bluuebunny/crossref_metadata_2025_split huggingface dataset:
1803. Analysis of National Policies and Antimicrobial Resistance Burden: An Ecological Study of 114 Countries
Authors: Vargas Moises R , Ikuta Kevin 
Published: November 2023

Abstract

Background
The rise of antimicrobial resistance (AMR) is a top public health concern. The drivers of AMR are complex, with antimicrobial misuse, lack of coordinated policies and inter-country data cooperation playing key roles. The growing burden of AMR is not shared proportionally across countries and there’s marked heterogeneity of national-level policies to tackle AMR. Our aim was to evaluate whether stronger national policies correlate with reduced burden 3rd generation cephalosporin (3GC) resistant Escherichia coli utilizing two recently published estimates.

Methods
We used 2019 estimates of deaths and Disability Adjusted Life Years (DALYs) due to 3GC resistant E. coli published by Murray et al. We matched these estimates to the governance score produced by Patel et al, which analyzed National Action Plans (NAP) through a governance framework, assigning a “governance score” to countries based on 54 indicators across 3 domains (Table 1). We describe the relationship between the burden of 3GC resistant E. coli and governance score across six WHO regions: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific.

Results
A total of 114 countries with both governance score and 3GC resistant E. coli data available were included. A multivariate log-linear regression model adjusted for region showed a relative risk reduction in the mortality of 3GC resistant E. coli of 2.8% (CI 1% –4.6%; p-value 0.002) for every increase in point of governance score (Figure 1).
When looking at DALYs as a measure of AMR burden, using a multivariate log-linear regression model adjusted for regions, we find a relative risk reduction of 4.7% (CI 1.8% - 6.2%; P value &lt; 0.001) for every increase in point of governance score (Figure 2).

Conclusion
We show that countries with high governance scores had overall lower burden of 3GC resistant E. coli. Additional time series analysis as well as evaluating specific aspects of NAPs against AMR burden would be an important next step.

Disclosures
All Authors: No reported disclosures
1804. A Hospital System Utilization of EMR towards New Jersey’s Goal of Viral Hepatitis and HIV Elimination
Authors: Xu Binghong , Brogden Ruth P , Velez Aryana , Pillay Meenakumarie , Yango Jaymie , Patel Ammie J , Handler Eric , Crean Christopher , Ramnarine Mityanand , Trattner Lauren , O’Mahony Stephen , Wang Su H 
Published: November 2023

Abstract

Background
New Jersey plans to reduce 75% of new HIV infections and promote access to testing and linkage-to-care (LTC) to end the HIV epidemic by 2025. In the US, CDC 2020 hepatitis surveillance report indicated cases of hepatitis C in 2020 corresponded to a 124% increase from 2013. Globally, if the HBV effort remains unchanged, the annual deaths from HBV are projected to increase by 39% from 2015 to 2030. We implemented an electronic medical record (EMR) based screening algorithm to scale up HBV, HCV, and HIV screening and provide LTC.

Methods
In March 2018, the EMR was modified at Cooperman Barnabas Medical Center in the Emergency Department (ED) to start automated screening, we expanded the screening criteria to boost identifying the undiagnosed. Subsequently, the program expanded to Somerset Medical Center and Rahway Hospital. Patient Navigators receive a real-time alert of positive results to contact patients and arrange LTC, the multidisciplinary team offers evaluation and treatment.Figure 1.Expanding Automated Screening Program

Results
We found HIV prevalence in CBMC is 1.5%, close to 5 times the NJ statewide 397.2 per 100,000 population. HBV infection rates varied in three hospitals, representative of the diverse population in their service areas. The HBV patients we confirmed came from more than 170 countries with different insurance statuses, the majority are immigrants from endemic countries or with high-risk behaviors identified. From Aug 2022, new HbsAg + cases reflex to HDVAb test, where 5% resulted HDVAb+ and no HDVRNA+. HCV prevalence rates are more consistent among the three sites, however, the percentages of the birth cohort (1945-1965) are varied. LTC rates are higher in HBV patients than HCV, thus far, 41 patients were cured of HCV from our team.Figure 2.Total Numbers of HBV, HCV & HIV Tested, Prevalence & LTC

Conclusion
EMR automated screening significantly scales up the diagnosis of HBV, HCV and HIV, as well as identifying HIV at-risk patients to receive comprehensive preventative services. HBV, HCV and HIV share similar risks, LTC is crucial to treat current infections and is beneficial to prevent transmission and potential exposure. In summary, automated screening and LTC work robustly toward elimination.

