bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-464. Implementation of Non-Mydriatic Fundus Imaging for HIV-Associated Meningitis Patients in Uganda
Authors: Yueh Spencer , Mugabi Timothy , Leon Kristoffer E , Tran Tu M , Meya David , Skipper Caleb 
Published: January 2025

Abstract

Background
Persons with HIV-associated meningitis are at increased risk of visual impairment. It is often unclear whether this is due to the underlying meningitis pathophysiology or whether a second etiology may be present, due to the difficulty in accessing expert exams in resource-limited settings. Our long-term goal is to determine retinal disease prevalence, particularly treatable infections (e.g. CMV retinitis), in those with HIV-associated meningitis. Here we present pilot feasibility data of non-mydriatic fundus imaging in a sick inpatient population in Uganda.Figure 1.Full FOV image of a healthy retina.Non-mydriatic photo of the left eye of a 31-year-old male admitted for cryptococcal meningitis.

Methods
We designed a prospective cohort pilot study of adult Ugandans with HIV-associated meningitis to determine the feasibility of portable digital fundoscopic photography in detecting retinal pathology. We trained medical officers to use the Phelcom Eyer Fundus Camera, which obtains high quality non-mydriatic images of the fundus. We categorized image quality into three groups: full field-of-view (FOV), partial FOV and interpretable, or uninterpretable photographs with minimal FOV. We determined: 1) the proportion of eyes in which an adequate image is obtained and 2) the prevalence of any retinal pathology in this population.Figure 2.Partial FOV image of CMV retinitis.Non-mydriatic photo of the left eye of a 36-year-old female admitted for cryptococcal meningitis. The fundus has a "cheese and ketchup" appearance, a classic finding in CMV retinitis. (Full case description will be included with the poster)

Results
From 2/15/23 to 5/2/24, we captured retinal images of 245 patients and 475 eyes (15 patients had only one eye imaged), who were hospitalized for HIV-associated meningitis. We obtained a full FOV image (Figure 1) in 62% (296/475) of photographed eyes, while 31% (148/475) of eyes had a partial FOV, and 7% (31/475) of eyes had uninterpretable photographs. Of the 245 patients screened, 75 (31%) showed any retinal pathology. Figure 2 demonstrates a case where non-mydriatic fundus imaging was used to capture and diagnose a reversible case of CMV retinitis.

Conclusion
We demonstrated that the portable Phelcom Eyer camera can successfully generate fundus images to identify retinal pathologies in our patient population. Our team captured interpretable images in 93% of eyes despite the confusion or neurological deficits often present in this sick population. These results demonstrate the necessity of screening for retinal pathology in this population, and that mobile non-mydriatic fundoscopic imaging is a promising solution in resource-limited settings.

Disclosures
All Authors: No reported disclosures
P-485. Enhancing Adolescent Human Immunodeficiency Virus (HIV) Screening : A Quality Improvement Approach with Point-of-Care Testing
Authors: Abutouk Mona , Pina Gabrielle , Davidge Rachel 
Published: January 2025

Abstract

Background
Pediatricians play a key role in preventing Human Immunodeficiency Virus (HIV) by offering routine HIV testing. While there has been great progress in treatment for patients with HIV/AIDS, many adolescents still believe they are not at risk for HIV and have never been tested. Recent studies have shown that almost half of adolescents who have HIV are undiagnosed. A key barrier to screening adolescents for HIV during clinic well child visits includes patient follow through with HIV screening lab work. Traditionally, this requires a visit to the lab, serum draw, followed by waiting hours to days for a result. We sought to eliminate this barrier by implementing a point of care (POC) HIV oral swab during adolescent well child visits with anticipation of increasing overall HIV screening rates.
Plan Do-Study-Act Cycle
Multiple PDSA cycles were implemented throughout the project to ensure continued improvement and integration of HIV screening during clinic visits. This was the an example of the main overarching PDSA cycle driving quality improvement.

