bluuebunny/crossref_metadata_2025_split huggingface dataset:
1563. Incidence of Errors in an INSTI-Based Era: A Comparison of Error Rates Between Single Versus Multiple Tablet INSTI-Based Regimens in the Inpatient Setting
Authors: Blackmon Kayla , Kelley Denise , Rose Dusten T T , Nguyen Brian L 
Published: November 2023

Abstract

Background
Errors related to antiretroviral therapy (ART) occur in up to 86% of hospitalized patients living with human immunodeficiency virus (HIV) and may contribute to treatment failure, increased drug resistance, adverse effects, and toxicity. ART can be administered as a single tablet regimen (STR) or multiple tablet regimen (MTR), with limited data on whether the number of tablets affects inpatient error rates. The purpose of this study is to evaluate the incidence of medication errors in adult patients admitted to an Ascension Seton hospital who are maintained on a bictegravir-based STR or a MTR with dolutegravir.

Methods
This is a multicenter, retrospective, observational study conducted in patients ≥18 years diagnosed with HIV and admitted to an Ascension Seton hospital between January 1, 2017 through September 1, 2022. Patients receiving the STR bictegravir-emtricitabine-tenofovir alafenamide fumarate or provided a dolutegravir(DTG)-based MTR (in place of the patient’s home DTG-based STR) while admitted will be included. DTG-based MTRs including lamivudine, or abacavir and lamivudine will be evaluated. The primary outcome is a composite ART-related error rate between groups. Statistical analysis of the primary outcome was evaluated using a chi-squared test with an α level of 0.05 for significance. Secondary outcomes include: each error type overall and between the two groups; time to error correction, defined as time between error occurrence and resolution of identified ART-related errors; and an acquisition cost-analysis of anticipated differences between dispensing DTG-based regimens as MTR versus commercially available STR.

Results
Overall, 726 patient encounters were screened and 514 patient encounters were included (257 encounters in each arm). Patients included in the study were 79.4% male and 48 years of age on average. The primary outcome occurred in 59/257 (23%) encounters in the STR bictegravir group compared to 81/257 (31.5%) encounters in the MTR dolutegravir group (p = 0.029). A total of 68 and 99 errors were identified in the bictegravir and dolutegravir groups, respectively.

Conclusion
Composite error occurrence was significantly higher in the MTR dolutegravir group compared to the STR bictegravir group.

Disclosures
All Authors: No reported disclosures
2071. Strongyloides stercoralis Testing in a Hospital in Bronx, NYC; A 3-year Experience
Authors: Vargas-Pena Coral N , Alyssa Policarpio Maria , Chan Bailey , Kladias Michael , Coyle Christina 
Published: November 2023

Abstract

Background
Once a parasitic infection limited to tropical/subtropical regions, as international travel and immigration continues to rise, Strongyloidiasis is now a disease also prevalent in non-endemic regions, including the United States. Its disease spectrum spans from an asymptomatic infection to a hyper-infection syndrome, predominantly in patients with HTLV-1 and/or on steroids, where it can be deadly if not recognized early.

Methods
Retrospective descriptive study describing patients who tested positive for Strongyloides stercoralis between 2019-2023 at Jacobi Medical Center, a safety net hospital in Bronx, NYC. Patients were diagnosed with a serum recombinant immunodiagnostic antigen from S. stercoralis-specific larvae.

Results
108 patients were included; the mean age was 53.7+/-16 years, 63% were male. The most common place of birth was Latin America, Caribbean, Mexico in descending order. Prolonged steroid use (more than 1 week) reported by 7.4% and 8.3% had been exposed to chemotherapy/cytotoxic drugs. 92.5% of individuals were asymptomatic. Reason for testing was eosinophilia in 56.5% and migrant screening in 36.1%. The remaining (8%) patients were tested for diarrhea, urticaria and abdominal pain. Infectious diseases performed 76% of testing while primary care tested 15%. Mean time from immigration was 19.9 years. Stool testing was performed in 60 patients; larvae were seen 21.7% of these. Eosinophilia (abs &gt;500/uL) was found in 70.4% of cases. Of the 29.6% w/o eosinophilia, 64.6 % of individuals reported an outdoor toilet. Ivermectin was given to 98% of cases.

Conclusion
Most cases were asymptomatic and identified on screening. Eosinophilia was seen in 2/3 of cases of strongyloidiasis, but 1/3 did not have eosinophilia. Larvae were reported in 21% of patients who had a stool for O/P underscoring the importance of establishing this diagnosis with serology. In patients without eosinophilia, strongyloidiasis should be considered if living conditions in country of birth put them at risk. As expected, patients had been in the US for many years prior to testing and only 15% of patients were screened by primary care. Increased awareness of the disease must be encouraged, especially amongst primary care physicians.

