bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-2187. Emergency Department Patients’ Perceptions of the Seriousness of Hepatitis C – Implication on Improvement of HCV Care Continuum
Authors: Brown Dante , Mann Spencer , Cho Mun Heol , Haines Haley M , Winguth Patrick , Cammer Lauren , Peron Liz , Bouhsane Wassim , Hsieh Emma , Feezel Kevin , Riggan Benjamen , Dashler Gaby , Rothman Richard E , Hsieh Yu-Hsiang 
Published: January 2025

Abstract

Background
U.S. urban emergency departments (EDs) have identified thousands of individuals infected with hepatitis C virus (HCV) through their testing programs. However, significant challenges remain with linkage to care (LTC) rates from EDs at &lt; 30%, representing the biggest drop-off along the HCV care continuum (HCV CC). Leventhal’s Common-Sense Model of Illness Representations, a framework to understand people's health brief and responses to illness, could help narrow that gap by defining key factors that contribute to self-perceived view of hepatitis C seriousness, and develop tools to improve the HCV CC.

Methods
Secondary data analysis of an ongoing randomized controlled trial of an individualized HCV educational web-based tool was performed. Patients presenting to an urban ED in Baltimore, Maryland from September 2022 to March 2024, ≥ 18 years, with a documented positive HCV Ab and no history of treatment (excluding those treated prior to reinfection) were eligible. The tool collected sociodemographic characteristics, historical healthcare utilization, HCV knowledge level, perceived barriers to care, and motivation level to care. Perceived seriousness of HCV was measured via an eight 5-point Likert scale which assessed perceptions of control, concern, awareness, and impact of HCV. Multivariable linear regression analysis was performed to determine factors associated with perceived seriousness of HCV.

Results
79 (87%) of 91 participants completed the baseline survey and were included for analysis. The majority were ≥40 years (71%), male (72%), or self-identified black (62%). Mean perceived seriousness of HCV was 3.2±0.7. A higher score was positively associated with the Black race, perceived barrier to HCV care score, and perceived motivation level for HCV care score [regression coefficient: 0.38±0.13; 0.30±0.10; 0.33±0.11, respectively; all p&lt; .05] after adjusting for confounders.

Conclusion
We observed that amongst HCV-infected ED patients who were not currently engaged in care, there was an overall neutral perception of their HCV illness. Factors associated with higher score in perceived seriousness reflect current HCV and opioid intersecting epidemic and suggest there are mutable health systems issues that can be addressed.

Disclosures
Richard E. Rothman, MD, PhD, abbvie: Grant/Research Support|CEPHEID: Advisor/Consultant|CEPHEID: Grant/Research Support|CEPHEID: Honoraria Yu-Hsiang Hsieh, PhD, AbbVie: Grant/Research Support
P-2195. Hepatitis C Virus Screening Guidelines Rates Among a National Sample
Authors: Ferval-Shioya Kenta , Kaelber David C , Kerandi Allan M 
Published: January 2025

Abstract

Background
Objective:
Evaluate US hepatitis C virus (HCV) screening rates after the 2013 and 2020 US Preventive Services Task Force HCV screening recommendations.
Design/Participants:
A retrospective observational study utilizing TriNetX, an electronic health record (EHR) aggregation platform among 100 million patients.Table 1.Percentages of Patients Screened for Hepatitis C Based on Sample

Methods
We identified patients eligible for HCV screening based on their age (58-78 for 2013 guidelines and 18-79 for 2020 guidelines) and having a preventative care visit, based on common procedure terminology (CPT) codes. Successful screening encompassed a HCV antibody test result. High risk patients: encounter diagnosis ICD codes for HIV or renal dialysis or a CPT code for hemodialysis. We examined age distribution, gender, race, and ethnicity for possible screening disparities.Figure 1.Overview of Cohorts.

