bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-501. Concerns and Opinions of People Currently or Previously on Oral and Long-Acting Injectable Forms of HIV Preexposure Prophylaxis (PrEP)
Authors: Schaack Alice , Allamong Maxwell , Hung Frances , Barfield Richard , McKellar Mehri 
Published: January 2025

Abstract

Background
Long acting injectable (LAI) preexposure prophylaxis (PrEP) is an effective tool that has the potential to increase PrEP uptake and adherence. However, the majority of studies investigating interest and opinions surrounding LAI PrEP were theoretical, done prior to its approval. It is important to better understand peoples’ opinions about LAI PrEP as uptake increases.

Methods
We administered a cross-sectional electronic survey to clients at an urban PrEP clinic in the US South. Eligible participants were 18+ years and had previously taken or been prescribed oral or LAI forms of PrEP. Participants were recruited at clinic appointments or through a link sent via the electronic medical record. Participants were asked about their preferences and concerns about oral and LAI PrEP and barriers to access PrEP.

Results
Between January 10-April 5, 2024, 110 participants completed the survey: 73 during in-person appointments and 37 via online links. Of those, 22 were currently using LAI PrEP, 71 oral PrEP, and 17 were not currently on a form of PrEP. Participants were mostly men (89.1%), and mean age was 38 (range 17-78). 54.5% of respondents were White, 30% Black, and 14.5% Latinx. Most participants preferred an injection versus a daily pill (100% of people already on LAI, 46.5% of people on oral PrEP, and 58.8% of people not currently on PrEP). The most common concerns about PrEP for all groups were side effects, cost of medication, and cost of clinic visits and tests. Of people taking oral PrEP, 59.2% had not switched to injectable either because it was not offered to them, or they were not aware of it. The most common reasons for stopping PrEP amongst people not currently using either form were side effects and no longer needing PrEP.

Conclusion
LAI PrEP is desired by many, but not all, people who are currently or have previously taken PrEP. Common concerns about PrEP include side effects and cost of medication and/or clinic visits. People on oral PrEP are frequently not offered LAI or do not know it exists. These data demonstrate the importance of improving LAI PrEP accessibility and offering people choice between PrEP methods.

Disclosures
Mehri McKellar, MD, Gilead: Grant/Research Support
P-502. Incorporating Behavioral Economics to Educate Adolescents and Young Adults about HIV Pre-Exposure Prophylaxis
Authors: Guss Carly , Gluskin Brittany , Krakower Douglas , Wisk Lauren 
Published: January 2025

Abstract

Background
Despite disproportionately high rates of HIV diagnoses, knowledge about and interest in pre-exposure prophylaxis (PrEP) is low among adolescents and young adults (AYA) in the USA. AYA need PrEP educational strategies that are tailored to their developmental stage. We hypothesized that behavioral economics techniques could help optimize PrEP messaging.

Methods
The research team developed two brief social media-style educational videos on PrEP. Both videos reviewed the same facts, but one used gain-framed messaging (emphasized positive effects of using PrEP) while the other featured loss-framed messaging (emphasized negative consequences of non-use). Thirty AYA were shown the videos and interviewed about their overall impressions, opinions on facts presented, message framing preferences, and impact (e.g., what steps they might take after viewing). The deidentified interview transcripts were reviewed for emerging themes by two coders until consensus was reached.

Results
Interviews were held May – October 2023. Participants ranged in age from 15-25 years (mean 21.5 years, IQR 17-23.8 years) and identified as White (70.0%) or Black/African American (13.2%). Most (80.0%) identified as cisgender and 16.7% as transgender. A third (33.3%) had ever tested for HIV, none had an HIV diagnosis, and 36.7% did not feel that PrEP applied to them (i.e., viewed themselves as low risk for HIV). Thematic findings included: participants generally expressed positive views of PrEP, would like to see the video in a doctor’s office, and viewing the video would lead them to do their own research. Gain-framed messaging was preferred over the loss-framed video messaging, though some youth felt the videos were too similar. PrEP efficacy was the most important medical fact presented. Youths disliked advertisement-like or “staged” video elements and favored genuineness and relatability.