Disclosures
All Authors: No reported disclosures
1582. Dolutegravir/Rilpivirine STR Switch Study in Persons with HIV-1 and Chronic Kidney Disease: 48-week Assessment of Viral Suppression, Treatment Adherence and Quality of Life
Authors: Kwakwa Helena , Stokes Tawanaha , Gebreselassie Millen , Maslankowski Lisa , Chernak Esther 
Published: November 2023

Abstract

Background
Single tablet regimens (STRs) are widely utilized in HIV treatment in the Western world largely because they improve convenience of oral regimens and eliminate differential adherence. US Blacks are disproportionately impacted by HIV, and are also disproportionately affected by chronic kidney disease (CKD) for a variety of reasons, especially in their later years. For PWH and CKD, STR options are limited due to pharmacokinetic considerations. We evaluate the impact on viral suppression, adherence, treatment satisfaction and quality of life (QOL) of switching to DTG/RPV STR for a largely Black aging US cohort with HIV and CKD.

Methods
In this 48-week open label single arm switch study conducted in a community health center setting, adults with HIV, a GFR&lt; 60 mL/min/1.73m2, an HIV RNA &lt; 50 copies/mL and no known prior resistance to DTG or RPV were switched to DTG/RPV STR. HIV RNA and CD4 were monitored per standard national clinical guidance following switch. Standardized tools for medication adherence, treatment satisfaction and QOL were administered at baseline, 24 weeks and 48 weeks. We present final 48-week data.

Results
Between August 2019 and December 2021, 35 participants were enrolled. One dropped out after 19 weeks and one after 22 weeks due to drug-drug interaction concerns following renal transplantation. 94% of participants were Black, 57% were female and 43% were 65 years and older. At baseline, 20% had a GFR &lt; 30 mL/min/1.73m2 per race-based calculation (36% per race-free calculation). At 48 weeks, 97% of participants maintained viral suppression with an HIV RNA &lt; 50 copies/mL in a per protocol analysis (91% in an intent-to-treat analysis). One participant with an HIV RNA of 62 copies/mL at 48 weeks subsequently re-suppressed on DTG/RPV. 69% reported an improvement in adherence, 77% noted an improvement in treatment satisfaction and 66% reported an improvement in QOL. The only adverse event reported in &gt;5% of participants was nausea (5.7%). There were no serious adverse events.

Conclusion
For this diverse aging cohort with HIV and CKD in a real-life community health center setting, DTG/RPV STR was efficacious, well-tolerated and associated with improvements in adherence, treatment satisfaction and QOL, sustained over 48 weeks. DTG/RPV is a feasible oral ARV option for PWH and CKD.

Disclosures
Helena Kwakwa, MD, MPH, ViiV Healthcare: Grant/Research Support
1584. Retrospective Study Comparing the Rate of HIV Blips With Combined Antiretroviral Therapy
Authors: Makhoul Jennifer , Uppal Surabhi , Barnes Anne A , Werner Logan A , Simon Gary , Siegel Marc O 
Published: November 2023

Abstract

Background
With the advancement of combined antiretroviral therapy (ART), control of viral replication has improved so that most patients living with HIV (PWH) can maintain undetectable viral. However, HIV blips (defined as non-sustained detectable low-level viremia) are still commonly encountered in practice. Although these generally do not indicate treatment failure or ART resistance, their clinical significance remains a topic of debate. The aim of our study is to compare the rate of blips in patients on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), rilpivirine/emtricitabine/tenofovir (RPV/FTC/TAF) or dolutegravir/abacavir/lamivudine (DOL/ABC/3TC).

Methods
We analyzed HIV viral load (VL) data of PWH who were treated in our clinic with either BIC/FTC/TAF, RPV/FTC/TAF or DOL/ABC/3TC between 3/2017 and 10/2021 for blips. We defined low level blips as HIV VL of 51-200 copies/mL and high-level blips of201-1000 copies/mL. The incidence of blips between these regimens was examined using Chi squared test.

