion
We found that for most of our clients, “culturally competent care” is a spectrum of integration of their indigenous and new cultural experiences. Care outcomes are improved when the clinic supports a client’s need to maintain community support, legal standing, and employment, all of which are key factors in immigrant/refugee success in a new country. However, fear of disclosure can be a barrier to establishing this support, requiring the clinic team to take an active role in building care support while ensuring privacy. Moving forward, we plan to restructure culturally competent care in our clinics in ways that include these important components.

Disclosures
All Authors: No reported disclosures
1864. Recruitment of Participants for Qualitative Research in Marginalized Populations
Authors: Adusumelli Yamini , Tabatneck Mary , Sherman Susan N , Lamb Gabriella S , Sabharwal Vishakha , Goldmann Don , Epee-Bounya Alexandra , Haberer Jessica , Sandora Thomas J , Campbell Jeffrey I 
Published: November 2023

Abstract

Background
There is limited understanding of barriers to participation in pediatric qualitative research, particularly for studies seeking to understand diseases primarily affecting marginalized and hard-to-reach populations.

Methods
We conducted a retrospective cohort study of participants and non-participants invited to enroll in a qualitative study of pediatric tuberculosis (TB) infection care. Potential participants in the initial study were adult caregivers of children diagnosed with TB infection between 2016-2021 in Boston. Most children were immigrants or children of immigrants, and all caregivers were English- or Spanish-speaking. We sent letters in English and Spanish to patients’ primary caregivers, and followed up with up to 2 phone calls. Enrolled participants completed a virtual qualitative interview. We compared characteristics of individuals who participated vs did not participate, and summarized reasons for non-participation.

Results
Of 61 invited caregivers, 19 (31%) enrolled in the initial qualitative study. Table 1 compares characteristics of participants and non-participants. The primary reason for non-participation was inability to contact caregivers (n=27, 64%). A total of 11 (26%) caregivers declined participation, and 4 (10%) participants were unable to join or complete interviews after initially agreeing to participate. Non-completion of TB infection care was significantly associated with non-participation in the qualitative study (P=0.049). We did not observe significant differences by language, insurance, relationship of caregiver to patient, or time from diagnosis to study invitation between participants and non-participants.

Conclusion
Inability to contact potential participants, participants’ lack of time, and lack of shared illness understanding posed barriers to recruitment in this qualitative study. Our findings suggest that alternative contact strategies (e.g. email, text messages), use of short interviews, and strategies to rapidly communicate illness scripts should be studied to improve inclusion in similar studies. While we were able to enroll participants who had not completed TB infection care, additional methods are needed to obtain qualitative perspectives from individuals who disengage from care.

Disclosures
Jessica Haberer, MD, MS, Merck: Advisor/Consultant
1866. Can β-lactam Combinations Restore Susceptibility Against Mycobacterium avium Complex: Exploring a New Approach to a “Difficult to Treat” Opportunistic Pathogen
Authors: Al-Jabri Maha Y , Dousa Khalid M , Wilson Brigid , Holland Steven M , Bonomo Robert A 
Published: November 2023

Abstract

Background
Mycobacterium avium Complex (MAC) are nontuberculous mycobacteria (NTM) responsible for chronic and debilitating diseases, with rising global prevalence. Clinical relapse/reinfection rates of MAC following treatment with first-line therapies range from 25% to 45%. β-lactam antibiotics are not utilized for the treatment of MAC due to clinically high minimum inhibitory concentrations (MICs). Recent studies have explored the effect of combining β-lactam antibiotics to reduce the MICs of other NTMs by inactivating multiple targets in the peptidoglycan synthesis pathway. Our hypothesis is that the cell wall of MAC is similar to that of other NTMs and thus, interrupting the peptidoglycan synthesis pathway using β-lactam combinations would result in lower MICs. In this study, we aim to determine the MICs of meropenem (MEM) in combination with ceftaroline (CPT), cefdinir (CDR), and cefuroxime (CXM) against MAC.

Methods
A total of 31 clinical MAC isolates underwent susceptibility testing using broth microdilution method. MICs were tested for MEM, CPT, CDR, and CXM, alone, as well as combination of MEM plus either CPT, CDR, or CXM.

Results
The susceptibility of MAC isolates to MEM was significantly enhanced when combined with CPT, CDR, and CXM. This effect was most prominent with the addition of CPT, with MIC50/MIC90 of &lt; 0.125/1 µg/mL (compared to 16/64 µg/mL for MEM alone and 16/128 µg/mL for CPT alone), and CDR, with MIC50/MIC90 of &lt; 0.125/2 µg/mL (compared to 16/ &gt;128 µg/mL for CDR alone) (Table 1). The distribution of MICs of β-lactams alone and in combination demonstrates a “left shift” towards lower MIC values for the latter. A Wilcoxon signed-rank analysis confirmed that the change in MIC values for all β-lactam combinations compared to β-lactams alone reached statistical significance (p-value &lt; 0.001, Figure 2).