Methods
Adolescents ages 15-18 presenting for well-child check who had not yet tested for HIV were eligible.
Interventions included creating educational curriculum for physicians regarding HIV screening guidelines, generating mulit-lingual resources for families about the importance of HIV screening, and utilizing a multidisciplinary team to implement testing into clinic workflow.
The primary outcome measure was the monthly percentage of adolescents ages 15-18 who were screened for HIV via the POC swab during their WCC.
Multiple “Plan-Do-Study-Act cycles” were implemented to reinforce change.
Proportion of Adolescents tested for HIV
Red arrow indicated when POC HIV swabs became available for use in clinic

Results
We found a statistically significant difference between the proportion of patients screened for HIV before and after the availability of POC HIV swab with p&lt; 0.001.
Prior to implementation, the year-to-date percentage of those screened among eligible patients from January 2023 to July 2023 was 29% (80/276). Within eight months of implementation of the HIV POC swab from August 2023 to March 2024 the percentage of adolescents screened increased to 47 % (155/331).

Conclusion
Improving HIV screening among adolescents is feasible and effective through the use of point of care rapid antibody testing. This type of testing is painless, can be quickly performed during clinic visits, and improves patient confidentiality as results are available at time of visit instead of traditionally waiting for the results by phone or email. Medicaid covers POC testing for HIV so this form of testing could be used in many clinics.

Disclosures
All Authors: No reported disclosures
P-490. Differentiation of Latent Versus Active HIV Infection at the Single Cell Level Using RT-ddPCR
Authors: Pernet Olivier , Wu Qinlan , anthony Patricia , McCaney Gwyndolyn , Kovacs Andrea 
Published: January 2025

Abstract

Background
With successful treatment of HIV, viral loads can drop to levels undetectable by regular qPCR diagnostic methods. However, the virus remains latent in cellular reservoirs . These reservoir cells are rare, and their quantification is a critical parameter to assess future HIV treatments. Digital PCR (dPCR) technology bypasses the limitation inherent to regular qPCR, and can quantify to some extent cells with latent HIV infection within a cell population.

Methods
Here we describe a protocol relying on dPCR that allows differentiation between active and latent infection at the single cell level. We used a digital droplet setting (ddPCR) that allows for reverse transcription (RT) within the droplet. The assay is multiplexed to detect both HIV proviral DNA as well as spliced mRNA indicative of HIV active replication. Briefly, single cell are isolated into droplet containing RT-ddPCR reaction, including the Bio-Rad Supermix One-Step RT ddPCR Advanced Kit and primers/probe sets targeting HIV genome gag in the FAMlow channel and the spliced 2kb class mRNA in the FAMhigh channel. After the RT-PCR reaction, the droplet fluorescence intensity was measured using a Bio-Rad Q200 droplet reader.

Results
We successfully evaluated HIV activation in cells lines with (8E5) or without HIV (CEM-T4) infection, as well as volunteer Peripheral Blood Mononuclear Cells (PBMC). We first determine the fluorescence bandwith for each target using DNA/RNA purified from cell lysate, identifying the HIV genomic DNA signal (FAMlow) between 2500 and 3500 MFI and the active replication signal (FAMhigh) between 4000 and 5000 MFI. We then repeated the RT-ddPCR reaction, this time using cells isolated in an excess of droplets (2000 cells for 15,000 droplet per reaction).

Conclusion
This
Single Cell RT-ddPCR protocol allows for identification and quantification of HIV infected cells and assess their individual level of activation/latency. In the future, the multiplexing approach could be used to not only assess HIV activation, but also to identify cellular transcripts specific to latency or active replication.

Disclosures
All Authors: No reported disclosures
P-493. Decreasing Depressive Symptoms among Adults Living with HIV - United States Medical Monitoring Project (MMP), 2015-2022
Authors: O’Connor Siobhan M , Weiser John , Yuan Xin , Kuo Yishiow , Beer Linda 
Published: January 2025

Abstract

Background
People with HIV (PWH) have higher rates of depression than people without HIV. We assessed trends in prevalence of depression among PWH in the United States (U.S.).