Results
In 2021, the first year after 2020 guidelines, 13.65% (219,333/1,607,333) of patients were screened. In 2022 and 2023, 15.25% (450,236/2,952,850) and 16.38% (638,335/3,896,376) were screened. In 2023, ten years after the 2013 guidelines, 22.66% (416,139/1,836,061) of eligible patients were screened. Among high-risk patients 10-year after the 2013 guidelines, 24.70% (62,332/252,402) with HIV and 25.80% (107,937/418,292) on dialysis were screened.
In our disparities analysis, we found that the percentage of unknown ethnicity or race, Asian, or other races was significantly less (p-value &lt; .001) among screened eligible patients compared to eligible patients based on the 2020 and 2013 guidelines.
Over time screening disparities generally decreased so that people eligible based on the 2013 guidelines had fewer disparities in 2023 than those eligible based on the 2020 guidelines, except for gender where disparities increased between the two sets of guidelines with men being screened ∼3% more than women based on the 2013 guidelines.Figure 2.Total Eligible Patients and Eligible Patients Screened for HCV.

Conclusion
The current percentage of eligible patients screened for hepatitis C (&lt; 20%) based on current guidelines is low and is only increasing slowly (1-2% per year). Even high-risk patients were only screened ∼25% of the time.Figure 3.Percentage of Eligible Patients Screened for HCV.

Disclosures
David C. Kaelber, MD, PhD, MPH, FAAP, FACP, FACMI, FAMIA, Dynavax Technologies Corporation: Advisor/Consultant
P-2200. Public Health Partnerships for Hepatitis C Elimination: Using Telemedicine and Syringe Service Program Hubs to Overcome Treatment Barriers in Rural Kentucky
Authors: Van Sickels Nicholas , Soria Jaime , Wilburn Amanda B , Collins Jana , Welty Kendal 
Published: January 2025

Abstract

Background
People who inject drugs (PWID) in rural areas of the United States face multiple barriers accessing Hepatitis C (HCV) care, including insurance-based treatment restrictions, long travel distances, and housing instability. The Kentucky Income Reinvestment Program (KIRP) provides harm reduction services, HIV and HCV testing, and linkage-to-care across most of Kentucky's Syringe Services Programs (SSPs). KIRP, in partnership with three high-prevalence counties (Figure 1) sought to reduce HCV treatment barriers by using SSPs as a hub for telehealth appointments, allowing for delivery of medications to the SSP, and providing inter-visit support to participants. We present early outcomes from this model and examine its effects on treatment initiation.

Methods
Advertising for the program began in McCreary County in June 2023, with Jessamine and Lee counties starting in January 2024. Patients were scheduled (or could walk-in) one weekday afternoon at each SSP. Visits were conducted via audio-visual (AV) telehealth, with KIRP staff present for support. HCV evaluation followed guideline-endorsed simplified pathways for those meeting criteria. Labs were performed at a 3rd party lab, and patients were followed using a minimal monitoring protocol.

Results
Between June 1, 2023 and April 30, 2024, 60 HCV seropositive patients were assessed, with 39 seen via AV telehealth. The median age was 39; 96% were White, 51% identified as cis-female, 93% were Medicaid recipients, and 34% reported unstable housing (Figure 2). Of 39 patients seen, 30 had labwork completed, 22 were RNA positive, and 18 initiated treatment. To date, ten patients completed treatment and one achieved SVR (Figure 3). Patients preferred to receive or house medications at the health department (78%). No significant effects of baseline demographics were found on the outcome of treatment initiation.

Conclusion
At baseline, less than a third of Kentuckians achieve a cure for HCV. Early findings from our intervention in three high-prevalence counties suggests the use of telehealth and an SSP hub can increase HCV treatment initiation and possibly completion for those who attend a visit. Further study of streamlined care delivery is needed to overcome HCV treatment barriers, especially in areas with limited healthcare access.

Disclosures
All Authors: No reported disclosures
P-2201. A Comprehensive Kidney Biomarker Panel to Assess Kidney Health after Hepatitis C Direct Acting Antiviral Therapy in Persons with HCV monoinfection and HCV/HIV coinfection
Authors: Perrone Lila A , Ma Yifei , Campos Kasey , Tse Warren , Tien-Smith Alexandra , Freasier Heather , Scherzer Rebecca , Estrella Michelle , Shlipak Michael , Tien Phyllis C 
Published: January 2025

