bluuebunny/crossref_metadata_2025_split huggingface dataset:
1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs
Authors: Soria Jaime , Collins Jana , Thacker James R , Thornton Alice C , Hoven Ardis , Van Sickels Nicholas 
Published: November 2023

Abstract

Background
Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites.

Methods
We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results
In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID.

Conclusion
SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount.

Disclosures
All Authors: No reported disclosures
1553. Cost Effectiveness of Cabotegravir versus Continuous and Event-Driven PrEP: A Systematic Review and Cost-Analysis
Authors: Sharma Ishani , Hill Andrew 
Published: November 2023

Abstract

Background
The HIV epidemic continues to grow with 1.5 million new infections globally in 2021. In 2019, 62% of new infections were amongst key at-risk populations. HPTN 083 and 084 trials showed up to 88% increased efficacy of long-acting cabotegravir (CAB-LA) compared to continuous oral tenofovir/emtricitabine (TDF/FTC). However, the expense of CAB-LA ($22,200 per person per year (pppy)) limits its availability to populations who need it most. In most countries, HIV prevention budgets are highly limited, with TDF/FTC available as a low-cost generic.

Methods
We conducted a systematic review of studies on global HIV incidence in at-risk populations. The weighted incidence was calculated for each population, blood donors, and the general population. We evaluated potential HIV infection rates for 4 prevention strategies: no PrEP, continuous CAB-LA (annual cost $22,200 per person (pp)), continuous TDF/FTC (annual cost $48pp), and event-driven TDF/FTC (annual cost $12pp). For each PrEP strategy we assumed an additional $4 pppy for HIV testing, and $14 pppy for education and service access. Assumed efficacy was 90% for continuous CAB-LA, 60% for continuous TDF/FTC, and 30% for event-driven TDF/FTC. Using weighted HIV incidence rates and an assumed $1million fixed budget for HIV prevention, annual HIV infection rates for each target population were calculated for each PrEP strategy.

Results
The database searches identified 98 studies in 5,230,189 individuals. Incidence per 100 person-years (pys) ranged from 0.03 in blood donors to 3.82 in people who inject drugs (Table 1). Within the fixed $1 million budget, annual HIV infections in commercial sex workers (incidence of 3.1/100pys) would be 1,033 for no PrEP, 1,032 for continuous CAB-LA, 752 for continuous TDF/FTC, and 723 for event-driven TDF/FTC. The same trends were seen across all populations: use of event-driven PrEP prevented the largest number of HIV infections for fixed budgets.
Table 1
A table showing the number of studies, total sample size, and average incidence of HIV infection in key populations, blood donors and the general population.

Conclusion
CAB-LA is the most efficacious form of PrEP, but high prices limit numbers who can be treated. More HIV infections can be prevented using low-cost event-driven TDF/FTC as PrEP: far more people can be treated for fixed budgets. This result is consistent across a range of at-risk populations in different countries.

Disclosures
All Authors: No reported disclosures
2069. Exploring the Barriers and Enablers of Safe Oral Sexual Practices among Transgender Women of Malaysia: A Qualitative Study on STI Transmission
Authors: Ajay Telang Lahari , Shaik Daud Hezreen , Cotter Aoife , Rashid Abdul 
Published: November 2023

Abstract

Background
Transgender women (TGW) in Malaysia experience unique social and interpersonal challenges that contribute to their risk of acquiring HIV and sexually transmitted infections (STIs). (Fig 1)The study aimed to understand the experiences of this vulnerable population, barriers and enablers of safe sexual practices relating to oral transmission of STIs.Fig 1Challenges faced by Transgender women in Malaysia

Methods
Participants were recruited through a snow-balling method of sampling with the help of TGW community advocates. Theories of Health Belief Model and Andersen’s Behaviour Model of health services use were used to devise the interview guide. Semi-structured in-depth interviews and Focus group discussion with participants gave insights into the needs of the community. (Fig 2) The data obtained was transcribed, coded and subjected to thematic analysis using the constructs of the Information, Motivation and Behavioural skills (IMB) theory. Results are presented as n (%) or median (interquartile range, unless otherwise stated).Fig 2:Methodology Flowchart -Qualitative analysis