Disclosures
All Authors: No reported disclosures
1807. Implications of Sewer Connectivity in the U.S. for Equity in Wastewater-Based Epidemiology
Authors: Yu QinQin , Olesen Scott , Duvallet Claire , Grad Yonatan H 
Published: November 2023

Abstract

Background
Wastewater-based epidemiology is a promising public health tool that can yield a more representative view of the population than case reporting. However, only about 80% of the U.S. population is connected to public sewers, and the characteristics of populations missed by wastewater-based epidemiology are unclear.

Methods
We used publicly available datasets to assess sewer connectivity in the U.S. by location, demographic groups, and economic groups. We used mathematical modeling to assess the impact of wastewater sampling inequities on inferences about epidemic trajectories at a local scale.

Results
Data from the U.S. Census’ American Housing Survey (AHS) revealed that sewer connectivity was lower than average for American Indian and Alaskan Native, White, non-Hispanic, older, non-poverty, and larger households. Data from the U.S. Census’ American Community Survey and Environmental Protection Agency (EPA) revealed geographical areas with low sewer connectivity, such as Alaska, the Navajo Nation, Minnesota, Michigan, Florida. In contrast to the AHS data, data from the EPA showed that sewer connectivity was correlated with income in Minnesota, Florida, and California. However, with the exception of the U.S. Census data, there were inconsistencies across datasets.
Using mathematical modeling, we found that even weak connections between communities may allow wastewater monitoring in one community to serve as a reliable proxy for an interacting community of similar population size with no wastewater monitoring when cases are widespread.

Conclusion
A systematic, rigorous assessment of variation in sewer connectivity will be important for ensuring an equitable and informed implementation of wastewater-based epidemiology as a public health monitoring system.

Disclosures
Scott Olesen, PhD, Biobot Analytics: Former employee Claire Duvallet, PhD, Biobot Analytics: Former employee|Biobot Analytics: Stocks/Bonds Yonatan H. Grad, MD, PhD, Day Zero Diagnostics: Board Member|GSK: Advisor/Consultant
1817. Skin and Soft Tissue Infection Incidence Before and During the COVID-19 Pandemic at A Large Safety Net Healthcare System
Authors: Merino Prudencio , Kupferwasser Deborah , Flores Evelyn A , Tran Donna Phan , Ortega Abisay , Miller Loren G 
Published: November 2023

Abstract

Background
Skin and Soft Tissue Infections (SSTIs) are one of the most common bacterial infections that drive persons to seek medical care. We hypothesized that during the COVID-19 pandemic, SSTI rates would significantly decrease due to Public Health directives to avoid unneeded care and due to attenuated risk behaviors, such as skin injury and person to person contact, that drive SSTIs.

Methods
We performed a health system wide retrospective study using databases from the Los Angeles Department of Health Services, the second largest U.S. safety net healthcare system which is composed of 4 major medical centers and 20 clinics and ambulatory care centers. We examined all patients who had ≥1 medical encounter (inpatient, Emergency Department [ED], outpatient, or observation) for an SSTI. SSTIs were identified using ICD-10 diagnosis code between March 16, 2017 and March 15, 2022. Pre-pandemic and intra-pandemic SSTI rates were compared using a student’s t-test.

