bluuebunny/crossref_metadata_2025_split huggingface dataset:
2068. Progress in the Infection Prevention and Control Monitoring System for the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Programs and Supported Facilities
Authors: Gomes Danica J , Insua Maria , Desai Mitesh , Forno Rodriguez Diana , Goldstein Deborah A , Date Anand , Bancroft Elizabeth A , Godfrey Catherine , Zender Nicole 
Published: November 2023

Abstract

Background
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) prioritizes infection prevention and control (IPC) activities in its 40,000 supported facilities in over 50 countries. PEPFAR’s 2015 quality assurance tool included four IPC indicators (tuberculosis IPC [TBIPC], waste management [WM], injection safety [IS], laboratory biosafety [LB]). In 2022, four new IPC indicators were added (IPC program [IP], environmental cleaning [EC], availability of personal protective equipment [PPE], medical device reprocessing [MD]). As of October 2022, PEPFAR programs are required to assess IPC indicators in 10% of facilities over the course of one year. We report quarter one data results.

Methods
Indicator data from October 1 - December 31, 2022 were analyzed. Scores were calculated based on compliance with 2-4 criteria each: green, yellow, and red represented good, fair, and poor compliance, respectively. Percentages of yellow and red scores were combined, to represent the percent of facilities requiring improvement.

Results
A total of 272 sites were assessed across 15 countries; each PEPFAR program selects the indicators to assess in each site. For existing indicators (TBIPC, WM, IS, LB), 16%, 34%, 22%, and 57% of sites assessed scored red or yellow, respectively; for indicators added in 2022 (IP, EC, PPE, MD), 74%, 67%, 64%, and 61% scored red or yellow, respectively (Figure). Specific gaps include: 63% of facilities lack adequate IPC leadership; ∼50% lack adequate environmental cleaning staff, protocols, and methods; 41% lack respirators; 30% lack device reprocessing protocols.Figure:Infection Prevention and Control (IPC) Indicator Scores from PEPFAR Panorama for Quarter 1 (October 1 – December 31, 2022)

Conclusion
Unknown IPC weaknesses were identified in PEPFAR supported facilities. PEPFAR requires that facilities with fair or poor compliance be reassessed within six months to monitor improvements. Strengthening IPC leadership is a priority. Improvement activities will require collaboration between facilities, implementing partners, and Ministries of Health (MOH). Future plans include increasing compliance with conducting required IPC indicator assessments; timely, data driven identification of gaps and advancements towards IPC standards; and developing guidance and resources to facilitate improvements. MOHs can leverage data to inform priorities and design context-specific interventions.

Disclosures
All Authors: No reported disclosures
1557. The Real-World Impact of Pre-Exposure Prophylaxis (PrEP) Prescription Uptake and Dispensing Status on HIV Infection Risk in the US
Authors: Tao Li , Yang Juan , Zachry Woodie , Gruber Joshua , Mezzio Dylan 
Published: November 2023

Abstract

Background
Despite effective HIV prevention options, there are continued disparities in uptake and persistence on PrEP. We assessed access to PrEP, time to dispense, and their potential relationship with HIV.

Methods
Individuals receiving FTC/TDF or FTC/TAF for PrEP between Jan 2019–Feb 2023 were selected from a de-identified prescription claims database (IQVIA Longitudinal Access and Adjudication Dataset). Use of either regimen for HIV or HBV treatment or HIV PEP was excluded. Individuals were categorized into 3 groups: ≥1 PrEP claim dispensed (DISP); never had PrEP dispensed with ≥50% of claims rejected by payer (ND-R); and never had PrEP dispensed with ≥50% of claims abandoned (ND-A). A 12-month window from the index (first PrEP claim submitted) was used to assess risk of HIV infection. New HIV infection diagnoses per 100 population were calculated as no. of new HIV infections diagnosed, divided by total no. of individuals x100, in each cohort. Logistic regression was used to calculate odds ratios (OR) and 95% CIs of HIV infection by cohort and time to dispense.

Results
Among 522,273 individuals, 88% were DISP, 7% were ND-R, and 5% were ND-A. Individuals in the ND-R and ND-A cohorts had a 95% and 38% higher risk of new HIV diagnosis, respectively, compared to those in the DISP cohort (Figure). For individuals with R or A claims, delayed time to dispense was significantly associated with a higher risk of acquiring HIV of ∼20%. Subgroup analysis (Table) showed that new HIV diagnoses were lowest in cisgender men who received a dispensed claim (2.1%) and highest in transgender women and transgender men in the ND-A cohort (6.1% and 4.6%, respectively), and in individuals with STIs in the ND-R and ND-A cohorts (8.1% and 5.4%).