Results
Participant characteristics are outlined in table 1. The major themes that emerged through qualitative analysis are highlighted (Fig 3). The results identified gaps in awareness of oral transmission of STIs among TGW and lack of condom use during oral sex. Self-medication / non-professional treatments and lack of utilization of dental services was a concern.Table 1:Participant characteristicsFig 3:Thematic analysis map of In-depth Interviews with Major themes and Minor themes indicating Barriers and Enablers

Conclusion
The importance of social support in positively influencing health promotion as well as improving health care and dental care utilization was highlighted. The areas of concern identified through this qualitative research will inform the design and development of an educational intervention aimed at addressing these concerns and providing support. Developing a customised, culturally sensitive, peer reviewed educational intervention that will be delivered through a widely popular social media platform is proposed.

Disclosures
All Authors: No reported disclosures
1566. Determinants associated with weight gain among persons with HIV who switch to integrase strand transfer inhibitors (INSTI)
Authors: Cutshaw Melissa Klein , Harding Mahmoud , Davenport Clemontina A , Okeke Nwora Lance 
Published: November 2023

Abstract

Background
Weight gain associated with integrase strand transfer inhibitors (INSTI) has been well documented among patients with HIV. However, recent reports suggest that the observed weight gain among patients who switch to INSTIs may be associated in part with their pre-switch regimen.

Methods
We conducted retrospective analyses of a 50% sample of all treatment-experienced patients who switched to second-generation INSTI containing regimen (bictegravir/dolutegravir) at the Duke Adult Infectious Diseases Clinic (Durham, NC, USA) between 1 January 2014 and 31 December 2021. Covariates included sex at birth, age, race, ethnicity, pre-switch regimen, body mass index (BMI), CD4 count and HIV-1 viral load. All weights documented within 24 months from regimen switch were included. Outcomes of interest were percent change in weight and absolute weight change. Ordinary least squares was used to obtain average percent weight change from baseline, adjusted for covariates.

Results
Overall, 339 persons were included in the analyses. Cohort demographics were: median age 51.2 (interquartile range 44.4, 57.6), 73% male sex at birth, 56% Black, 4% Hispanic ethnicity. At regimen switch, median CD4 count was 671 (IQR 460-935), and 78% had a viral load &lt; 200 copies/cc. Mean weight at regimen switch was 87.8 kg (standard deviation [SD] 22.1kg), and mean total weight change over 24 months post-switch was +1.3 kg (SD 7.1 kg). Overall, 28% of cohort members gained &gt;5% of baseline body weight within 24 months of switch. Hispanic ethnicity (5.9% [95% CI 1.0, 10.7]) and BMI &lt; 20 (3.7% [95% CI -0.3, 7.7]) were associated with post-switch weight gain. Only efavirenz-containing pre-switch regimens were significantly associated with weight gain over 24 months post-switch; EFV/FTC/TDF (3.1% [95% CI 0.2, 6.1]), all other EFV-containing regimens (6.3% [95% 0.1-12.4]).

Conclusion
Pre-switch regimens containing efavirenz were significantly associated with weight gain after switch to second-generation INSTI-based regimens, consistent with findings from non-US based cohorts.

Disclosures
Nwora Lance Okeke, MD MPH, Gilead Sciences: Advisor/Consultant
1572. Impact of an Educational Initiative to Close Gaps in Knowledge, Confidence and Engagement in HIV Care
Authors: Okulicz Jason F , Fallon Stephen J , SAWYER J E W E L , Carter Jeffrey D , Rodriguez Melissa , Herbin Shelbye , Simone Laura , Molloy Leah 
Published: November 2023

Abstract

Background
Ongoing engagement in HIV care is crucial to optimizing outcomes while addressing changing needs. This project aimed to identify and address gaps in HIV education, counseling and engagement.

Methods
Between 12/2021 and 5/2022, 20 education sessions for people with HIV (PWH) were held in 5 US HIV clinics as a 4-part series emphasizing (1) benefits of viral suppression, (2) talking about sexual health, (3) HIV treatment options, and (4) aging well with HIV. Surveys were administered to participating PWH and healthcare professionals (HCP). Content was extended for nationwide use through an online toolkit for HCPs, and a peer mentorship video for PWH.