Conclusion
AYA preferred gain-framed over loss-frame PrEP messaging, and information on PrEP efficacy delivered by authentic messengers is likely to resonate. These findings offer novel insights into AYA perspectives around PrEP messaging for brief videos that could be disseminated through social media for PrEP education, which could help empower AYA to make informed decisions around PrEP as part of their sexual health.

Disclosures
Douglas Krakower, MD, FluidForm Bio: Stocks/Bonds (Private Company)|Gilead: Grant/Research Support|Matchbox Health: Stocks/Bonds (Private Company)|Medscape: Funding to develop educational content|Merck: Grant/Research Support
P-506. Improving HIV Pre-exposure Prophylaxis (PrEP) among Transgender Individuals
Authors: Wang Heather M , Biswas Ruchi , Daudelin Isaac , Czeresnia Jonathan M , Dalla-Piazza Michelle L , Reyes Raquel , Swaminathan Shobha , Finkel Diana 
Published: January 2025

Abstract

Background
Due to numerous structural factors, transgender (TG) individuals are disproportionately affected by HIV in the United States. Prioritizing PrEP for this population remains a priority. In 2020, only an estimated 3% of TG individuals were taking PrEP. However, one study showed that TG women who had access to gender-affirming care were more likely to discuss PrEP use with their healthcare provider. This study aims to evaluate PrEP prescription patterns among TG individuals seen in our integrated infectious disease and gender-affirming care practice.

Methods
We conducted a retrospective chart review for all patients who were prescribed PrEP from January 1st, 2022 to December 31st, 2023 at our institution. Data from 2017 to 2023 was collected to evaluate the frequency of PrEP prescriptions over time.

Results
Two hundred and five total individuals were prescribed PrEP in 2022-2023 at our institution. Of these, 125 (61.0%) patients identified as male, 33 (16.1%) as female, 42 (20.5%) as TG female, 6 (2.9%) as TG male, and 3 (1.5%) as nonbinary. Of the 48 TG patients, 19 (39.6%), 18 (37.5%), and 13 (27.1%) were Black, Latinx, or White, respectively. Out of 48 TG patients, 32 (66.7%) were new to PrEP at our institution compared to 98 (47.8%) of all patients prescribed PrEP (p&lt; 0.01). Thirty-four TG individuals (70.8%) remained on PrEP by the end of the study period, compared to 130/205 of all patients prescribed PrEP (63.4%; p=0.22). Linear regression indicated an increase in prescription rates in TG patients from 2017 to 2023 (R2 = 0.86).

Conclusion
At our institution, gender-affirming care integrated within an infectious disease practice led to higher levels of PrEP uptake and persistence for a marginalized TG patient population. Improving access to high-quality gender-affirming care is an essential component of HIV prevention programs with the goals of ending the HIV epidemic and ensuring equitable access to services.

Disclosures
Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant
P-508. Opportunities for Prep Prescription At Two Urban Academic Healthcare Institutions
Authors: Caputo Matthew , Ridgway Jessica , Mason Joseph A , Achenbach Chad , McNulty Moira 
Published: January 2025

Abstract

Background
Pre-exposure prophylaxis (PrEP) use for HIV prevention remains unequal across groups vulnerable to HIV. Reasons for inequalities include both individual and healthcare level factors. We sought to understand opportunities for prescribing PrEP at two urban academic healthcare institutions in Chicago, Illinois.

Methods
We analyzed electronic medical record data from both institutions including persons &gt;18 years of age with &gt;1 negative HIV test between 1/1/2015-12/31/2021 who had indications for PrEP. Data included demographics, social history, medications, sexually transmitted infections (STI), and encounters. Indications for PrEP included STI with gonorrhea, chlamydia, and/or active syphilis infection or injection drug use (IDU). Eligible encounters were those within six months after an STI, or as long as IDU was documented. We categorized encounters as inpatient, emergency department (ED), primary care, infectious disease (ID), obstetrics and gynecology/women’s health (OBGYN) and other outpatient settings.

Results
In total, 9644 persons contributed 53031 encounters that resulted in 941 people with PrEP prescriptions. The two healthcare institutions had differing patient demographics, institution A had more 18-24 year olds (58.3% vs 31.3%), more African Americans (83.8% vs 27.9%), and more women (65.7% vs 46.3%). Institution B had more White (40.6% vs 7.1%) and Hispanic persons (14.0% vs 4.2%), and more men who have sex with men (MSM) (15.2% vs 3.3%). Institution A had more eligible encounters in the ED (30.8% vs 7.3%) as well as in infectious disease, inpatient, OBYGN, and primary care settings. Institution B had more eligible encounters in other outpatient settings (67.7% vs 18.7%). Institution B accounted for the majority of PrEP prescriptions (89.1%).