Conclusion
This study is the first to find that rejected claims for PrEP were linked to a 2-fold increase in new HIV diagnoses, emphasizing the impact of timely access to PrEP on HIV prevention in real-world settings. This underscores the urgent need to remove barriers to PrEP from a prescription perspective to end HIV transmission.

Disclosures
Li Tao, MD, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Juan Yang, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Woodie Zachry, RPh, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Joshua Gruber, PhD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds Dylan Mezzio, PharmD, Gilead Sciences, Inc: Employee|Gilead Sciences, Inc: Stocks/Bonds
2070. Outbreak of Crimean-Congo Hemorrhagic Fever in Kyzylorda region, Kazakhstan, March-July 2022
Authors: Gabdullina Malika , Gazezova Saya , Ayapova Gulzhan , Horth Roberta , Nabirova Dilyara 
Published: November 2023

Abstract

Background
Crimean-Congo Hemorrhagic Fever (CCHF) is a viral tick-borne disease with a high mortality rate. It is endemic in Kazakhstan. The Kyzylorda region reported higher-than-expected cases from March to July 2022 (15 compared to 10 in the previous year). We conducted an investigation to identify additional cases, determine risk factors, and assess CCHF knowledge and practices.

Methods
We conducted a case-control study in July 2022. We defined cases as PCR-confirmed or hospitalized with CCHF symptoms. The control group was made up of regional contacts including neighbors and household members at a 1:2 ratio. We reviewed medical records from April to July. We conducted face-to-face interviews using structured questionnaires. Blood collected from the control group was tested with PCR and ELISA for detection of IgM and IgG antibodies. We also collected ticks from domestic animals for PCR-testing. We used logistic regression to assess factors associated with CCHF.

Results
We identified 38 cases (n=15 confirmed, n=7 probable and n=16 suspected cases) and 71 controls. Cases were mostly male (74%) with mean age of 45 (range 17-81); 27% died. Top patient symptoms (n=38) were weakness (100%), headache (97%), fever (84%) and loss of appetite (55%). Risk factors for CCHF were being male (odds ratio and 95% confidence interval: 5.5, CI: 2.3-13.1), animal husbandry (3.1, 1.3-7.2), crop production (4.0, 1.5-10.5), tick contact (262.5, CI: 31.4-2192.2), tick bite (70.0, 8.8-556.9), contact with tick blood (18.7, 2.2-155.9), ticks on the body or clothing (77.8, 9.8-618.9) and having been in places with high tick risk (15.1, CI: 4.6-49.7). The control group were more likely to have awareness of CCHF, know that they can protect themselves from CCHF, refrained from visiting forests and rural areas, used repellents, and taken protective measures to reduce ticks in domestic animals. Of 55 controls tested: one was IgG positive. Of 163 ticks tested, one was PCR-positive.

Conclusion
Exposure to activities that are high risk for exposure to ticks increased odds of CCHF. Improved awareness of prevention to exposure from ticks, CCHF associated risk factors, and the importance of seeking early treatment is needed. This can be achieved by increasing population awareness and educating medical providers.

Disclosures
All Authors: No reported disclosures
1569. Antiretroviral Treatment (ART) Packaging Preferences and Their Impact on Adherence Among People With HIV (PWH): Findings From a Best–Worst Scaling Survey
Authors: Dunbar Megan , Gandhi-Patel Bhumi , Kopenhafer Lewis , Olsen Patrick , Mercadante Amanda R , Way Nate , Beusterien Kathleen Marie 
Published: November 2023

Abstract

Background
ART is highly effective when taken as prescribed, but adherence can be a challenge due to privacy concerns, convenience or stigmatization of HIV (especially among PWH facing health disparities). Blister packs (BPs) may improve medication adherence; however, ART packaging preferences have not been fully explored in PWH. We assessed preferred ART packaging and packaging features perceived to support daily adherence.

Methods
A cross-sectional, online survey was completed by PWH aged 18–65 years living in the US currently on a single-tablet ART regimen. Participants were recruited via patient databases/panels/associations, social media, physician referrals and community centers. The survey elicited preferences for a BP versus a pill bottle. Best–worst scaling (BWS) was used to quantify how PWH prioritized 14 packaging features based on how helpful they were perceived to be for taking daily ART.