Conclusion
In this study, we demonstrate that the susceptibility of MAC to MEM is restored with the addition of CPT and CDR. Our data support further exploration of β-lactam combinations as a therapeutic strategy against resistant MAC infections, refractory cases, and when first-line agents are poorly tolerated. Furthermore, our observations suggest that MAC and other NTMs share cell-wall synthetic pathways and that β-lactam combinations can overcome resistance.

Disclosures
Robert A. bonomo, MD, Entasis, Merck, VenatoRx, Wockhardt: Grant/Research Support
1869. Knowledge about and Perceptions of Latent Tuberculosis Infection (LTBI) among Physicians and Advanced Practice Providers at Tufts Medical Center
Authors: Boomsma Cassidy , Vindenes Tine 
Published: November 2023

Abstract

Background
Mycobacterium Tuberculosis (TB) is a leading cause of infectious disease mortality worldwide. Most active TB cases result from reactivation of latent tuberculosis infection (LTBI). A large reservoir of latent TB is a major public health problem worldwide and in the United States. A better understanding of provider perspectives on LTBI could improve a sub-optimal LTBI care cascade.

Methods
A 13-question survey was fielded to attending physicians, fellows, and advanced practice providers working in the infectious disease, pulmonary/critical care, and general medicine departments at Tufts Medical Center (TMC), an academic tertiary care center in Boston, Massachusetts.

Results
The response rate of the survey was 33% (62/186). Only 17 (30.9%) providers were able to correctly identify all indications for screening. When asked how they decide who to treat, 26.8% (15/56) of providers selected that they would refer their patient to another specialist. Overall, provider confidence in LTBI management decreased along the care cascade (Figure 1). Infectious disease providers expressed more confidence in management than general medicine and pulmonary/critical care providers. The two most observed issues/barriers to care for patients were language, reported by 39 (76.5%) providers, and lack of knowledge or understanding about TB, reported by 39 (76.5%) providers. The two most selected interventions to improve LTBI care at TMC were use of in-person language interpreters, chosen by 37 (71.2%) providers, and information pamphlets available in patients’ preferred languages, chosen by 36 (69.2%) providers.
Providers were asked “On a scale of 1-5, (“1” = not at all, and “5” = perfectly) “How confident are you in your ability to do the following” for the listed management tasks.

Conclusion
Results suggest that providers believe the largest barriers to patient LTBI treatment completion are due to a lack of patient comprehension about their infection. Improving patient understanding could be accomplished through in-person interpreters, information pamphlets about LTBI in patients’ preferred languages, and forming community partnerships to improve awareness and understanding of the risks of LTBI. Additionally, ensuring that providers feel confident in their ability to manage LTBI, are updated on screening guidelines, and have referral resources when needed, could help close the gaps in the LTBI care cascade.

Disclosures
All Authors: No reported disclosures
1882. Contact Investigation of Congenital Tuberculosis in a Neonatal Intensive Care Unit in South Korea
Authors: Lee Sojeong , Namgung Songhee , Jo Eunbyeol , Yun Mina , Kim Ja Young , Lee Yumi , Jeong Jihye , Kim Sun Kyung , Park So-Yeon , Lim Young-Ju , Kim Eun Ok , Jung Jiwon , Lee Jina , Lee Byong Sop , Kim Sung-Han 
Published: November 2023

Abstract

Background
Congenital tuberculosis (TB) is uncommon and difficult to detect in neonates due to its nonspecific symptoms. We conducted a contact investigation of infants and healthcare workers (HCWs) exposed to a neonate with congenital TB in a neonatal ICU (NICU) in Korea.

Methods
A premature infant born was admitted to NICU on September 16, 2022. On October 24, the infant's mother was diagnosed with miliary TB, and infant’s sputum AFB stain showed 4 positive results. All NICU infants and HCWs during the same period were screened for active pulmonary TB using chest radiography (CXR) immediately. Exposed infants were evaluated with a TST and CXR three months after exposure. Interferon-Gamma Release Assay (IGRA) testing was performed on those with a positive TST or abnormal CXR finding. Prophylactic rifampin was provided to the exposed infants for 3 months, as index had isoniazid-resistant M. tuberculosis infection. Exposed HCWs underwent IGRA testing immediately after exposure (1st IGRA) and at 8 to 10 weeks post-exposure (2nd IGRA), and CXR was performed 6 months after exposure.

Results
Five out of 82 exposed infants had positive TST (≥ 10 mm) results, while all 31 infants who underwent IGRA testing had negative results. All five with positive TST had received BCG vaccination a median 105 days before. Of the 119 exposed HCWs, three had a conversion; two had negative results (on annual IGRA testing performed according to the national TB prevention Act) before exposure and positive at 1st IGRA test, and one had negative 1st IGRA test then positive 2nd IGRA test. None had active TB during 6-month follow-up.

Conclusion
We found that 6% of exposed infants had positive TST results and 0% had positive IGRA, while 2.5% of exposed HCWs had conversion. Considering the possibility of false positive TST results due to prior BCG vaccination, the chance of transmission to the infants would be 0%; otherwise, it would be 6.1%.