Conclusion
Institution A contained persons historically underrepresented in PrEP prescriptions, while institution B had more encounters in other outpatient settings where ]PrEP prescriptions commonly occur. These factors are likely to be responsible for our findings. Future work will examine associations between these factors and the likelihood of PrEP prescriptions in a combined as well as institution specific models.

Disclosures
Jessica Ridgway, MD, Gilead Sciences: Expert Testimony Moira McNulty, MD, Gilead Sciences, Inc.: Advisor/Consultant
P-509. Impact of an Innovative Educational Initiative Using Community-Based Organization Partnerships to Reach Young Adults at Risk for HIV
Authors: Clement Meredith E , Molloy Leah , Simone Laura , Napolitan Chris , Carter Jeffrey D , Pillinger Kelly E 
Published: January 2025

Abstract

Background
Young adults (YA) are particularly vulnerable to acquiring HIV due to low self-perceived risk, low rates of HIV testing, and lack of knowledge/awareness about pre-exposure prophylaxis (PrEP).

Methods
Between 3/23 – 8/23, six education sessions for YAs were conducted in the Southeastern U.S. by local healthcare professionals (HCPs) along with community-based organizations (CBOs) in non-clinical settings (e.g. college campuses, breweries). Pre- and post-surveys were administered, with follow-up surveys 3 weeks later. A scale-up education toolkit was disseminated to HCPs nationwide.

Results
A total of 264 YAs participated in the education sessions (mean age: 24 years; 85% female; 54% Caucasian; 87% heterosexual) with 29% previously tested for HIV and 21% who previously discussed PrEP with a HCP. YA’s knowledge of different forms of PrEP improved significantly (38% pre- vs. 96% post-activity; p &lt; 0.001) as did their confidence in protecting themselves from acquiring HIV (55% pre vs. 93% post; p &lt; 0.001). In addition, awareness of local resources for HIV testing improved from 60% to 93% (p &lt; 0.001) with a significant increase in YAs who stated they were likely to get tested for HIV (26% pre vs. 63% post, p &lt; 0.001).
Seventy-five HCPs and CBO leaders also participated. Interestingly, there was a disconnect between CBO/HCPs’ perceptions of barriers to HIV/STI testing compared to YAs’ reported challenges (Fig 1). All providers stated they were likely/very likely to organize another session. A follow-up survey of HCPs (N = 10) found they helped 58 YAs access HIV testing and 33 access PrEP since the education, with 70% of HCPs using the materials during 1:1 counseling with YAs, suggesting sustainability of the resources.
HCPs (N = 867) who reviewed the toolkit had improvements in their confidence in differentiating between PrEP options and identifying who would benefit from each approach (p &lt; 0.001) and counseling YAs about PrEP (p &lt; 0.001).

Conclusion
Providing HIV prevention education to YAs in informal, community settings increases reach to those who may not have these discussions with their HCPs during regular visits. This type of educational initiative, which includes partnering with CBOs, is scalable and sustainable.

Disclosures
Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|Viiv Pharmaceuticals: Advisor/Consultant Kelly E. Pillinger, PharmD, AHFS: Contractor
P-517. Low Awareness but High Acceptability of HIV Post Exposure Prophylaxis (PEP) among Transpeople Receiving Telemedicine Gender Affirming Care across Rural, Suburban and Urban Areas in the United States
Authors: Aitcheson Nancy , O’Brien Caroline , Li Yun , Feng Yixuan , Kyweluk Moira , Momplaisir Florence , Dowshen Nadia 
Published: January 2025

Abstract

Background
Transgender people are disproportionately impacted by the HIV epidemic and face unique barriers in accessing HIV prevention services. Post-exposure prophylaxis (PEP), which requires surmounting these barriers within 72 hours of potential HIV exposure, is underused among transgender individuals. Little is known about barriers to using PEP in this population. This survey explored knowledge of and attitudes toward PEP among individuals engaged in gender affirming care (GAHC) via telemedicine.