Results
The survey population had diverse race/ethnicity and socioeconomic status reflective of US PWH (Table). Of 208 PWH, 91% used pill bottles; 19% were dissatisfied with their current ART packaging and 26% were neither satisfied nor dissatisfied. Less than half (47%) of respondents reported never skipping/missing a medication dose; 25% skipped/missed a dose &lt; 1× a month, and 28% ≥ 1× a month. Overall, 48% of PWH preferred pill bottle packaging, 38% preferred the BP and 15% had no preference. For Black PWH, 40% preferred a BP and 39% preferred a bottle, which differed from preferences in White PWH (35% preferred a BP, 59% preferred a bottle; P = 0.04). Among packaging features that PWH found helpful for taking medication as prescribed, the top four were ‘easy to open’, ‘convenient when traveling’, ‘easy to remove one pill at a time’ and ‘discreet’ packaging. PWH who preferred the BP prioritized ‘easy to remove one pill at a time’, ‘convenient when traveling’ and ‘easy to open’ features; those who preferred the bottle prioritized ‘easy to open’, ‘convenient when traveling’ and ‘discreet’ packaging (Figure).

Conclusion
PWH identified packaging features of a BP and/or a pill bottle for ART that may help them adhere to a once-daily treatment regimen. Offering a choice of ART in a BP or bottle may increase convenience and discreet use of HIV medication, helping to address stigma and support adherence.

Disclosures
Megan Dunbar, PhD, Gilead: Employment Bhumi Gandhi-Patel, PharmD, Gilead: Employment Kathleen Marie Beusterien, BS, MPH, Gilead: Employee of Cerner Enviza, which provides consulting services to Gilead
1575. Comparison of virologic suppression rates pre-, intra- and postpartum in women with HIV in an underserved US community
Authors: Gerdes Elise N , Suh Jin S , Kim Chloe , Jimenez Humberto R 
Published: November 2023

Abstract

Background
Antiretroviral therapy (ART) has significantly reduced mother-to-child transmission of HIV among pregnant women. Nonetheless, numerous factors can impede ART adherence and thus virologic suppression (HIV RNA &lt; 200 copies/mL). Although there are limited data on current rates of virologic control in women with HIV around pregnancy, previous studies have highlighted lower rates at the start of pregnancy and 6 months postpartum. The objective of this study was to compare virologic suppression rates in women pre-pregnancy, intrapartum, and postpartum at a clinic serving a marginalized community and to identify factors associated with virologic control

Methods
This study was a single-center, retrospective chart review including pregnant patients receiving care at a hospital-based, NJ Ryan-White funded clinic between 2015-2022. The primary endpoint was to determine whether there is a difference in the proportion of patients with virologic suppression at the start of pregnancy, at delivery, and 6 months postpartum

Results
At the first visit, 64.4% of mothers were virologically suppressed. Our study found that the proportion of women remaining virologically suppressed was lower at 6 months postpartum compared to the time of delivery (82.2% versus 90.4%, p=0.017), regardless of virologic suppression at the first visit. Older age at pregnancy was associated with improved virologic suppression at 6 months postpartum (OR 1.13, 95% CI 1.01-1.27). However, perinatal HIV acquisition, as compared to heterosexual acquisition, was correlated with increased virologic failure at 6 months postpartum (OR 5.4, 95% CI 1.42-20.08).

Conclusion
Although a high percentage of patients were controlled at delivery, the drop in virologic suppression postpartum highlights the need for additional efforts to support the mother and child during that time. While further research is warranted to identify further confounders that may impact virologic control and other barriers to care, the healthcare team should work together holistically on frequent outreach and follow up during the entire pregnancy.

Disclosures
All Authors: No reported disclosures
1583. Optimal timing of antiretroviral therapy initiation in AIDS-associated Toxoplasma encephalitis: a prospective observational multicenter study in China
Authors: Chen yaokai , Li Yao 
Published: November 2023

Abstract

Background
Toxoplasma encephalitis (TE) is the most frequent cause of expansive brain lesions among acquired immunodeficiency syndrome (AIDS) patients; however, the optimal timing of antiretroviral therapy (ART) initiation in these patients remains controversial.

Methods
This was a multicenter prospective observational study, and eligible patients were recruited from eleven treatment centers in China.