Results
Surveys were completed by 312 PWH and 68 HCPs who participated in the live sessions. At baseline, 32% of HCPs were confident in counseling PWH about improving ART switching and 41% about adherence, which improved to 47% (p&lt; 0.001) and 55% (p&lt; 0.001), respectively, after accessing the online toolkit. Most PWH demonstrated greater knowledge about “undetectable = untransmittable” (96%) and the need for ART for all PWH regardless of viral load (86%) after the sessions than before (69%; p&lt; 0.05 and 46%; p&lt; 0.05, respectively). Compared to baseline, more HCPs reported high confidence in counseling PWH about achieving and maintaining viral suppression (96% vs 64%; p&lt; 0.05) after the sessions. While not meeting the level of statistical significance, some increases in HCP confidence were identified in counseling PWH about coping with mental health challenges (90% vs 69%; p=0.34), and managing HIV with comorbidities (80% vs 58%; p=0.41). When asked about medication adherence, HCPs commonly identified health insurance (55%) as a barrier, while most PWH reported no barriers (61%). All participants identified top goals. Most PWH indicated a goal to educate themselves about HIV treatment and prevention while HCPs prioritized education and conversations about sexual wellness. As of August 2022, the online toolkit extension was accessed by 3,320 HCPs, and the peer mentorship video by 4,331 PWH.

Conclusion
PWH knowledge and HCP confidence in counseling PWH improved following live collaborative educational sessions. Post-program goals were aligned amongst PWH and providers who prioritized improving PWH understanding of HIV management.

Disclosures
Jason F. Okulicz, MD, Gilead Sciences: Advisor/Consultant JEWEL SAWYER, PA-C, MSHS, AAHIVS, Janssen: Speakers Bureau|Prime Education: Speakers Bureau
1574. Co-Utilization of HIV, Substance Use, and Mental Health Services Among Women with Current Substance Use
Authors: Fujita Ayako W , Ramakrishnan Aditi , Mehta Cyra Christina , Yusuf Oyindamola , Wilson Tracey , Shoptaw Steven , Carrico Adam , Adimora Adaora A , Eaton Ellen , Cohen Mardge H , Cohen Jennifer , adedimeji Adebola , Plankey Michael , Chandran Aruna , Weiss Deborah Jones , Colasanti Jonathan , Sheth Anandi N 
Published: November 2023

Abstract

Background
Integrated HIV, mental health, and substance use (SU) treatment strategies to improve health outcomes among women living with HIV (WWH) are limited. We described co-utilization of HIV, SU, and mental health treatment services among women enrolled in the Women’s Interagency HIV Study (WIHS) who report current SU.

Methods
We included data from participants enrolled in 10 WIHS sites during their last study visit from 2013-2020. Current SU was defined as self-reported, non-medical use of drugs in the past year, excluding use of only marijuana. We described utilization of each treatment service (SU treatment, HIV care, mental health care, alcohol use treatment, tobacco cessation treatment) by subgroups of participants with current SU and either HIV, depressive symptoms (Center for Epidemiologic Studies–Depression score ≥ 16), heavy alcohol use ( &gt; 7 drinks/week), or current tobacco use. We then compared utilization of services by those who did or did not utilize SU treatment using Chi-square/Fisher exact tests.

Results
Among women with current SU (n=377), 41.9% reported utilizing SU treatment (Table) and 82.7% receiving any health care. Among women with current SU+HIV (n=233), 86.3% had an HIV healthcare provider visit since last study visit; among current SU+depressive symptoms (n=204), 39.2% had a mental health provider visit since last visit; among current SU+heavy alcohol use (n=87), 23.0% utilized alcohol treatment in the past year; and among current SU+current tobacco use (n=296), 10.1% utilized tobacco cessation treatment in the past year. Among subgroups of women with current SU who were eligible for another service, utilization of other services was significantly higher among those who utilized SU treatment for alcohol and tobacco cessation treatment, but not for any healthcare provider, HIV care, or mental health care provider (Figure).

Conclusion
Among this sample of WWH with current SU, we found 1) high engagement in SU treatment, and high engagement in health care and HIV care regardless of SU treatment, but 2) low engagement in alcohol and tobacco cessation treatments. Integrated drug, alcohol, and tobacco treatment programs should not be missed opportunities for WWH with concurrent SU, alcohol or tobacco use.