Methods
We surveyed clients of a telemedicine gender affirming healthcare company in December 2023, using purposeful sampling to ensure representation of all genders, and across geographies. Participants were &gt;18 years old and currently accessing GAHC. Zip codes were classified by urban, suburban, and rural by modified Rural Urban Commuting Score. The online survey asked about knowledge, perceived barriers, and willingness to use PEP. Chi-squared tests were used for statistical comparisons.

Results
Of 387 respondents, 212 identified as transfeminine, 170 as transmasculine and 5 had unknown gender identifications. Participants were spread across geographies of rural (53), suburban (126) and urban (168). Zip codes were missing for 40 participants. 82.7% were white and 51.9% were between the ages of 18-25. 23.8% reported not knowing their HIV status. Awareness of PEP was low among all participants—26.6% had heard of PEP prior to the survey. However, the majority (66.2%) of participants were willing to take PEP if recommended and prescribed by their GAHC providers. Those in rural areas were more likely to be uninsured (37.7%) than those residing in suburban (28.8%) or urban (11.3%) areas (p&lt; 0.001).

Conclusion
Knowledge about PEP was limited among this population, but those seeking GAHC via telemedicine were willing to take PEP and have it prescribed by their GAHC providers. Given the relatively lower rates of insurance coverage, individuals residing in rural areas may experience greater barriers to accessing PEP. Integrating PEP into GAHC may be a strategy to increase timely access to this HIV prevention tool.

Disclosures
All Authors: No reported disclosures
P-518. High Acceptance of Integrating HIV Pre-Exposure Prophylaxis into Gender Affirming Care among Transpeople Receiving Telemedicine Gender Affirming Hormone Therapy across Rural, Suburban and Urban Areas in the United States
Authors: Aitcheson Nancy , O’Brien Caroline , Feng Yixuan , Li Yun , Kyweluk Moira , Momplaisir Florence , Dowshen Nadia 
Published: January 2025

Abstract

Background
Transgender people are disproportionately impacted by the HIV epidemic, experiencing heightened risk factors for seroconversion and barriers to HIV prevention, such as a dearth of gender-affirming medical providers and concerns about drug-drug interactions with existing hormone regimens. Recent literature indicates urban-residing transgender women with access to gender affirming care (GAHC) may have higher awareness and uptake of pre-exposure prophylaxis for HIV (PrEP). This project explores PrEP knowledge, experience, and acceptability among individuals accessing GAHC via telemedicine in urban and rural settings.

Methods
We surveyed clients of a telemedicine gender affirming healthcare company in December 2023, using purposeful sampling to ensure representation of all genders, and across geographies. Participants were &gt;18 years old and currently accessing GAHC. Zip codes were classified by urban, suburban, and rural by modified Rural Urban Commuting Score. The online survey asked about knowledge, perceived barriers, and willingness to use PrEP. Chi-squared tests were used for statistical comparisons across geographical settings.

Results
Of 387 respondents, 212 identified as transfeminine, 170 as transmasculine and 5 had unknown gender identifications. Participants were spread across geographies of rural (53), suburban (126) and urban (168). Zip codes were missing for 40 participants. 83% were white and 51% were between the ages of 18-25. 24% reported not knowing their HIV status. Awareness of PrEP did not vary significantly across geographies, with 57% of rural, 56% of suburban, and 64% of urban residents reporting being aware of PrEP prior to the survey. Less than 3% had ever taken PrEP. Two-thirds (67%) of participants were willing to take PrEP if recommended and prescribed by their GAHC provider and did not differ across geographical settings.

Conclusion
Compared to recent literature, this survey of geographically diverse trans people engaged in GAHC demonstrated lower PrEP awareness and use of PrEP. However, there was consistent interest in PrEP if recommended and prescribed by a GAHC provider. Integrating HIV prevention into GAHC may be an effective avenue to reaching a vulnerable community.