Results
A total of 324 patients were included; 138 patients on BIC/FTC/TAF, 91 patients on RPV/FTC/TAF, and 95 patients on DOL/ABC/3TC). Patients on DOL/ABC/3TC were over twice as likely to have a viral blip (36%) compared to both BIC/FTC/TAF (16%, p=.0003) and RPV/FTC/TAF (14%, p=.0004). There were no statistically significant differences between patients taking BIC/FTC/TAF or RPV/FTC/TAF. Although the DOL/ABC/3TC group had a higher rate of high-level blips (6.3%) compared to BIC/FTC/TAF (3.6%) and RPV/FTC/TAF (4.4%), the total number of patients with high blips was low (n=15) and the differences were not statistically significant. Patients on DOL/ABC/3TC had average of 8 HIV VLs checked over the study period compared to 5 for patient on RPV/FTC/TAF and 3 for patient on BIC/FTC/TAF.

Conclusion
Our data suggests that PWH on DOL/ABC/3TC have higher rates of blips compared to PWH on BIC/FTC/TAF or RPV/FTC/TAF. Additional studies are needed to determine if this might be due to the lack of tenofovir alafenamide in the DOL/ABC/3TC or due to increased HIV VL testing in this population.

Disclosures
All Authors: No reported disclosures
1585. The Annual Cost per Newly Virally-Suppressed Person with HIV in Those Starting Long-Acting Injectable Antiretroviral Therapy with Detectable Viremia in a Safety-Net Clinic in San Francisco
Authors: Marseille Elliot , Walker Ryan , Oskarsson Jon , Grochowski Janet , Hickey Matt , Imbert Elizabeth V , Szumowski John , Koester Kimberly , Smith Mollie , Neilands Tor , Johnson Mallory , Sauceda John , Montgomery Elizabeth , McNulty Moira , Colasanti Jonathan , Christopoulos Katerina 
Published: November 2023

Abstract

Background
Long-acting injectable cabotegravir/rilpivirine (CAB/RPV-LA) holds promise to effectively treat people with HIV (PWH) who are unable to achieve or maintain viral suppression on oral antiretroviral therapy (ART).

Methods
We employed standard micro-costing techniques to identify the resources and associated annual costs to provide CAB/RPV-LA to those initiating it with detectable viremia at San Francisco General Hospital’s Ward 86 clinic, accounting for q4week vs. q8week injections. Through structured interviews with service providers and administrators, we elicited the time in minutes for each staff member to perform each task, using mid-points for ranges. Person-minutes were applied to the personnel compensation rate to derive the total personnel cost per person. One-time costs required for CAB/RPV-LA initiation were distributed over 29.3 years, the expected average duration of treatment. We used the Medi-Cal reimbursement rate for the cost of CAB/RPV-LA and a literature-based estimate of other medical care costs of treating people with viral suppression to derive the total variable cost of CAB/RPV-LA treatment from the payer’s perspective. This result was adjusted by the viral suppression success rate at Ward 86 (96.5%) to derive the cost per new virally-suppressed PWH. We deducted the cost of standard ART and medical care to derive the incremental cost per additional virally suppressed PWH. Costs were adjusted to 2022 dollars.

Results
The annual variable cost of providing CAB/RPV-LA was $36,511, $35,252 for CAB/RPV-LA medication and $1,259 for other variable costs, mainly personnel. Including other medical care costs yielded a total annual medical care cost of $43,945 per newly virally-suppressed person. Deducting the cost of standard care, $42,276, from this sum suggests an incremental annual variable cost for CAB/RPV-LA of $1,668 per newly virally-suppressed person. If the cost of CAB/RPV-LA were reduced slightly, e.g. to 90% of current cost, CAB/RPV-LA would generate net savings of $1,985.
Table 1
Annual Cost of Providing CAB/RPV-LA and Cost per Newly Suppressed Person with HIV

Conclusion
We found that the additional cost per newly-suppressed PWH was $1,668. CAB/RPV is likely to be highly cost-effective for this population. Modest reductions in CAB/RPV-LA price could render it cost-saving from a health care payer perspective.

Disclosures
Jonathan Colasanti, MD, MSPH, DKB MED LLC: Honoraria|Prime Education LLC: Advisor/Consultant Katerina Christopoulos, MD, MPH, Gilead Sciences: Advisor/Consultant
1621. "False-Positive" Cytomegalovirus (CMV) Screening Tests in Neonates: A Real Dilemma!
Authors: Lewald Zachery S , Crisan Rachelle , Pifer Traci , De Alba Romero Conception , Shimamura Masako , Mejias Asuncion , Medoro Alexandra Katherine , Salamon Doug P , Wang Huanyu , Leber Amy , Findlen Ursula M , Adunka Oliver , Malhotra M D S , Sanchez Pablo J 
Published: November 2023

Abstract

Background
PCR testing of clinical specimens has been associated with false-positive test results. Detection of CMV DNA by PCR in saliva and urine has been used to identify neonates with congenital CMV infection, but the frequency of false-positive PCR results is not fully known. Our objective is to describe the frequency of "false-positive" saliva and urine CMV PCR tests when performed as screening for congenital CMV infection.

