bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-524. Comparative Costs of Implementing an Evidence-Based Online HIV Prevention Program: Direct-to-Consumer Marketing vs. Community-Based Organization Recruitment
Authors: Munroe Sarah J , Schackman Bruce R , Madkins Krystal , Saber Rana , Macapagal Kathryn , Vititow Jocelyn , Sweeney Nicholas , Feder Noah , Benbow Nanette , Mustanski Brian , Linas Benjamin P 
Published: January 2025

Abstract

Background
Black/African American and Hispanic/Latino men who have sex with men face a disproportionate burden of new HIV diagnoses. The Keep It Up! (KIU) program, an evidence-based online intervention, is effective in reducing risk behaviors. The KIU 3.0 study, conducted between 2019-2022, compared two delivery strategies: centralized, national direct-to-consumer (DTC) recruitment, and decentralized recruitment via community-based organizations (CBO). Here, we report strategy costs.

Methods
We conducted interviews to identify and quantify start-up (e.g. equipment, training), time-dependent (e.g. advertisements, payroll), and variable (e.g. incentives, medical materials) costs for both delivery models. We report costs in 2021 USD. We analyzed cost variation among CBOs and present a hypothetical scenario where all CBOs match the efficiency of the two with the lowest cost per participant.

Results
The DTC arm enrolled 1,468 participants. Start-up costs totaled $398,384 of which $376,393 was content design and development. Ongoing costs per participant totaled $501 (66.8% variable, 29.8% time-dependent, and 3.4% overhead, Table 1). The CBO arm enrolled 656 participants across 22 sites. Start-up costs totaled $511,528 of which $401,141 was content design and development. Ongoing costs per participant totaled $4,239 (9.2% variable, 69.3% time-dependent, and 21.4% overhead, Table 1). Site-specific costs ranged from $467 - $26,950 per participant with no correlation to the number of participants (Table 2, Figure 1, Spearman’s Rho = 0.007). In a hypothetical optimized CBO scenario, we estimated that 1,991 participants would enroll, start-up costs would be $470,653 and ongoing costs per participant would be $573, demonstrating that CBO delivery has the potential for similar costs to DTC delivery.

Conclusion
DTC implementation demonstrated lower costs per participant than CBO distribution. CBO costs were highly variable with no correlation to enrollment. It is important to note the challenges related to the COVID-19 pandemic (clinic closures and restrictions, material shortages, and price increases) when contextualizing these costing outcomes. Efficient implementation models are crucial for scaling evidence-based interventions.

Disclosures
Brian Mustanski, PhD, Hologic: Grant/Research Support
P-535. Implementation of Injectable Cabotegravir/Rilpivirine for Treatment of HIV in Patients with Substance Use Disorders at a Syringe Exchange Clinic
Authors: Perez Amanda E , Nieves Shane , Meisner Jessica 
Published: January 2025

Abstract

Background
Injectable Cabotegravir + Rilpivirine (CAB+RPV-LA) is a long-acting anti-retroviral therapy (ART) that has the potential to be utilized for people living with HIV (PLWH) who face significant barriers to daily ART. A key population that can benefit is PLWH with concomitant opioid use disorder (OUD) and housing instability. In this case series, we describe the implementation of a program that provides low-barrier access to CAB+RPV-LA for PLWH and OUD.

Methods
The electronic medical record (EMR) was reviewed to identify individuals aged 18 years or older with a documented HIV diagnosis and a history of intravenous drug use (IVDU) who were initiated on CAB+RPV-LA between June 2022 - January 2024 at the Sana Clinic at Prevention Point Philadelphia (PPP). Fifteen patients were identified as having initiated CAB+RPV-LA during this time period. Descriptive statistics were used to summarize demographics, clinical characteristics, and outcomes of the study population.

Results
A review of the patients started on CAB+RPV-LA found that 100% of patients (n =12) with follow-up labs after initiation had HIV viral load suppression and CD4 counts &gt; 200. Three patients did not yet have follow-up labs since initiation due to their recent start on CAB+RPV-LA. Viral load on initiation ranged from undetectable to 1440. There were no missed doses during the two-year period. All patients had OUD and 67% had housing instability.

Conclusion
Overall, CAB+RPV-LA was effective in maintaining and obtaining viral suppression in PLWH and OUD. To our knowledge, there is currently no literature on the implementation of long-acting ART for HIV maintenance in patients with OUD at a syringe exchange. Our findings support that long-acting ART is a key tool in ending the HIV epidemic especially at clinics serving patients with comorbid substance use and housing instability.