Disclosures
All Authors: No reported disclosures
P-521. Assessing Infectious Disease Screening and Prevention Practices for Persons who Inject Drugs in a Large Midwestern Academic Medical Center
Authors: Bailey Rosemary C , Tischendorf Jessica S , Hollnagel Fauzia 
Published: January 2025

Abstract

Background
Persons who inject drugs (PWID) are at risk for infection, including HIV, hepatitis C virus (HCV), and sexually transmitted infections (STIs). Harm reduction counseling, HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and routine STI screening are recommended to prevent infectious complications among those with substance use disorder (SUD). Hospitalizations serve as an opportunity to provide these infection prevention and screening interventions which are often difficult to access in the ambulatory or community setting for patients with active SUD. We sought to describe the frequency of infectious disease screening and preventive counseling and interventions among PWID admitted to our hospital with a serious injection related infection (SIRI).

Methods
We conducted a retrospective chart review of PWID &gt; 18 years of age admitted to our large tertiary medical center in the Midwest with SIRIs in 2022. The conditions included were bacteremia, endocarditis, skin and soft tissue infection, epidural abscess, septic arthritis, osteomyelitis and other. We assessed the frequency of screening for HIV, hepatitis C, gonorrhea, chlamydia, and syphilis, and the frequency of harm reduction counseling and assessment for HIV-PrEP and PEP eligibility. We collected demographic information, discharge location and conditions, and whether infectious disease and addiction medicine were consulted. Descriptive analysis was performed.

Results
45 patients with SIRIs were admitted in 2022. Of the 45, 56% underwent HIV screening, 53% HCV screening, and 16% received gonorrhea, chlamydia, and syphilis screening during the index hospitalization. Harm reduction counseling was documented for 69% of patients and was almost exclusively documented by addiction medicine. There was no documentation of PrEP consideration despite 36 patients meeting eligibility and no PrEP or PEP was prescribed.

Conclusion
In our institution, there were suboptimal rates of infectious disease screening, harm reduction counseling, and HIV prevention interventions among PWID admitted with SIRI in 2022. The most marked gap in care is regarding consideration for HIV-PrEP. Further work will inform barriers and facilitators to optimizing these practices in the hospital setting.

Disclosures
Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support
P-526. A Low Cost, Low Technology Intervention for Hospitalized Patients Who Inject Drugs is Feasible for Increasing Evidence-Based Addiction Care but HIV PrEP Uptake Remains Limited
Authors: Bhadkamkar Tanvi , Gagnon Kelly , Parman Mariel , Ingram Kedarius , Figgat Marry , O’Rear Stephen , Bradford William , Asgari Sara , Eaton Ellen 
Published: January 2025

Abstract

Background
Approximately 14% of new HIV cases in Alabama are from injection drug use, and this does not include HIV transmission from substance use related behaviors such as transactional sex. Hospitalized patients who inject drugs (PWID) present an opportunity to provide addiction treatment and HIV pre-exposure prophylaxis (PrEP). The objective of this study is to assess the feasibility and acceptability of novel, low barrier interventions aimed at increasing uptake of medications for opioid use disorders (MOUD) and PrEP in PWID.

Methods
In this prospective study, 60 hospitalized PWID who were HIV negative and receiving care at UAB Hospital (from October 2022 to February 2024) were randomized in a two-by-two factorial design to 4 arms: a smartphrase summary of evidence-based care added in the medical record (n=15), an outpatient peer recovery coach intervention (n=15), both (n=15), or standard of care (n=15). Patients completed standardized surveys on substance use, HIV risk behaviors, and their preferences for MOUD and PrEP at baseline. Exit surveys were conducted by phone to assess utilization of addiction treatment, PrEP services, and peer coaching. Feasibility was primarily defined by the ability to recruit hospitalized PWID and retain them in the study to determine post-discharge clinical outcomes, but feasibility was also defined by appropriate use of smartphrase and access and engagement with the peer. We assessed preliminary effectiveness by including utilization of MOUD, PrEP, and the peer coach.

Results
In the groups who received the smartphrase with or without the peer (n=30), 70% had documentation of the smartphrase in their provider’s consult note, and 90% had a MOUD referenced in their treatment plan. In the groups who received a peer with or without the smartphrase (n=30), 100% were contacted, and 90% had MOUD referenced in treatment plan. However, PrEP was not provided on discharge for any patients in the study.

Conclusion
In this pilot study of two low barrier interventions for PWID, we found that both interventions are feasible and acceptable, but HIV prevention with PrEP is still lacking. Future directions are to expand the sample size to test if these interventions will increase MOUD and PrEP uptake in a Southern cohort of PWID.

Disclosures
All Authors: No reported disclosures