Methods
From 2018 to 2023, neonates were screened for CMV infection if they had abnormal clinical, laboratory, or radiographic findings, referred on the newborn hearing screen, and since 2019, on admission to the 9 neonatal intensive care units (NICU) of the Nationwide Children’s Hospital neonatal network, Columbus, OH. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Infants who had an initial positive PCR screening test for CMV but subsequent negative PCR tests were identified.

Results
During the 6 year study period, 139 infants were diagnosed with congenital CMV infection. An additional 28 (17%) neonates tested positive for CMV DNA in saliva (n=26) or urine (n=2) but subsequent tests of urine specimens were negative for CMV. Most of the infants were tested as part of universal NICU screening (n=22), 5 had symptomatic disease, 3 referred on the newborn hearing screen, and 1 had thrombocytopenia. The infants were tested at a median (IQR) age of 3 (2-6) days. Their median (IQR) birth weight and gestational age were 2458 (1865-3360) grams and 37 (33-39) weeks, respectively. Four infants had their dried blood spot tested for CMV by PCR and were negative. 17 (77%) of 22 infants had known maternal milk exposure in the neonatal period.

Conclusion
Neonatal saliva and/or urine screening for congenital CMV infection was associated with a “false-positive” test result in 17% of neonates who tested positive for CMV DNA by PCR. These results suggest that confirmation of a diagnosis of congenital CMV infection by PCR requires testing of multiple specimens with one of them being urine.

Disclosures
Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant Alexandra Katherine Medoro, MD, Merck: Grant/Research Support Amy Leber, PhD, Biomeriux: Grant/Research Support|BioRad: Advisor/Consultant|Cephied: Grant/Research Support|Diasorin: Grant/Research Support
1625. Challenges in Addressing Congenital Syphilis in a Large Hospital System
Authors: Rodriguez Gilhen , Shrager Sebastian , Hernandez Stacy Gomez , Heresi Gloria , Thiviyanathan Asvini , Murphy James , Perez Norma 
Published: November 2023

Abstract

Background
Congenital Syphilis (CS) has increased markedly in the Houston-TX metropolitan region; the rate per 100,000 live births was 138.6 in 2018. Therefore, we reviewed CS exposures presented to our network of institutions to identify possible changes in practice having the potential to improve CS management.Table 1.RPR-Reactive Newborns of Mothers Receiving Prenatal Care.

Methods
Retrospective record review. From June 2015 through July 2022, 754 RPR+ at-delivery mothers were identified. A random sample of 25% was selected for an ongoing investigation. Eighty-seven mothers and their 89 newborns have had their medical records extracted and analyzed for the presented analysis. Prenatal care was defined as ≥ 3 visits to an obstetrics provider. Maternal treatment of syphilis was categorized as complete when the CDC criteria were met. The χ2 test was used, and significance was set to P ≤ 0.05. The institutional IRB approved the study.

Results
Notable characteristics of the 87 mothers were 68% African American, 81% not Hispanic, 79% single parents with median gestation of 3 (1-11) and age of 26 (±6).
Of the 89 newborns, 54% were female, 57% were full-term, and 51% were delivered by C-section. In addition, 53% were RPR-reactive at birth, and 57% were treated for CS.
Analyses targeting interventions doable within our institutional circumstances revealed that 36% of mothers who received prenatal care and delivered newborns who were RPR-reactive at birth had no record of receiving recommended treatment for syphilis, Table1.

Conclusion
Our population has a well-established pattern of risk factors for CS, including the use of illicit drugs. In addition, our medical record review identified a possible failure to provide or record treatment for syphilis for women who received prenatal care and delivered RPR-reactive infants. Therefore, an effort is being directed to improve these outcomes.

Disclosures
All Authors: No reported disclosures
1626. Group B Streptococcus detection rate and clindamycin resistance among reproductive-age women and early-onset sepsis in neonates in Korea from 2003 to 2022
Authors: Sung Ji-Hee , Kim Doo Ri , Choi Suk-Joo , Oh Soo-young , Kim Yae-Jean , Roh Cheong-Rae , Shin Areum 
Published: November 2023

Abstract

Background
Group B Streptococcus (GBS) is the leading cause of early-onset sepsis (EOS) in neonates and intrapartum penicillin prophylaxis is recommended for pregnant women with GBS colonization to prevent vertical transmission. For pregnant women with penicillin allergy, clindamycin is recommended. In this study, we retrospectively examined the GBS detection rate and clindamycin resistance rate among Korean women of reproductive age and EOS in neonates in the last 20 years from a single center.