Methods
We analyzed the weighted prevalence and estimated annual percentage change (EAPC), with associated 95% confidence intervals (CI), of DSM-IV criteria-defined major or other depression (depression) based on self-reported answers to Patient Health Questionnaire-8 questions from a nationally representative sample of U.S. adults with diagnosed HIV. Data were collected in 7 annual cycles (2015-2021) from June 01 of the indicated year to May 31 of the following year.

Results
From the 2015 through 2021 data collection cycles, prevalence of depression symptoms decreased an average of 8% annually (EAPC = -8.0%, CI -8.1%, -7.9%). Prevalence declined across most sociodemographic groups examined. Particularly large declines were seen among PWH self-identifying as heterosexual men (EAPC = -12.4%, CI -12.6%, -12.2%) or Black/African American persons (EAPC = -11.7%, CI -11.9%, -11.6%), particularly Black/African American cisgender women (EAPC = -13.8%, CI -14.0%, -13.6%; Fig 1a-1b). In contrast, prevalence of depression increased an average of 3% (EAPC = 3.0%, CI 2.2%, 3.8%) among transgender women (measured 2016-2021 due to small 2015 sample size) and changed minimally among people who injected drugs (PWID; EAPC = 0.4, 95% CI 0.1%, 0.8%; Fig 1a-1c). Further, in 2021 high prevalence of depression persisted among adult PWH who self-identified as transgender women (27.9%), PWID (39.5%) or aged 18-24 years (24.4%); experienced food insecurity (33.1%), homelessness (29.7%) or unemployment (22.8%); or self-reported disability (27.9%).

Conclusion
Overall, prevalence of depression among PWH declined an average of 8% per year during 2015-2022. However, this positive outcome was not observed among certain National HIV/AIDS Strategy priority groups; depression increased in transgender women and did not change among PWID. Understanding reasons for the decline could inform interventions to further reduce depression among PWH and address unique needs of transgender women and PWID who are most affected by persisting high levels of depression.

Disclosures
All Authors: No reported disclosures
P-505. Integrating PrEP Services into a Gynecology Clinic in Alabama: A Qualitative Analysis of Key Determinants
Authors: Goymer Hannah , Pratt Madeline , Burgan Kaylee W , Phillips Desiree , Matthews Lynn T , Kempf Mirjam-Colette , Johnson Bernadette , Mugavero Michael J , Williams Audra , Elopre Latesha 
Published: January 2025

Abstract

Background
In the Southeastern United States, Black women are disproportionately diagnosed with HIV compared to White women. Client-centered approaches are needed to increase uptake of HIV prevention tools, including pre-exposure prophylaxis (PrEP). Gynecology (GYN) clinics are uniquely positioned to provide PrEP for women and Black women prefer receiving PrEP from GYN providers, but PrEP delivery in GYN settings has been limited. Thus, we evaluated barriers and facilitators to PrEP provision in GYN clinics.

Methods
From 08/2022-04/2023, we conducted dyadic focus groups and in-depth interviews with providers (i.e., physicians, nurses, and medical assistants) and clients accessing care at a university-affiliated GYN clinic in Alabama where clients face high STI burden. Interview guides grounded in the Information-Motivation-Behavioral Skills Model explored barriers to PrEP service delivery. Inductive qualitative analysis identified emergent themes from transcripts.

Results
10 providers and 21 clients (100% Black, 100% female, median age 32 (range 19-44), 90.5% insured (67% with Medicaid)) were interviewed. Emergent themes included: (1) Sexual health – including STI/HIV prevention – as part of routine women’s healthcare. Providers preferred a risk-based approach to sexual healthcare while clients preferred a sex-positive approach. (2) Incorporation of PrEP services into women’s healthcare. Both clients and providers supported that PrEP is important for women’s health. Providers felt PrEP discussions should be limited to specific visits whereas clients desired regular discussions of PrEP. (3) Multi-level barriers for PrEP service delivery in GYN clinics. Barriers included limited client and provider PrEP knowledge, inadequate clinic resources, financial costs, and STI/HIV stigma.