Disclosures
All Authors: No reported disclosures
P-553. The Impact of Six-Months Antiretroviral Drug Dispensing on Viral Load Suppression in 18 Health Facilities in Mozambique From 2019 to 2023
Authors: Namburete Bauaze Evangelina Inacio , Macul Helder , Nhaguiombe Herminio , Bila Erica , Gaspar Irenio , Tiberi Orrin , da Cunha Morais 
Published: January 2025

Abstract

Background
In 2019, Mozambique adopted the six-months antiretroviral drug dispensing (6MMD) for all eligible People Living with HIV (PLHIV) subgroups. Patients on 6MMD, pick up their antiretroviral drugs at the clinics every six months. As of June 2023, the model was rolled out to 85 health facilities (HFs) and overall viral load suppression was 93%. We analyzed United States President’s Plan for AIDS Relief (PEPFAR) program monitoring and evaluation data to understand the impact of six-months drug dispensing on viral load suppression.

Methods
At the end of June 2023, we analyzed Viral Load data obtained from electronic patients tracking system (EPTS) an OpenMRS used by PEPFAR to report HIV data nationally in all PEPFAR supported sites in Mozambique. Based on the volume of clients served ( &gt;1000 PLHIV) by each health facility, we selected 9 out of 85 health facilities that implemented six-months antiretroviral drug dispensing and 9 that were not implementing, and we compared the overall percentage of viral load suppression at each HF in June 2019 and June 2023.Viral load was considered suppressed if &lt; 1000 copies/ml in the last consultation for patient enrolled on 6MMD and in the last 6 months for patient not enrolled on 6MMD. All the 18 HFs were PEPFAR supported sites.

Results
As by June 2023, the 18 HFs selected had 126,719 PLHIV on treatment, representing 6% of PLHIV on treatment in the country. Overall Viral load suppression in June 2019 & June 2023 in the 9 HFs with 6MMD ranged from 69 – 72% & 91 – 94% while in the 9 HFs that were not implementing 6MMD ranged from 69 – 74% & 78 – 89%.

Conclusion
In the sites we assessed, six-months antiretroviral drug dispensing contributed to reduce HIV transmission by improving viral load suppression rates in Mozambique.

Disclosures
All Authors: No reported disclosures
P-575. Evaluation of Weight Gain on Incident Hypertension among People Living with HIV-1 Receiving Dolutegravir (DTG)-Based Regimens or Comparator Antiretroviral Therapy (cART) in Randomized Clinical Trials through 96 Weeks
Authors: Jones Clifford B , Pozsonyiova Sofia , Grove Richard , McKenna Michael , Patel Parul 
Published: January 2025

Abstract

Background
Weight gain has been observed with integrase strand transfer inhibitor (INSTI)-based treatment with an association between INSTI use and hypertension (HTN) in some studies. We observed no difference in odds of incident HTN and minimal weight increase in participants receiving DTG-based or comparator antiretroviral therapy (cART) through Week (W)96. Here, we evaluated the relationship between ART use, weight gain, and HTN risk among participants without baseline (BL) HTN receiving DTG or cART in pooled phase 2/3 studies.

Methods
Data from ART-naive participants randomized to either DTG-based ART (+ ABC/3TC or TDF/FTC), or cART (EFV/TDF/FTC, RAL + 2 NRTIs, or DRV/r + 2 NRTIs), were pooled from the SPRING-1 and -2, SINGLE, and FLAMINGO trials. HTN at BL, W24, W48, and W96 was defined as a single systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, HTN history or HTN adverse event, and/or antihypertensive use. Mixed-models repeated-measures (MMRM) analyses evaluated adjusted change from BL in weight. Bayesian Joint Models (JM) evaluated the associations between treatment, weight change, and treatment and weight change interaction with HTN risk. Models were adjusted for key BL variables and pooled treatment.

Results
Among 2345 participants, 23% (n=530) were excluded for BL HTN; of the remaining, 927 received DTG-based ART and 888 received cART. At W96, adjusted mean (SE) change in weight was 1.98 (0.242) kg for DTG-based ART vs 1.59 (0.212) kg for cART (treatment difference: 0.39 kg; 95% CI: −0.25, 1.04; P=0.230). From JM, treatment (DTG-based ART vs cART) was not independently associated with HTN risk through W96 (mean, M [hazard ratio, HR]: 1.099; 95% credible interval [CrI]: 0.876, 1.370). On average, a 1-kg increase in weight was estimated to increase HTN risk (HR) by 1.012 (CrI: 1.004, 1.020). No evidence of treatment separation was observed through the treatment-weight interaction (DTG-based ART HR: 1.013 [1.003, 1.022]; cART HR: 1.009 [0.998, 1.020]).