Methods
From 2003 to 2022, microbiologic studies on genital/rectal swab pairs from females of reproductive age (15-49 years) were reviewed. Among the total number of tests, the number of GBS positive results were extracted and GBS detection rates per year were calculated. Multiple tests from the same person within a year were counted as once. Among the GBS isolates, the clindamycin resistance rate was calculated. The total study period was divided into two periods (period 1 for 2003-2012 and period 2 for 2013-2022) by 10 years and GBS detection rates and clindamycin resistance rates were compared (Chi-square test). EOS caused by GBS in neonates was investigated among all neonates who received sepsis work-up within 3 days after birth.

Results
For the past 20 years, a total of 14,571 women were tested 16,879 times and GBS was isolated in 1,054 tests (6.2%). GBS detection rate increased from 1.7% (101/6,066) in period 1 to 8.8% (953/10,813) in period 2 (p&lt; 0.001, OR 5.708, 95% CI 4.638-7.025). Among the GBS isolates, clindamycin resistance rates were 29.7% (30/101) in period 1 and 41.1% (392/953) in period 2 (p=0.026, OR 1.654, 95% CI 1.059-2.583).
In a separate database, among 9,280 neonates who underwent blood culture or CSF culture studies within 3 days after birth, 9 patients were diagnosed with EOS by GBS and 4 patients died within 30 days.

Conclusion
Close monitoring is needed on the epidemiology of increasing GBS detection rate and clindamycin resistance rate in GBS isolates from Korean women of reproductive age.

Disclosures
All Authors: No reported disclosures
2077. Utility of a Real-Time Spatiotemporal Mapping Surveillance System in Detection of Healthcare-Associated Acute Respiratory Viral Infection Clusters in a Tertiary Healthcare Institution
Authors: Venkatachalam Indumathi , Philip Edwin , XY Sim Jean , Chow Weien , Cai Yiying , Graves Nicholas , Whiteley Sean , Arora Shalvi , Auw Maybelle , Chuanwen Tiang Daniel , Leng Neo Siow , Meng Cheong Joseph Kin , Wei Hong Wei 
Published: November 2023

Abstract

Background
Transition to endemic COVID-19 has been associated with a rise in community respiratory viral infections (ARIs) with a corresponding increase in healthcare-associated ARIs (HA-ARIs) (Figure 1). 4D-Disease Outbreak Surveillance System (4D-DOSS) is a real-time spatiotemporal mapping surveillance system being developed to detect healthcare-associated infection clusters. We aimed to assess 4D-DOSS’s utility in detection of HA-ARI clusters.

Methods
4D-DOSS is a system that integrates and maps clinical, laboratory and patient movement data onto a digital twin of the hospital’s physical space. In addition to a virtual mapping replica of Singapore General Hospital, a 2000-bedded tertiary hospital in Singapore, it constitutes detailed healthcare cloud architecture and surveillance algorithms.
Respiratory specimens from inpatients with ARI symptoms are tested for 16 human respiratory viral pathogens via a respiratory virus multiplex PCR (RV16) panel. HA-ARI constitutes first positive sample beyond the maximum incubation period of the corresponding virus (from admission date). Earlier positive test is categorized as community-associated ARI (CA-ARI). Two or more patients with spatial temporal overlap of three-days or less, during the infectious period (7-days) of an index patient are deemed a HA-ARI cluster.

Results
Incidence of HA-ARI, as per 10,000 patient-days was 7.4 pre-COVID-19 pandemic (Jan 2018 to Dec 2019), 1.5 during pandemic (Jan 2020 to Dec 2022) and 6.4 during transition to endemicity (Jan 2023 – April 2023). Between September 2018 and December 2018, one influenza cluster of ten inpatients (Nov 2018) was identified in the proof-of-concept version of 4D-DOSS. There were four HA-ARI clusters during the Jan 2020-Dec 2022 COVID-19 pandemic phase. 19 HA-ARI clusters were identified between Jan 2023-April 2023.

Conclusion
4D-DOSS can detect HA-ARI clusters and has potential to trigger an alert-response process for more effective infection prevention. It enables study of infectious disease transmission kinetics in real-time.

Disclosures
Sean Whiteley, BSc (IT), Axomem: Board Member|Axomem: Fees received for service and software licenses Maybelle Auw, MBBS, Axomem: Work for company that received fees for service and licensing