Results
During the study period there was a mean of 426,995 empaneled of patients per month. In total there were 72,218 SSTIs, 36,167 in the outpatient setting, 21,035 in the ED, 1143 in the observation unit, and 13,433 in the inpatient setting. Intra-pandemic SSTI rate was significantly lower than pre-pandemic (2.3 cases/1000 empaneled patient-months versus 3.3 cases/1000 empaneled patient-months, p&lt; 0.0001). SSTI subgroups stratified by site of care all had significant SSTI decreases between the intra-pandemic and pre-pandemic time periods (inpatient (0.5 vs 0.6 empaneled patient-months), observation unit (0.05 vs 0.07), ED (0.6 vs 1.0), and outpatient clinics (1.2 vs 1.6), p&lt; 0.0001 for all comparisons, see Figure).
Skin and Soft Tissue Infection Rates Pre- and Intra- COVID-19 Pandemic

Conclusion
Compared to the pre-COVID-19 pandemic period, SSTI rates in our large U.S. safety net healthcare system significantly decreased by over 30% during the COVID-19 pandemic. Decreases occurred at all levels of care delivery. Whether the results of this study reflect a true reduction in SSTI incidence rates or a reduction in health system utilization for SSTIs requires further examination. Our data provide some insights as to expected changes in common bacterial infections during subsequent pandemics.

Disclosures
Loren G. Miller, MD MPH, ContraFect: Grant/Research Support|GSK: Grant/Research Support|Medline: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support
2894. PEP-in-Pocket (PIP): Long-Term Follow-Up of On Demand HIV Post-Exposure Prophylaxis
Authors: Billick Maxime J , Fisher Karla , Myers Samantha , Tan Darrell , Bogoch Isaac 
Published: November 2023

Abstract

Background
Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are well established methods of HIV prevention through the use of antiretroviral medications. However, the suitability of these tools for individuals with infrequent, higher-risk HIV exposures might be limited due to cost, high pill burden and/or barriers to care. PEP-in-pocket (PIP) involves prospectively identifying such individuals, proactively prescribing them 28 days of PEP medication, and providing instructions on when to self-initiate medications and how to follow up with care. We present long-term follow-up of a cohort of patients provided with PIP for HIV prevention.

Methods
We evaluated the clinical characteristics and outcomes of patients using PIP for HIV prevention. Patients referred for PrEP or PEP care were offered PIP if they reported a low frequency (0-4 per year) of higher-risk HIV exposures of any type. The HIV prevention method was chosen through shared decision-making between patients and clinicians and was outside the realm of this study. Patients were followed at regular 4-6 months intervals.

Results
We followed 112 patients prescribed PIP between the ages of 20-69 for a total of 183.8 patient-years. 108 (96%) patients were assigned male at birth. Thirty-five (31%) patients self-initiated a total of 69 courses of PIP during the observation period. Patients fluidly transitioned between HIV prevention modalities as circumstances warranted: 34 (31%) changed from PIP to PrEP, and 33 (30%) changed from PrEP to PIP. There were 18 episodes of bacterial sexually transmitted infections in 13 individuals (12%) using PIP. No HIV seroconversions were detected.

Conclusion
PIP is an innovative HIV prevention strategy for individuals with a lower frequency of higher-risk HIV exposures, and provides patients with autonomy and agency over their care. Patients may transition between PIP and PrEP based on evolving risk. PIP should be included with PEP and PrEP as a biomedical HIV prevention option for individuals at risk for infection.

Disclosures
Darrell Tan, MD PhD, Abbvie: Grant/Research Support|Gilead: Grant/Research Support|Glaxo Smith Kline: Grant/Research Support Isaac Bogoch, MD, MSc, BlueDot: Advisor/Consultant|NHL Players' Association: Advisor/Consultant
1823. Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from the First Year of the Pandemic
Authors: Allen Upton D , Barton Michelle , Upton Julia , Bailey Annette , Campigotto Aaron , Abdulnoor Mariana , Julien Jean-Philippe , Gubbay Jonathan , Kissoon Niranjan , Litosh Alice , Wong Peter , Allen Andrew , Bailey Renee , Byrne Walter , Hwang Matthew , Phillips Chantal , Polack Alicia , Prescod Cheryl , Thompson Kimberly , Thompson Sylvanus , Wisener Nicole , James Carl 
Published: November 2023

Abstract

Background
Black North American communities have been disproportionately affected by COVID-19. These data have been largely based on case counts, hospitalizations and mortality data. Serologic testing enables a more complete determination of infection burden by documenting infection in persons with symptomatic as well as asymptomatic infection. We used serologic testing to determine the extent to which SARS-CoV-2 had penetrated into the Black community. We examined risk factors associated with seropositivity, including the presence of medical comorbidities and the social determinants of health.