Disclosures
Cyra Christina Mehta, PhD, MSPH, Merck: Grant/Research Support Ellen Eaton, MD, MPH, Gilead: Grant/Research Support|Gilead: Honoraria
1576. Implementation of a Pharmacist-Driven Initiation of Antiretroviral Therapy in Patients Newly Diagnosed with Human Immunodeficiency Virus
Authors: Griffith Kamron Amir , Wallace Katie L , Stoner Bobbi Jo , Burgess Donna R , Jeter Sarah B 
Published: November 2023

Abstract

Background
Human Immunodeficiency Virus (HIV) infects over one million people annually. A major barrier to ending this pandemic is access to care. Prompt antiretroviral therapy (ART) initiation after diagnosis reduces time to viral suppression, decreases rates of opportunistic infections, and increases patient retention. At University of Kentucky HealthCare, there was a significant wait time from intake appointment to ART initiation with a provider. Beginning in November 2019, the HIV clinical pharmacist developed a program to initiate ART at intake appointments to curb this delay.This study was conducted to evaluate the impact of this initiative.

Methods
We conducted a retrospective, quasi-experimental study assessing newly diagnosed HIV ART-naïve adult patients pre- and post-implementation of the pharmacist-driven ART initiation. Exclusion criteria included initial HIV-1 RNA &lt; 40 copies/mL (undetectable) and patients transferring care. Those enrolled between November 2017 to October 2019 were included in the pre-group and those enrolled from November 2019 to November 2021 in the post-group. The primary outcome was time to undetectable from ART prescribing. Secondary outcomes included time to HIV-1 RNA &lt; 200 copies/mL from ART prescribing, and time to undetectable from HIV-1 diagnosis.

Results
Overall, we included 185 patients (pre-group=104 and post group=81). Undetectable was achieved in 95.5% of patients. Demographics were similar between the groups (Table 1). Median days to undetectable (63.0 vs 56.5; p=0.518) and HIV-1 RNA &lt; 200 copies/mL (49 vs 43; p=0.388) from ART prescribing were similar between the two groups. Median days to undetectable from diagnosis (122 vs 85; p=0.004) and days to ART prescribing from initial visit (31 vs 0; p=0.001) were significantly shorter in the post-group. Median days to initial visit from HIV-1 diagnosis were shorter in the pre-group (13.5 vs 18.0; p=0.015). One-year retention was similar (93.2% vs 90.0%; p=0.433).

Conclusion
Our study showed a significantly shorter time to undetectable from HIV-1 diagnosis with ART initiation by a clinical pharmacist at intake visits. Additionally, retention of care remained similar despite ART initiation prior to provider visit. This initiative improved timely access to care at our institution.

Disclosures
All Authors: No reported disclosures
1580. A national prospective HIV provider survey of antiretroviral therapy preferences for management of treatment naïve and experienced individuals with genotypic resistance
Authors: Krishnan Sonya , Bjerrum Stephanie , Rivera Marina B Martinez , Shah Maunank 
Published: November 2023

Abstract

Background
HIV clinical practice guidelines outline broad treatment principles, but offer less explicit recommendations for complex patient situations. We hypothesize there is variability in antiretroviral (ARV) decision-making among experienced providers when considering HIV drug resistance.

Methods
US HIV clinicians and pharmacists were enrolled to provide ARV recommendations for up to 36 clinical case-vignettes in a series of electronic surveys (minimum survey length, 6 cases), encompassing variations of ARV resistance. Responses were categorized for each case based on drugs and classes selected, as well as anticipated activity based on genotypic susceptibility.

Results
119 experienced clinicians from across the US participated (Table 1). In the setting of high-level viremia and an isolated M184V, 85.9% selected a regimen with 2 NRTI+INSTI, while 9.9% selected regimens with &gt; 3 ARVs (Table 2, Case #1). Alternatively, when presented scenarios with treatment-failure and moderate to high-level NRTI resistance (Table 2, Case #2, 3) without PI or INSTI resistance, providers most frequently ( &gt;50%) selected an NRTI-sparing regimen, while a minority recommended 2NRTI + INSTI (21/123). Following EVG/c/TAF/FTC failure (isolated M184V, potential low level INSTI resistance, Table 2, Case #4), most providers recommended a PI-based regimen (31.2%) with 2 NRTI, or an intensified regimen with &gt; 3 drugs (32.5%), while a minority suggested a second generation INSTI (23.4%). By contrast, when low-level INSTI resistance was present with more extensive NRTI resistance (Table 2, Case #5), the majority chose an NRTI-sparing regimen (45.6%) or a regimen with &gt; 3 drugs (e.g., 2NRTI+INSTI+PI; 36.8%).
Table 1. Characteristics of survey respondents