Conclusion
Weight gain was moderately associated with HTN risk through W96. ART was not an independent risk factor for HTN. Weight gain attributed to treatment effect impacted HTN risk similarly.

Disclosures
Clifford B. Jones, BSc MSc MB ChB, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Sofia Pozsonyiova, MS, GSK: Employee|GSK: Stocks/Bonds (Public Company) Richard Grove, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company) Michael McKenna, MBChB, GSK: Employee|GSK: Stocks/Bonds (Public Company) Parul Patel, MSW, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee
P-583. Admission Diagnoses and Outcomes among Hospitalized People Living with HIV during Pre-COVID-19, COVID-19 and Post-COVID-19 Pandemic Periods
Authors: Khawcharoenporn Thana , Panutat Pattarapoom 
Published: January 2025

Abstract

Background
Coronavirus disease 2019 (COVID-19) has affected human immunodeficiency virus (HIV) care in many ways. However, impacts on admission diagnoses and outcomes among hospitalized people living with HIV (PLHIV) have not been evaluated.

Methods
A retrospective cohort study was conducted among hospitalized PLHIV at a Thai tertiary care center during the 3 periods, Period 1: Pre-COVID-19 (September 2017-March 2020), Period 2: COVID-19 (April 2020-September 2022, and Period 3: Post-COVID-19 (October 2022-October 2023). Characteristics, admission diagnoses and outcomes were compared between PLHIV admitted during these 3 periods. Factors associated with hospital mortality were determined.

Results
Of the 310 PLHIV included, 117, 125 and 68 were admitted during Period 1, 2 and 3, respectively and 115 (37%) were newly diagnosed HIV on admission. Median CD4 cell counts and proportions of those with antiretroviral therapy (ART) adherence rates of ≥95% at admission were different between the periods [(206, 97 and 138 cells/mm3 and 97%, 89% and 100% in Period 1, 2, and 3 (P=0.02 and P=0.06)]. Of the 310 PLHIV, admission diagnoses were non-AIDS-related (62%) and AIDS-related (38%). Most of the non-AIDS-related diagnoses were infections (40%) while opportunistic infections were the most common for AIDS-related diagnoses (88%). The types of admission diagnoses were not different between the 3 periods. Among 62 PLHIV who developed in-hospital complications, 47% and 39% had nosocomial infections and drug-related complications, respectively. Hospital mortality rates were 10%, 13% and 16% during Period 1, 2, and 3 (P=0.80). By multivariable analysis, intensive care unit admission, underlying malignancy, monthly income less than $USD 400, and admission CD4 count less than 50 cells/mm3 were independently associated with hospital mortality.

Conclusion
Although admission during COVID-19 pandemic period was not associated with increased mortality, we observed the impact of the pandemic on the lower CD4 cell count and ART adherence at admission among hospitalized PLHIV. Interventions to improve early care engagement, ART adherence, and close monitoring for those with identified mortality risks are needed for better HIV care, especially during pandemics.

Disclosures
All Authors: No reported disclosures
P-584. Tailored telehealth behavioral health coaching demonstrates feasibility and potential in overcoming barriers to HIV treatment outcomes
Authors: Labisi Titilola , Furl Renae , Hansen Deanna M , Burwell Lance L , Carr Rachelle , Fadul Nada 
Published: January 2025

Abstract

Background
People with HIV (PWH) face challenges, including behavioral health, stigma, financial constraints, homelessness and homophobia that negatively impact their HIV care. Unfortunately, limited, tailored programs exist to address these problems. Additionally, transportation and time constraints may hinder participation in available programs. Thus, Nebraska’s Specialty Care Center implemented the Intervention to Telehealth and Text to Improve Engagement in Care (i2TEC), a Health Resources and Services Administration (HRSA) HIV/AIDS Bureau-funded evidence-informed intervention aimed to address the intersection of mental health, substance use, and HIV. Here, we describe i2TEC program and its early impact on viral suppression (VS) among PWH in Nebraska.