Methods
We conducted a cross-sectional survey in a COVID-19 high-prevalence zone in Ontario along with 2 areas that have lower rates of COVID-19 cases. SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study samples were collected between August 15, 2020, and December 15, 2020 prior to the deployment of COVID-19 vaccines. Proportions were compared using Fishers Exact test or chi-square; potential risk factors were examined using a multiple logistic regression approach.

Results
Among 387 evaluable subjects, the majority, 274 (70.8%) were enrolled from northwest Greater Toronto Area (GTA) and adjoining suburban areas of Peel, Ontario with a high proportion of Black residents. The seropositivity rates for the lower prevalence areas (Oakville and London, Ontario) were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). The seropositivity rate for the northwest GTA was 12.6% (26/206); RR 3.5, 95% CI 1.3-9.8). Persons under the age of 19 years had the highest seropositivity rate (10/50; 20.0%, 95% CI 10.3-33.7%). Front-line workers were greater than 3 times more likely to be seropositive compared with non-frontline workers (13.0 vs 3.2%; p=.01; RR 3.3 (95% CI 1.3 – 8.3). There was an interaction effect between race and location of residence as this relates to the relative risk of seropositivity.

Conclusion
During the pre-vaccine phase of the COVID-19 pandemic, the seropositivity rate for SARS-CoV-2 within a COVID-19 high-prevalence area was 3-fold greater than lower prevalence areas of Ontario, Canada. The data help to define the burden of COVID-19 within a community with a high proportion of Black residents compared with other communities.

Disclosures
All Authors: No reported disclosures
1825. Project ECHO HIV: Engaging Clinicians to Address Substance Abuse, Interpersonal Violence, and Depression in Patients with HIV
Authors: Beals Dean K , Pogroszewski Stan , Anderson Jean , Livingston Alison 
Published: November 2023

Abstract

Background
Finding the Invisible Patient (FIP): Substance abuse (SA), interpersonal violence (IPV), depression and HIV are part of overlapping epidemics adversely affect HIV and the burden of each (SAVA). The Johns Hopkins HIV Women's Clinic (JHWC) initiated screening for SAVA to better identify these problems, link to needed services and evaluate the impact. Challenges included time and impact on clinic flow; need for clinic wide training and sensitization and a systems approach. SAVA Project ECHO- FIP took the learnings from FIP and expanded it to ten small groups across the US in order to enhance the reach and share the learnings

Methods
FIP: Education and a series of clinic-wide changes were implemented at JHWC. Patients were now routinely screened for SAVA. and if positive sent for care. Resources were developed for patients including linkage to local assistance programs, temporary housing, posters on bathroom doors and emergency contacts. SAVA Project ECHO- FIP featured expert specialists to provide ongoing telementoring to clinicians through regularly scheduled educational sessions over five weeks. There were ten separate workshops, each covering a 5-part curriculum.

Results
FIP: Of 116 women 60% were + for SAVA. Six months post-intervention, 56% were engaged in care; 39% were given a referral for psych/SUD/IPA therapy; 50% entered psychologic therapy; 28% entered substance abuse treatment; 39% for mental health issues. SAVA Project ECHO- FIP trained 208 clinicians to become experts in screening, identifying and treating SAVA. There was a 105% increase in confidence on identifying and treating SAVA and a 177% improvement in competence. Clinicians shared insights around building relationships with their patients and utilizing local community-based programs to help patients overcome SAVA.

Conclusion
SAVA is common among many women in HIV care and is likely underestimated. There was a significant correlation with + screens and higher no show rates, reflecting increased resources needed to optimize VLS screening for components of SAVA. Screening for SAVA should be routine in HIV care settings. Resources for appropriate referral are critical. SAVA Project ECHO- FIP demonstrated knowledge transfer and practice improvement through its curriculum and small-group engagement.

Disclosures
Jean Anderson, MD, Merck & Co: Stocks/Bonds
1832. Rise in Deaths from Firearm Injury and Drug Overdose During COVID-19 Pandemic and its Impact on Organ Donation in the United States
Authors: Dhand Roshan , Dhand Abhay , Nishida Seigo , Okumura Kenji 
Published: November 2023

Abstract

Background
COVID-19 pandemic had profound societal impact in United States (US) with decrease in overall life expectancy and associated increase in polysubstance abuse.