Results
In total, 87 patients were included, and 38 of them were assigned to the Early ART group (initiating ART within 2 weeks after anti-Toxoplasma treatment initiation), while the remaining 49 patients were allocated to receive deferred ART (initiating ART at least 2 weeks after anti-Toxoplasma treatment initiation). Our results indicated that the incidence of immune reconstitution inflammatory syndrome (IRIS) (2.6% vs. 0, p=0.437) and the number of death events (1 vs. 5, p=0.225) were not significantly different between the two groups at Week 48. The timing of ART initiation was also found to not significantly contribute to human immunodeficiency virus (HIV) viral load control. The difference in the number of patients who maintained an undetectable HIV viral load of &lt;50 copies/mL in each of the two groups of patients was calculated to not be statistically significant at Week 24 (8 vs. 3, p=0.142) and Week 48 (7 vs. 7, p=1.000). Meanwhile, median CD4+ T-cell counts were also observed not to reach statistical significance between the two groups, both at Week 24 (155 vs. 91, p=0.837) and Week 48 (181 vs. 96, p=0.219).

Conclusion
In our study, early ART initiation was observed to not confer statistically significant differences in the incidence of IRIS, mortality, and HIV virological and immunological outcomes, when compared to deferred ART initiation.

Disclosures
All Authors: No reported disclosures
2072. Clinical Evaluation of the BioFire® Global Fever Special Pathogens Panel
Authors: Collins Brittany , Rabiger David S , Gurling Mark , Helm Jared R , Smith Wendy , Belgique Pascal , Jackson Olivia , Johnson Michael , Kelley Alex J , VanHollebeke Hannah , Webster Sidney , Wiltsie Ashley , Kim Marianne , Phillips Cynthia L 
Published: November 2023

Abstract

Background
BioFire Defense has developed the BioFire® Global Fever Special Pathogens Panel, in collaboration with the U.S. Department of Defense and NIAID (contract Nos. W911QY-13-D-0080 and HHSN272201600002C), as an in vitro diagnostic test for the simultaneous identification of viral, bacterial, and protozoan pathogens directly from whole blood in under an hour using the BioFire® FilmArray® platform. The BioFire Global Fever Special Pathogens Panel has been cleared by the U.S. FDA for the detection of chikungunya virus, Crimean-Congo hemorrhagic fever virus (CCHFV), dengue virus, (serotypes 1-4), Ebolavirus spp., Lassa virus, Marburg virus, West Nile virus (WNV), yellow fever virus (YFV), Bacillus anthracis, Francisella tularensis, Leptospira spp., Yersinia pestis, Leishmania spp., and Plasmodium spp. from individuals with signs and/or symptoms of acute febrile illness (AFI) and known or suspected exposure to target pathogens.

Methods
BioFire Defense performed a prospective clinical evaluation for the Global Fever Special Pathogens Panel at eleven geographically distinct sites across the globe. A total of 2139 prospective whole blood specimens were tested between March 2018 and March 2021.

Results
The Global Fever Special Pathogens Panel detected at least one analyte in 33.9% of specimens (725/2139). The most prevalent analyte was Plasmodium (29.0%, 118/407), followed by dengue virus (36.4%, 266/730). Chikungunya virus, Leptospira spp., Leishmania spp., CCHFV, and WNV were detected in fewer than 5% of specimens. Two or more analytes were detected in 4.3% (31/725) of positive specimens. All other analytes were not detected by the Global Fever Special Pathogens Panel. Positive percent agreement between the Global Fever Special Pathogens Panel and comparator testing ranged between 92.7-100%, and the negative percent agreement ranged between 99.2-100%.

Conclusion
The results show that the BioFire Global Fever Special Pathogens Panel could aid in rapid and actionable AFI diagnosis caused by multiple, sometimes co-occurring, pathogens. The Global Fever Special Pathogens Panel will be a valuable diagnostic tool to aid in national preparedness for disease outbreaks.

Disclosures
All Authors: No reported disclosures
1605. Dual Therapy VS Triple Therapy in Experienced PLWH: a Multicentre One-Year Long Observational Study
Authors: Russotto Ylenia , Saia Antonino Gaspare , Rullo Emmanuele Venanzi , Pellicanò Giovanni Francesco , Nunnari Giuseppe 
Published: November 2023

Abstract

Background
The introduction of new antiretroviral drugs with increased viral potency, as integrase inhibitors (INI), has changed the history of HIV. The higher potency has brought to light the necessity to reduce drug adverse effects, drug-drug interaction and costs. We conducted a multicentre observational study and we observed a group of people living with HIV (PLWH) who had switched to a two drugs regimen (2DR) for a year, comparing it with a group of PLWH who maintained the 3DR regimen, focusing on inflammation markers.