Methods
Delivered by a licensed behavioral health therapist (BHT), participants receive 12 weekly behavioral health virtual coaching sessions. Participants could choose from various topics such as HIV care, mental health, relationships, sexuality, housing, and lifestyle. Then, they collaboratively work with the BHT to identify barriers to their HIV care and establish goals to overcome them. Participation in i2TEC requires being an HIV diagnosed adult not fully engaged in HIV care.

Results
Of the 50 participants enrolled in i2TEC, 84% were males, and 50% were non-Hispanic Whites. At baseline, 64% had a positive screen for substance use, 54% had a positive screen for depression or anxiety, and 71% did not have durable VS. Sixty percent had follow-up viral load labs, of which 97% had achieved VS within one-year post-enrollment. Participants' most identified discussion topics were lifestyle/health and socioeconomic needs (housing, food, and transportation). Overall, 95% would recommend the program, 86% agreed that i2TEC helped improve their mental health, and 76% reported that the program improved their medication adherence.

Conclusion
Preliminary findings from this tailored telehealth behavioral health program demonstrate feasibility and potential for improving HIV outcomes and overcoming individual barriers to VS. Through the delivery of i2TEC, we identified priority coaching needs among PWH. Future studies focusing on the topics identified by participants and the long-term impact of such programs are recommended.

Disclosures
Nada Fadul, MD, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support
P-622. Diurnal Rhythms in Varicella Vaccine Effectiveness
Authors: Danino Dana , Kalron Yoav , Hazan Guy 
Published: January 2025

Abstract

Background
Immune processes are influenced by circadian rhythms. A previous study evaluating the relationship between vaccination time-of-day and vaccine efficacy was conducted during a pandemic mass vaccination campaign. We evaluate this association with the varicella vaccine in a setting of a childhood immunization program.

Methods
A national cohort study was conducted: All patients under 6 years old who received one dose of the varicella vaccine between January 2002 and December 2023 were enrolled. The main outcome was defined as a varicella breakthrough infection according to ICD-9 codes. We compared children vaccinated during morning hours (7:00-10:59), late-morning to afternoon (11:00-15:59), or evening hours (16:00-19:59). A Cox proportional-hazards regression model was used to adjust for differences in ethnicity, sex, and comorbidities, estimating the association between varicella vaccine administration time-of-day and varicella breakthrough infection.

Results
Of 238,432 children vaccinated against varicella, 1.8%) 311,4) experienced breakthrough infections. Breakthrough infection rates differed based on vaccination time, with the lowest rates associated with late-morning to afternoon (11:00-15:59), HR 0.88, 95% CI 0.82-0.95, P&lt; 0.001, and the highest rates with evening vaccination (16:00-19:59), HR 1.44, 95% CI 1.33-1.55, P&lt; 0.001. Vaccination timing remained significant after adjustment for patient ethnicity, sex, and comorbidities (Figure 1A,B). The association between varicella immunization time and infection risk followed a sinusoidal pattern, consistent with a diurnal rhythm in vaccine effectiveness (Figure 2).

Conclusion
We report a significant association between the time of varicella vaccination and its clinical effectiveness, similar to the association observed with the COVID-19 vaccine, providing proof of concept consistent with a diurnal rhythm in vaccine effectiveness.

Disclosures
Dana Danino, Dr. MD, Pfizer: Grant/Research Support
P-624. Changes in Pneumoccocal serotypes in adults and children after 2 years of introduction of PCV13 in National Inmunization Plan in Colombia
Authors: Escobar Franco Omar Huang , Giraldo Erika Alejandra 
Published: January 2025

Abstract

Background
Pneumococcal disease remains a significant public health concern globally, particularly affecting vulnerable populations such as children and adults. The introduction of pneumococcal conjugate vaccine 13 (PCV13) into national immunization plans has aimed to reduce the burden of pneumococcal disease by targeting specific serotypes. However, monitoring changes in pneumococcal serotypes following vaccine introduction is crucial for understanding vaccine effectiveness and potential serotype replacement.
Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia 2023
Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia by age group, INS data as of December 2023.

Methods
In this study, data were extracted from the National Institute of Health for the Surveillance of Pneumococcus in Colombia. We conducted a comparison of proportions to analyze changes in pneumococcal serotypes among both adults and children after two years of PCV13 introduction. Serotype distribution was examined pre- and post-vaccine introduction to identify shifts in prevalence.
Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age, Colombia 2023
Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age in Colombia by age group, INS data as of December 2023.