Abstract

Background
Chronic Hepatitis C virus (HCV) infection is associated with greater risk of chronic kidney disease and proteinuria. We examined effects of 12 weeks of elbasvir/grazoprevir, an HCV NS5A inhibitor/NS3/4A Protease Inhibitor on glomerular filtration (creatinine, cystatin C), injury (albuminuria), and 9 novel kidney tubule biomarkers in adults with HCV infection over a 24-week period.Figure.Percent Change (95% Confidence Interval) from Baseline of Urine Kidney Tubule Markers 24 weeks after initiating Elbasvir/Grazoprevir in Patients with HCV

Methods
We included 36 participants with HCV (7 with HIV coinfection) from the San Francisco Bay Area. Urine biomarkers included kidney tubule function (α-1-microglobulin [α1m], β-2-microglobulin [β2m]) and injury (kidney injury marker-1 [KIM-1], neutrophil gelatinase-associated lipocalcin [NGAL], (interleukin-18 [IL-18]), fibrosis/repair (monocyte chemoattractant protein 1 [MCP-1], chitinase-3-like protein-1 [YKL-40]) and synthetic function (epidermal growth factor [EGF], uromodulin [UMOD]). Biomarkers were measured at baseline, wk 12 (end of treatment), and week 24 (time of assessment for sustained virologic response [SVR]). We used linear mixed regression models with time as the main predictor to assess changes in kidney health, adjusting for demographics and urine creatinine.

Results
Over two thirds identified as Black/African American;89% were men and median age was 62 years. All but 2 achieved an SVR and 17% had advanced liver fibrosis using the FIB-4 serum marker. Median (interquartile range) for eGFRcr, eGFRcys, and urine albumin to creatinine ratio (ACR) were 82(63-100 ml/min),74(58-87 ml/min), and 10.4(4.9-24 mg/g), respectively at baseline. The percent (%) change from baseline for eGFRcr and ACR at weeks 12 and 24 was not statistically significant; eGFRcys was -11.4% lower (95%CI:-18%,-4.6%) at week 24. After 12 weeks of treatment, there were significant reductions in α1m, β2m, KIM-1, and MCP-1, with smaller reductions seen in most other markers (Figure). At week 24, these reductions were sustained for KIM-1.

Conclusion
Our findings suggest that HCV treatment with elbasvir/grazoprevir improves proximal tubule function and reduces cellular injury and fibrosis. Further research is needed to understand longer-term trends in kidney health following HCV cure.

Disclosures
Michelle Estrella, MD, Astra Zeneca: Board Member|Bayer: Grant/Research Support|Boehringer Ingelheim: Board Member Michael Shlipak, MD, Astra-Zeneca: Honoraria|Bayer: Grant/Research Support|Bayer: Honoraria|Boehringer Ingelheim: Honoraria Phyllis C. Tien, MD, MSc, Merck: Grant/Research Support
P-2205. The impact of pharmacist-driven transitions of care protocol in the treatment of hepatitis C infection
Authors: Chan Sophea , Cimino Christo , Ing Austin , Ereshefsky Benjamin , Bobbitt Laura , Moss Ryan , Muscarella Anahit 
Published: January 2025

Abstract

Background
Treatment for hepatitis C virus (HCV) can be delayed due to extensive documentation needed for insurance approval. Pharmacists can play critical roles in facilitating treatment approval, but the evidence regarding pharmacist-driven transitions of care protocols to facilitate HCV treatment approval and therapy initiation is limited. Therefore, we evaluated the feasibility and effectiveness of a pharmacist-driven transitions of care protocol for HCV treatment.

Methods
This was a non-randomized, prospective, single-center study at a large academic medical center. Adult patients admitted to the Infectious Diseases (ID) primary team were screened for HCV between 09/01/23 and 02/29/24. Exclusion criteria included decompensated cirrhosis, hepatocellular carcinoma, pregnancy/breastfeeding, current/prior HCV treatment, and transplant evaluation/receipt. Patients with HCV infection were offered treatment upon discharge at the outpatient ID clinic. Inpatient ID pharmacists performed pre-treatment workup and coordinated handoff to outpatient ID specialty pharmacists. Endpoints included treatment initiation and completion rates, time from screening to treatment initiation, and time from discharge to treatment initiation.