Methods
We did a multicentre parallel-group, observational study, from four Sicilian hospitals: “Gaetano Martino” hospital of Messina, “Cutroni-Zodda” hospital of Barcellona Pozzo di Gotto, “Papardo” hospital of Messina, “Cannizzaro” hospital of Catania. First group comprehends PLWH aged 18 years or older, who switched from a 3 or more drugs antiretroviral therapy (ART), of any class, to a 2DR ART, of any class excluded long acting treatment with cabotegravir + rilpivirine, between 2020 and 2022. Second group comprehends PLWH aged 18 or older, who maintained their 3DR, of any class. We performed blood analyses at three time-points (time 0, 6 months and 12 months).We considered the following items: HIV viral load, CD4+, CD4+/CD8+, platelets (PLT) count, C reactive protein (CRP) and lactate dehydrogenase (LDH). We performed a statistical analysis using the student T test.

Results
Group one comprehends 81 individuals, 69 males, mean age of 54 ± 8 years old. Group two comprehends 97 individuals, 55 males and 43 females, mean age of 49 ± 11 years old. No statistically significant difference between 2DR group and 3DR group was found in terms of HIV viral load (p-value 0.203), CD4+ count (p-value 0.238), CD4+/CD8+ (p-value 0.556), PLT count (p-value 0.631), LDH (p-value 0.295) and CRP (p-value 0.558). No adverse effects to the therapy were reported.

Conclusion
The major concern in switching to 2DR is the diminished pressure on HIV and increase of inflammation factors. Recent studies have reported no changes in inflammation markers in HIV-suppressed people who switch to 2DR, compared to those who maintain the 3DR. Considering the brief time of observation, we did not observe statistically significant changes in inflammation markers nor viral load, similarly to other studies.

Disclosures
All Authors: No reported disclosures
1633. Willingness to receive maternal RSV vaccine and infant monoclonal RSV antibody
Authors: Gidengil Courtney , Jones Jefferson M , Fleming-Dutra Katherine E , Pike Jamison , Prill Mila , Wodi Patricia , Lindley Megan , Gedlinske Amber , Parker Andrew , Scherer Aaron 
Published: November 2023

Abstract

Background
RSV results in substantial morbidity among young infants. Maternal RSV vaccines and monoclonal antibodies against RSV for infants have been developed, but little is known about acceptance of these products.

Methods
We conducted an online survey of U.S. adults who were pregnant (50%) or &lt; 12 months postpartum (50%) between December 21, 2022 and January 2, 2023. Primary outcomes in two logistic regression models were willingness to receive RSV vaccine during pregnancy (definitely or probably would) and willingness to give their infant RSV monoclonal antibody. Covariates included prior vaccinations, vaccine attitudes, RSV risk perceptions, and RSV knowledge.

Results
Among respondents (N=523), mean age was 32 years (SD + 8 years); 48% had a high school education or less. In the last 12 months, 56% had received a COVID-19 vaccine and 58% an influenza vaccine; 66% had received Tdap during the pregnancy or intended to. A third of respondents thought their infant would get RSV in the first year of life; 14% thought severe illness would result. Sixty-one percent were willing to receive maternal RSV vaccine and 70% were willing for their infant to receive monoclonal antibody; 74% expressed willingness for at least one of these products. Predictors of maternal RSV vaccine willingness were Tdap during pregnancy (adjusted Odds Ratio [aOR] 2.83; 95% CI 1.75, 4.59), influenza vaccine in last 12 months (aOR 1.63; 95% CI 1.01, 2.63), positive feelings towards vaccines (aOR 4.15; 95% CI 2.49, 6.91), and higher perceived likelihood of their infant getting RSV illness (aOR 2.42; 95% CI 1.43, 4.09). Predictors of infant monoclonal antibody willingness were Tdap during pregnancy (aOR 2.50; 95% CI 1.52, 4.11), positive feelings towards vaccines (aOR 2.52; 95% CI 1.49, 4.26), and higher perceived likelihood of RSV illness (aOR 3.57; 95% CI 1.95, 6.53); living in the South versus Northeast was associated with lower willingness (aOR 0.41; 95% CI 0.20, 0.84).

Conclusion
Most respondents (74%) were willing to receive RSV vaccine and/or give their infant RSV monoclonal antibody. Receiving Tdap during pregnancy, favorable attitudes to vaccines, and higher perceived likelihood of RSV illness were associated with willingness for these products, which may inform future roll-out.

Disclosures
All Authors: No reported disclosures