Conclusion
Incorporating PrEP services into GYN clinics could increase PrEP uptake amongst Black women. Effective multi-level interventions should focus on increasing client and provider PrEP knowledge, integrating sexual health history assessment into routine care, mitigating STI/HIV stigma, and addressing structural barriers.

Disclosures
Latesha Elopre, MD, Merck: Grant/Research Support
P-507. Implementation of Guideline-Based HIV Prevention at an Academic Primary Care Clinic
Authors: Daudelin Isaac , Kim Eileen , Palani Arthi , Goyal Ritik , Wang Heather M , Swaminathan Shobha , Walsh Jared , Finkel Diana 
Published: January 2025

Abstract

Background
Primary care providers often lack familiarity with pre-exposure prophylaxis (PrEP) for HIV and miss screening for high-risk behavior. From 2017-2019 the Academic Internal Medicine Clinic (AIMC) at University Hospital in Newark, NJ averaged 2 PrEP prescriptions/year. Multiple resident lectures to improve screening and treatment saw minimal improvement to 4 PrEP prescriptions/year from 2020 to 2021, all of which were refills. This QA/QI project uses Epic smart tools to speed integration of guideline directed HIV prevention at AIMC.

Methods
Intervention: A PrEP screening smartlist was created in Epic and implemented in the common healthcare maintenance (HCM) smartphrase used by residents at AIMC. A positive screen directs the user to another smartphrase which guides the user to start or continue PrEP safely.
Assessment: 2021 CDC HIV PrEP Guidelines were used. Charts from 100 patients randomly selected from 5320 patients visiting AIMC in 2023 were reviewed for documentation of PrEP screening. Epic was queried and charts were reviewed to find all patients prescribed PrEP by AIMC residents in 2023.

Results
Of patients seen by residents at AIMC in 2023, 23% were screened for PrEP compared to 0% in previous years. 11 unique patients were prescribed PrEP, 5 of which were new prescriptions.
22% of patients seen in 2023 were new to the clinic. Of these, 52% used the common HCM smartphrase, 38% used a personal HCM smartphrase, and 10% used outdated versions of the common HCM smartphrase.
When the common HCM smartphrase was used, 72% of users screened for PrEP, 8% deferred screening to a future visit, and 20% removed the screening tool.

Conclusion
This study shows that an intuitive smart tool can create immediate change in a resident training program. Outdated versions of HCM copied forward from old visits were the largest barrier to this initiative, however this should spontaneously improve each year with 22% of patients in the year new to the clinic. Future directions include: tool use training, email reminders to use the smartphrase or to update personal templates annually to include updated guidelines, resident champions, and/or resident surveys.

Disclosures
Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant
P-510. Describing the Cohort of Women Veterans Prescribed HIV PrEP at the Veterans Health Administration
Authors: Broderick Kaitlyn , Keddem Shimrit , Beste Lauren , Sorrentino Anneliese , Dixon Tammara , Agha Aneeza , Caceres Omaris 
Published: January 2025

Abstract

Background
Pre-Exposure Prophylaxis for HIV (PrEP) is a highly effective option available to women in the Veteran’s Health Administration (VHA). However, PrEP uptake among VHA patients has remained modest, particularly among women. To better understand PrEP uptake for women Veterans, we used VHA administrative data to describe the cohort of women Veterans prescribed PrEP and their prescribers at the VHA.

Methods
We conducted a cross-sectional study of women enrolled in VHA care between January 1, 2012 and June 30, 2022 who were prescribed HIV PrEP for at least 30 days.

Results
PrEP initiation increased gradually over the study years, with most patients receiving initial prescriptions after January 1, 2020. Among the cohort of 417 women, 48% lived in the South, and most were aged 18-39 years. In terms of racial demographics, 53% identified as white and 40% as Black, while ethnically Hispanic women constituted 12% of the group. Eleven percent were homeless. Nearly half of the cohort were noted to have military sexual trauma. There was a high prevalence of mental health disorders, with 85% experiencing depressive disorder. Regarding prescriber profiles, 22% were advanced practice providers, 20% were clinical pharmacists, and 58% were physicians, 87% of whom specialized in infectious diseases.