Results
Of 180 patients screened during the study, 13 (7%) were eligible for HCV treatment. The median age was 43 years, and 69% were male. More than 90% of patients were Caucasian and had a history of substance use disorder/injection drug use. Five patients (38%) were uninsured. Of the 13 patients, two had treatment approved, and one completed therapy. The remaining patients were lost to follow-up. The median times from screening to treatment initiation and from discharge to treatment initiation were 64 and 62 days, respectively.

Conclusion
This pharmacist-driven protocol resulted in inpatient screening of a large number of patients over six months and successfully identified 13 patients eligible to begin hepatitis C treatment after discharge. This is a novel approach to engaging patients in hepatitis C care. Despite facilitating transitions of care for these patients, the clinic no-show rate was unexpectedly high. Additional measures may be required to optimize treatment outcomes for this patient population.

Disclosures
All Authors: No reported disclosures
P-2208. Previously Diagnosed, Untreated Hepatitis C Among Emergency Department And Urgent Care Patients
Authors: Vinaithirthan Vall , Kamis Kevin , Hopkins Emily , Vaughn Shawni , Haukoos Jason , Rowan Sarah E 
Published: January 2025

Abstract

Background
Hepatitis C (HCV) incidence has been increasing steadily over the past decade despite the growing availability of well-tolerated, highly effective treatment. Additionally, many individuals who have been living with HCV for decades remain untreated. Emergency departments (EDs) serve large numbers of patients at risk for HCV who commonly do not have access to other forms of care. To address these gaps, innovative approaches to identification and linkage to care are needed. The goal of this study was to assess the number and characteristics of individuals with previously diagnosed but still untreated HCV presenting for acute, unscheduled episodic care, defined as ED or urgent care (UC) visits, in an effort to better understand the potential for HCV care interventions in these settings.

Methods
We performed a retrospective cohort study using electronic health record (EHR) data from Denver Health Medical Center in Denver, Colorado. ED or UC visits between January 1, 2019 and December 31, 2021 among those aged ≥ 18 years with evidence of HCV viremia at any time between January 1, 2016 and the day prior to the visit were included. We used descriptive statistics to characterize patient- and visit-level characteristics, timing of visits, and evidence of HCV clearance afterward.

Results
Over the 3-year study period, 1,407 unique individuals with evidence of current HCV infection were seen in the ED or UC, representing 5,829 total visits. At the patient level, the median age was 51 years (IQR 38-60), 53% were white, non-Hispanic, 29% Hispanic, and 73% cis-gender male. At the visit level, 17% were triaged as emergent status, 60% as urgent, and 16% less urgent. Visits were distributed relatively evenly throughout the week with Thursday being the most common day for qualifying visits (16%). Median length of stay for visits that did not lead to hospitalization was 276 minutes (IQR 153-461). Medicaid was the payer source for 73% and the most common chief complaints were related to substance use (18%) and pain (18%).

Conclusion
Substantial numbers of patients with previously diagnosed but untreated HCV are seen in the ED and UC annually, many of whom have Medicaid coverage. These healthcare locations may be ideal venues for addressing HCV through identification, referral to care services, and potentially treatment.

Disclosures
All Authors: No reported disclosures
P-2210. Perinatal Acquisition of Resistant E. coli Alters the Gut Microbiome in a Murine Model
Authors: Kremer Aspen N , Kremer Aspen N , Mithal Leena B , Sajwani Alima , Holm Johanna 
Published: January 2025

Abstract

Background
Maternal and neonatal colonization by pathogenic E. coli, particularly extended-spectrum beta-lactamase producing E. coli (ESBL-EC), heightens the risk of invasive infections in infants, complicating treatment and increasing morbidity. We developed a mouse model of perinatal transmission to explore this by first comparing the transmission rate among commensal E. coli strains, the pan-sensitive uropathogenic E. coli strain, UTI89, and four clinical ESBL-EC strains. We then determined the impact of early life acquisition of these strains on the mouse pup intestinal microbiome through sequencing analysis.
Figure 1
Proportion of pups colonized by each indicated strain, Sample sizes are for 24h and Day 7, respectively. The two control animals were not received no intervention.