Conclusion
There was heterogeneity in treatment preferences among providers when presented with ARV resistance. A majority suggested INSTI-based regimens (with 2 NRTI) with limited NRTI resistance alone. By contrast, most providers recommended regimens with at least 2 active drugs (e.g., NRTI-sparing or intensified with PI and INSTI) with more extensive NRTI resistance.

Disclosures
All Authors: No reported disclosures
1598. Predictive equations for immune recovery at 48 weeks of BIC/FTC/TAF treatment in Virologically Suppressed PLWHIV.
Authors: Tomé Roberto Pedrero , Buzón Luis , Pousada Guillermo , Dueñas Carlos , Galera Carlos , Sanz Jose , Troya Jesús 
Published: November 2023

Abstract

Background
The possibility to anticipate immune recovery could be of great interest when a switching strategy is planned, especially among those patients with low CD4+ count as an indirect marker of potential immunological success not only in absolute CD4+ and CD8+ count but also with CD4/CD8 ratio. The objective is to provide predictive equations that allow prognostication of 48-week immune recovery in HIV-positive men and women treated with BIC/FTC/TAF based on baseline CD4+ and CD8+ cell counts.

Methods
We collected data from 1315 adult patients with undetectable HIV+ who switched to a bictegravir/emtricitabine/tenofovir triple therapy regimen (1028 men; 287 women). We studied CD4+ and CD8+ cell counts at baseline and 48 weeks. Simple linear regression models were performed to predict patient immune status at 48 weeks according to patient sex. A logarithmic transformation of each variable was performed to obtain equations with higher predictive power. Each simple linear regression model was validated by an ANOVA test (p &lt; 0.001). In addition, the assumptions of linearity, normality of residuals (Shapiro-Wilk test), homoscedasticity (Breusch-Pagan test), and independence of residuals were verified using the Durbin-Watson test. Each model was internally validated with one-third of the dataset using a bootstrap of 5000 iterations.

Results
All four proposed equations yield good predictive values (adjusted R-squared: 0.705 - 0.835). In the case of women, the proposed formulae are as follows: [1] 48 weeks Log10 [CD8+ cells/mm3] = 0.923 + 0.671*Baseline Log10 [CD8+ cells/mm3] (adjusted R-squared = 0.835); [2] 48 weeks Log10 [CD4+ cells/mm3] = 0.702 + 0.757*Baseline Log10 [CD4+ cells/mm3]] (adjusted R-squared = 0.746). For males, the formulas are as follows: [1] 48 weeks Log10 [CD8+ cells/mm3] = 1.392 + 0.571*Baseline Log10 [CD8+ cells/mm3] (adjusted R-squared = 0.705); [2] 48 weeks Log10 [CD4+ cells/mm3] = 0.605 + 0.795*Baseline Log10 [CD4+ cells/mm3] (adjusted R-squared = 0.810). The results obtained in the bootstrap do not differ from the initial models and therefore support the equations proposed.

Conclusion
Available data on immunological recovery in patients with triple therapy are scarce, and this could be an adjunct to predicting the evolution of these patients.

Disclosures
Luis Buzón, MD, PhD, Janssen: Advisor/Consultant|Janssen: Expert Testimony|MSD: Expert Testimony|Viiv: Advisor/Consultant|Viiv: Expert Testimony Carlos Dueñas, MD, Gilead: Advisor/Consultant|Gilead: Expert Testimony|Jannsen: Advisor/Consultant|Jannsen: Expert Testimony Jose Sanz, MD, PhD, Gilead: Expert Testimony|Janssen: Expert Testimony|MSD: Expert Testimony|ViiV: Expert Testimony Jesús Troya, Staff, Gilead: Advisor/Consultant|Gilead: Expert Testimony|Janssen: Board Member|Janssen: Grant/Research Support|ViiV: Advisor/Consultant