Disclosures
All Authors: No reported disclosures
1888. The Impact of COVID-19 on Adherence to Directly Observed Therapy Among a Tuberculosis Treatment Cohort
Authors: Overbeck Victoria , Malatesta Samantha , Carney Tara , Myers Bronwyn , Parry Charles , Horsburgh C Robert , Theron Daniel , White Laura F , Warren Robin , Jacobson Karen R , Bouton Tara C 
Published: November 2023

Abstract

Background
The COVID-19 pandemic negatively impacted all levels of tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared the rate of adherence to DOT before and during the pandemic among observational research study participants on drug-susceptible (DS)-TB therapy in Worcester, South Africa.

Methods
We analyzed adherence data from 263 study participants who participated in DOT for the duration of their DS-TB treatment. Participants enrolled between May 16, 2017, to September 27, 2019, and October 16, 2020, to March 4, 2022, were classified as pre- and post-COVID lockdown groups respectively. Adherence to DOT was used as a proxy for treatment adherence and defined as the number of successful DOT encounter days. Negative binomial regression models were used to compare the rate of non-adherence to DOT between the two groups. A sensitivity analysis was conducted that excluded participants in the post-COVID lockdown group enrolled after May 30, 2021, when South Africa increased their COVID-19 related restrictions in response to a third COVID wave (Figure 1).

Results
The overall median rate of DOT adherence across both groups was 87.1% (IQR: 75.47%, 92.64%). The adjusted rate of non-adherence to DOT was higher in the post-COVID lockdown group (aIRR = 1.42, 95% CI = 1.04 – 1.96, p = 0.028) compared to the pre-COVID lockdown group, after adjusting for age, sex, employment status, household hunger, depression risk, and smoked illicit drug use. The rate of non-adherence to DOT was even greater in the post-COVID group (aIRR = 1.74, 95% CI = 1.17–2.67; p=0.006) when participants enrolled after May 30, 2021, were excluded from the analysis (Figure 2).
Solid lines are weighted least squares regression line with local fitting and 95% confidence intervals, implemented with R function geom_smooth.
Solid lines are weighted least squares regression line with local fitting and 95% confidence intervals, implemented with R function geom_smooth. Rectangle represents period that study enrollment was paused due to COVID-19 restrictions (March 26, 2020 – September 20, 2020).

Conclusion
The COVID-19 pandemic had significant adverse effects on participants’ adherence to a TB DOT programs in this setting. The change in DOT adherence persisted even after adjusting for measurable socioeconomic and behavioral variables and was most notable immediately following the first wave of COVID-19 infections. Further work is needed to understand barriers to treatment adherence that were exacerbated by the COVID-19 pandemic itself and lockdowns in order to identify individuals needing additional supports and ways to improve systems even during non-pandemic times.

Disclosures
All Authors: No reported disclosures
2938. Hepatitis C Virus Care Continuum in the Direct-acting Antiviral Era within the US Veterans Health Administration
Authors: Varley Cara D , Lowy Elliott , Cartwright Emily J , Morgan Timothy R , Rozenberg-Ben-Dror Karine , Beste Lauren , Maier Marissa 
Published: November 2023

Abstract

Background
Estimated hepatitis C prevalence within the Veterans Health Administration is higher than the general population and is a risk factor for advanced liver disease and its associated complications. We describe the hepatitis C care continuum within the Veterans Health Administration between January 1, 2014 and December 31, 2022.

Methods
Individuals in Veterans Health Administration care 2021-2022 who were eligible for direct-acting antiviral treatment between January 1, 2014 and December 31, 2022 comprised our cohort. We evaluated the proportion of Veterans who progressed through each step of the hepatitis C care continuum, and identified factors associated with initiating direct-acting antivirals, achieving sustained virologic response, and repeat hepatitis C viremia after achieving sustained virologic response.

Results
We identified 133,732 Veterans with hepatitis C viremia during our study timeframe. Hepatitis C treatment was initiated in 107,134 (80.1%), with sustained virologic response achieved in 98,136 (91.6%). In those who achieved sustained virologic response, 1,097 (1.1%) had subsequent repeat viremia and 579 (52.8%) were retreated for hepatitis C. Veterans of younger ages were less likely to initiate treatment and achieve sustained virologic response, and more likely to have repeat viremia. Stimulant use and unstable housing were negatively associated with each step of the hepatitis C care continuum.Table 1:Characteristics of Veterans with HCV ViremiaTable 2:Factors Associated with DAA Treatment Initiation in those with HCV ViremiaFigure 1:Overview of the VHA Hepatitis C Care Continuum as of December 31, 2022

Conclusion
The Veterans Health Administration has treated 80% of Veterans with hepatitis C with direct-acting antiviral therapy since its approval in 2014 and achieved sustained virologic response in more than 90% of those treated. Repeat viremia is rare and is associated with younger age, unstable housing, opioid use, and stimulant use. Ongoing efforts are needed to reach younger Veterans, and Veterans with unstable housing or substance use disorders.

Disclosures
All Authors: No reported disclosures