Methods
Crude rates of population-based deaths among adults (18-75 years) from firearm injury and drug overdose were obtained from centers of disease control (CDC) WONDER database from period of 2011- 2021. Crude rates of underlying causes of donor (18-75 years) deaths from 2011- 2021 were obtained from United Network for Organ Sharing (UNOS) database. Trends of cause of death and impact of COVID-19 period on deaths from drug overdose and firearm injury were analyzed using joint point regression analysis. Correlation between population and organ-donor deaths was analyzed using spearman's rank correlation coefficient.

Results
Average annual percentage change (AAPC) in deaths among the US population from drug overdose was 9.5 % and from firearm injury was 3.4%, with the highest ever rates from both causes in the US seen in 2021 (figure 1).
AAPC in cause of death among donors of organs for transplantation was 10.9% from drug overdose and 2.1% from firearm injury (figure 2).
There was a significant progressive increase in deaths from drug overdose (1.48 fold) and firearm injury (1.2 fold) from 2019 to 2021 (P &lt; 0.01).
There was a significant correlation between population and organ-donor deaths from drug overdose and firearm injury during the COVID-19 period of 2020-2021 ( P &lt; 0.01).

rates per 100,000 population

rates per 100,000 population

Conclusion
COVID-19 pandemic has further exacerbated the trends in US population of deaths from drug overdose and firearm injury (including suicide and homicide). There was a consequent increase in organ donation for transplantation from donors who died from these two causes. Identifying socio-economic, regional and racial discrepancies associated with this rise can help guide public health policies for the immediate and long-term future. Unique risk factors, including increased infectious risk, associated with use of organs from these donors and subsequent long-term graft outcomes in the recipients will need to be monitored.

Disclosures
All Authors: No reported disclosures
1838. Determinants of Antimicrobial Resistance among ≤5-Year Children in Low-Income Urban Bangladesh
Authors: Harun Md Golam Dostogir , Sumon Shariful Amin , Abdullah Syed Abul Hassan Md , Islam Md Saiful , Anwar Mahabub Ul 
Published: November 2023

Abstract

Background
Antimicrobial resistance (AMR) is a growing global concern, with the most significant health and financial implications for low- and middle-income countries. Due to irrational and inappropriate use, AMR is rapidly increasing in Bangladesh, especially among low-income urban populations. This study explored the factors for antimicrobial resistance among ≤ 5 years children in low-income urban Bangladesh.

Methods
From February 2018 to April 2019, we did quantitative and qualitative assessments of antibiotic use among urban ≤5-year children. We conducted a cross-sectional survey among 626 low-income urban ≤5-year children's parents in four cities in Bangladesh. We used a semi-structured questionnaire to collect data related to antibiotic use through face-to-face interviews. We also conducted eight focus group discussions among the parents to gather in-depth information on antibiotic use to treat their children. Bivariate and multivariate analysis was done to see the causes and associated factors.

Results
The study identified that 62.9 % (394/626) of parents used antibiotics last year to treat their children. More than half (52.7%) of the parents bought antibiotics from local drug stores without a prescription. 46.5% (291/626) of the parents stopped antibiotics soon after the symptom disappeared, and 62.6% used leftover antibiotics for similar symptoms. However, 82.9% of parents opined that qualified physicians' advice is important to treat children with antibiotics. Inappropriate antibiotic use was significantly associated with participants' education (p=0.02), family income (p=0.01), and profession (p=0.04). Qualitative investigation revealed the convenience of getting treatment and medicine from the drug store, the financial burden to buy the full course, the distance and waiting time at qualified physicians, and parents' inadequate knowledge were identified as the key causes of irrational antibiotic use.
Pattern of Antibiotic Consumption among ≤5-Year Children in Low-Income Urban Bangladesh

Conclusion
Intervention packages are required to improve parents’ knowledge and awareness on the rational use of antibiotic. Strengthening the health system could enhance the optimum use of antibiotics and combat antibiotic resistance. Antibiotic dispensing, prescription, purchase, and selling policy required with enforcement of the policy to reduce AMR.

Disclosures
All Authors: No reported disclosures