Conclusion
These findings indicate an increase in prescriptions over time and significant geographic disparities among a vulnerable population of women Veterans. Although most patients lived in the South, this region has a lower rate of PrEP prescription to HIV incidence than in other regions. Most prescribers were infectious disease physicians, in contrast to estimates amongst general and commercially insured populations. Many patients in the study were prescribed PrEP via clinical pharmacists, and although data is lacking to compare to the general population, this suggests that Clinical Pharmacist Practitioners, who possess a scope of practice within the VHA which includes medication prescriptive authority and serving as a direct care provider, are an important tool to enhance PrEP uptake among women Veterans. More research is needed to identify barriers and strategies to overcome them for PrEP service implementation among women Veterans.

Disclosures
All Authors: No reported disclosures
P-513. Recruitment Challenges for Youth HIV Pre-exposure Prophylaxis (PrEP) Research
Authors: Abuogi Lisa , Limas Alexander , Moor Jennifer , De La Garza A J , Leonard Katherine , Pierce Kimberly , Gallegos Sam , Vyas Priya H , McFarland Elizabeth , Straub Diane M 
Published: January 2025

Abstract

Background
Recruitment for youth-focused PrEP studies among sexual and gender minority (SGM) youth is a challenge. We report on recruitment strategies and lessons learned from a youth TelePrEP study in Colorado.Table 1:Recruitment strategies used for youth PrEP study

Methods
Youth assigned male at birth, ages 18-24 years, eligible for PrEP using FTC/TAF, and at risk for HIV in Colorado were recruited to participate in a pilot feasibility trial of PrEP services provided via telehealth. Participants agreed to be seen via telehealth and to obtain initial lab testing at one of seven sites located throughout the state. PrEP medications were offered free for up to 12 months via in-person pick up or mail delivery. Youth were able to enroll and receive clinical care regardless of insurance type. HIV self-test kits were available via mail for follow up testing. Participants received $25 at time of enrollment. Recruitment methods were informed by two electronic youth surveys (N= 375 total), student young adult advisors, youth PrEP providers, and research team experience in youth HIV treatment and prevention studies.Figure 1:Recruitment Flow Chart

Results
A total of 319 individuals completed an online recruitment survey of which 44 (14%) were eligible and 21 (48%) of those enrolled between January 2023 and March 2024 out of a target of 100 study participants. (Figure 1) An estimated 107,500 individuals received at least one form of study recruitment. (Table 1) Direct recruitment occurred through adolescent clinics (including family planning/STI, transgender care, adolescent primary care, and youth HIV clinics) and pediatric primary care offices via primary care provider referral (N=4 enrolled). Community recruitment was done through SGM youth-serving organizations, community events, during community HIV education sessions (N=4 enrolled). On-line recruitment utilized social media (including targeted ads and sponsored influencers), dating apps, and survey outreach (N=6 enrolled). (Figure 2) Dating apps and social media were the most common recruitment strategies among eligible participants.Figure 2:Examples of Youth TelePrEP Recruitment Materials

Conclusion
Despite a multipronged approach to recruitment of SGM youth for a study on youth TelePrEP, recruitment was below targets. Additional innovation and evaluation of strategies are needed to not only increase recruitment to youth PrEP studies but also youth PrEP services.

Disclosures
Lisa Abuogi, MD, MS, Gilead Sciences: Grant/Research Support Alexander Limas, MSW, Gilead Sciences: Grant/Research Support AJ De La Garza, BSW, Gilead Sciences: Grant/Research Support Katherine Leonard, MSN, FNP-BC, Gilead Sciences: Grant/Research Support Sam Gallegos, BS, Gilead Sciences: Grant/Research Support