Methods
Pregnant dams were inoculated with control or test strains one week prior to expected delivery date. Fecal pellets were collected and plated on selective agar to determine burden of colonization. Pups were born without intervention and sacrificed 24h or 7 days later, large intestines were collected, and bacterial transmission was quantified using selective agar. DNA was extracted and the V3-V4 region of the 16s rRNA gene was amplified for next generation sequencing.
Figure 2
Microbiome analysis was conducted on dam fecal pellets and pup large intestines. Mean relative abundance of top 26 taxa is shown for dam stool before birth, and 24h and 7-day old pup large intestines. Control is no dam manipulation, MG1655 and ST6438 are non-pathogenic, pan-sensitive E. coli and UTI89 is a pan-sensitive uropathogenic E. coli strain.

Results
While all strains adequately colonized the pregnant dam’s intestinal tract, only UTI89, ESBL-EC ST5, ST10, ST511, and the commensal ST6438 were transmitted to pups. ST511 and ST10 yielded colonization at both 24h and day 7 (Figure 1). Figure 2 shows the mean relative abundance of microbiota taxa in dam stool and pup intestines at 24h and 7 days old. As expected, pups born to dams colonized with E. coli had at least some Escherichia at 24h. However, at day 7, ESBL-EC ST10, ST511 and ST809 had higher Escherichia abundance than control strains, and all ESBL-EC strains had lower abundance of Ligilactobacillus, a common commensal, than the control strains. MG1655 and UTI89 pups had no Escherichia present by day 7. The ST511 pup data also suggests that ESBL-EC induced dysbiosis is not due to high maternal abundance and higher inoculation effect on pups, since Escherichia were not seen in a significant abundance in ST511 dams.

Conclusion
These results suggest that E. coli strains differ in their ability to perinatally transmit, and that ESBL-EC strains more often cause a sustained dysbiosis of the murine gut. Our ongoing work aims to understand the impact of this early life dysbiosis on neonatal development.

Disclosures
All Authors: No reported disclosures
P-2214. The Microbiome of Community-Dwelling Adults and Risk Factors for Colonization with Antibiotic-Resistant Bacteria in Chile
Authors: Rafael Araos , Ugalde Juan , Jara Alejandro , Sanchez Felipe , Rivas Lina M , Munita Jose M , D’Agata Erika M C 
Published: January 2025

Abstract

Background
Intestinal colonization due to antibiotic-resistant bacteria (ARB) often precedes episodes of infection and fosters the spread of antibiotic resistance. This study explores the clinical, epidemiological, and microbiome factors associated with ARB colonization in Chilean adults.

Methods
A cross-sectional study of 357 community-dwelling individuals from a community in central Chile was conducted between December 2018 - May 2019, using stool samples and health questionnaires. Stool samples were cultured on selective media, followed by identification with MALDI-TOF and disc diffusion susceptibility method. Fecal microbiome assessments were conducted using 16S rRNA gene sequencing performed on Illumina MiSeq. ARB colonization was defined as phenotypic resistance of recovered isolates to extended-spectrum cephalosporins, fluoroquinolones, and/or carbapenems.
Associations between colonization and clinical and epidemiological factors were analyzed through classification trees and logistic regression, while diversity and composition of microbiomes were compared between participants based on colonization status.

Results
No exposures were associated with the risk of ARB colonization. The microbiomes of colonized individuals featured Firmicutes, with Bacteroidetes, Actinobacteria, and Proteobacteria also present, paralleling the microbiome profile of the non-colonized individuals. However, ARB-colonized individuals had an overrepresentation of Escherichia/Shigella, Klebsiella, and Enterococcus genera. There were no differences in alpha or beta diversity by ARB colonization status.

Conclusion
The lack of risk factors regarding ARB colonization suggests that such colonization might occur without overt selective pressures. However, the overrepresentation of specific genera in colonized individuals could subtly indicate the influence of unrecognized selective pressures, such as environmental exposure to antibiotic residues. This scenario underscores the complexity of ARB dynamics and the need for further studies to explore potential environmental and indirect factors contributing to ARB colonization in the community setting.

Disclosures
All Authors: No reported disclosures