Results
Our analysis revealed a notable decrease in vaccine serotypes among both adults and children following the introduction of PCV13. However, an increase in non-vaccine serotypes was observed during the same period. Of particular significance, isolates of serotypes 19A, 3, and 6C continued to predominate, suggesting a persistent challenge in combating these serotypes despite vaccination efforts.
Distribution of Streptococcus pneumoniae serotype isolates in persons over 60 years old, Colombia 2023

Conclusion
The findings of this study underscore the complex dynamics of pneumococcal serotype distribution following the introduction of PCV13. While the vaccine has led to a reduction in vaccine-targeted serotypes, the emergence of non-vaccine serotypes presents a new challenge for pneumococcal disease prevention and control efforts. Continued surveillance and research are essential to monitor serotype trends and inform vaccine strategies to effectively combat pneumococcal disease in both children and adults.

Disclosures
Omar Huang Escobar Franco, MD, MSc, PhD., Pfizer: Honoraria
P-627. Modeling the Clinical and Economic Impact of Increasing Varicella Vaccination Coverage in Panama
Authors: Burgess Colleen , Samant Salome , Hirata Luciana , Parellada Cintia I , Estripeaut Dora , Pawaskar Manjiri D , Lang John C 
Published: January 2025

Abstract

Background
Panama implemented two-dose universal varicella vaccination (UVV) in 2018. First-dose vaccination coverage rates (VCRs) declined from 91% (2018) to 70% (2021) during the COVID-19 pandemic. We quantified the clinical and economic impact of increasing UVV VCRs over a 10-year time horizon.

Methods
A previously published age-structured dynamic transmission model was adapted to Panama using country-specific demographic, healthcare resource use, cost, and epidemiological data or comparable proxy. Four UVV strategies (1st dose: 15 months; 2nd dose: 4 years) were evaluated, with 1st dose VCR assumed to be (A) 70% (status quo), (B) 80%, (C) 90%, and (D) 95% for the strategies A-D (Table 1). Second dose VCR was assumed to be 50% of first dose VCR. Outcomes were evaluated over a 10-year time horizon (2022-2031) and included cumulative varicella cases, outpatient cases, hospitalizations, deaths, payer (direct) costs, and societal (direct and indirect) costs. Costs were reported in 2023 USD with 3% annual discounting.

Results
Under the status quo (strategy A), we estimated 232,381 cumulative varicella cases, 159,123 outpatient cases, and 7,320 hospitalizations over 10 years, resulting in total payer and societal costs of $29,335,329 and $36,893,235, respectively. Increasing 1st dose/2nd dose VCR from 70%/35% (Strategy A) to 80%/40% (Strategy B) will avert approximately 3.6% of varicella cases, 4% of hospitalizations, and 1.8% of deaths. Increasing VCR to 90%/45% (Strategy C) will avert 6.8% of all cases, 7.7% of hospitalizations, and 3.5% of deaths compared to reference Strategy A. The impact of increasing VCRs to 95%/47.5% (Strategy D) resulted in a further reduction in varicella cases by about 20% more than Strategy C. Strategies B-D increased payer costs by 2%-6% ($0.02-$0.04 per person per year [PPPY]) and societal costs by 1%-4% ($0.01-$0.03 PPPY) over the 10-year time horizon versus reference strategy A (Figure 1).

Conclusion
Increasing UVV VCRs compared to the status quo will result in improved clinical outcomes with marginal increases in payer and societal costs.

Disclosures
Colleen Burgess, MS, Merck & Co., Inc., Rahway, NJ, USA: Contractor Salome Samant, MBBS, MPH, Merck & Co., Inc., Rahway, NJ, USA: Employee- earned salary and own stock|Merck & Co., Inc., Rahway, NJ, USA: Stocks/Bonds (Public Company) Luciana Hirata, PhD, Merck & Co., Inc., Rahway, NJ, USA.: I am an employee of MSD subsidiary of Merck & Co., Inc., Rahway, NJ, USA. and may hold stock or stock options in Merck & Co., Inc. Cintia I. Parellada, MD, PhD, Merck & Co., Inc: Employee|Merck & Co., Inc: Stocks/Bonds (Private Company) Manjiri D. Pawaskar, PhD, merck: employee|merck: Stocks/Bonds (Public Company) John C. Lang, PhD, MSc, MSc, BSc, Merck & Co., Inc.: Stocks/Bonds (Private Company)|Merck Canada Inc.: Employee