bluuebunny/crossref_metadata_2025_split huggingface dataset:
1848. Barriers and Facilitators to HIV Care in the Transgender Population
Authors: Martinez Dora , Hines Dana D , Inurritegui-Lint Arianna , Pillinger Kelly E , Simone Laura , Molloy Leah 
Published: November 2023

Abstract

Background
Transgender-inclusive healthcare focused on HIV prevention and treatment is a critical component to ending the HIV epidemic. Understanding the needs of this population is essential.

Methods
Between March – May 2022, surveys were distributed by Arianna’s Center to the transgender community to assess barriers and facilitators related to HIV care services. These results informed a national webinar for healthcare providers (HCPs), who were surveyed before and after the webinar.

Results
There were 254 individuals who completed the survey (50% transgender female; 20% transgender male; 58% LatinX; 30% African American; 31% living with HIV). The biggest barriers to accessing or staying engaged in HIV prevention/care services were socioeconomic (24%), discrimination/racism/transphobia (15%), and mental health challenges (13%).
Over half (52%) felt there were barriers to initiating conversations about sexual health and HIV and 27% reported being denied healthcare services because of their gender and/or sexual orientation.
For those taking medication for HIV prevention or treatment (59%, n = 150/254), the biggest adherence facilitator was having a supportive provider knowledgeable about transgender health (56%, n = 84/150). However, there was a disconnect between those who felt highly involved in decisions regarding their sexual/HIV health and those who wanted to be highly involved (Fig. 1). Among those who felt uninvolved in these care decisions (54%, n = 137/254), 39% (n = 53/137) felt too overwhelmed with other things in their lives and 24% (n = 33/137) felt they tried to be involved but their care team did not listen.
Most HCPs (55%, N = 98/178) attending the webinar had little to no experience caring for transgender individuals. Only 12% (n = 21/178) of HCPs felt they included their transgender clients extremely well in their HIV care (Fig. 1). Notably, there was improvement in HCPs’ knowledge (p &lt; .001) and confidence in counseling (p &lt; .001) about drug interactions between antiretrovirals and gender-affirming hormone therapy.

Conclusion
Insights from the transgender community indicate potential areas for improvement in HIV care, and can be leveraged to support HCP education to improve engagement with transgender individuals and promote shared decision-making.

Disclosures
Dora Martinez, MD, FAAFP, AAHIVS, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|Janssen: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria|ViiV Healthcare: As of May 16th will be employed by ViiV, however was not a ViiV employee at time of project Arianna Inurritegui-Lint, -, Gilead Sciences, Inc.: Advisor/Consultant|Human Rights Campaign Foundation: Advisor/Consultant|National Minority AIDS Council: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant
1858. Examining the Racial Differences in Polymicrobial Bacteremia Infections in an Area of Varying Social Vulnerability
Authors: Tan Karen K , Abdul-Mutakabbir Jacinda C 
Published: November 2023

Abstract

Background
Polymicrobial bacteremia (PMB) is associated with heightened disease severity and an increased burden of comorbidities has been identified as a key risk factor. Of interest, racially and ethnically minoritized (REM) individuals that reside in areas of high vulnerability have been shown to be more likely than their non-racially and ethnically minoritized (n-REM) counterparts to be diagnosed with chronic comorbidities. Nonetheless, there is a cessation of data that examines the confluence of these factors on PMB infection outcomes. This study aims to describe the racial differences in the outcomes of patients diagnosed with PMB in an area of varying social vulnerability.

Methods
This is an IRB-approved, retrospective cohort study of adult patients hospitalized at Loma Linda University Medical Center between January 2018 and April 2021. Positive polymicrobial blood culture samples were identified with the use of Microscan Bacterial Identification Panel. Demographics (including race/ethnicity), comorbid conditions, sepsis incidence, and infection source were collected through chart review. The Centers for Disease Control and Prevention (CDC) SVI scoring tool was used to determine the social vulnerability index (SVI). A P value of ≤ 0.05 was defined as statistically significant.

Results
A total of 70 patients REM (60%, 42/70) and non-REM (40%, 28/70) among PMB gram-negative (GN) and gram-positive (GP) cultures collected from hospitalized adult patients were included. Hispanic/Latino was the most prominent REM group (59.5%) and overall, REM patients were more likely to be classified as “highly vulnerable” when compared to non-REM patients (47.6% vs 42.9%). Also, REM patients were younger (61.5 years vs. 65.1 years) and were more likely to have underlying comorbidities (diabetes mellitus (47.6% vs 21.4%; p=0.026 and moderate to severe chronic kidney disease (28.8% vs 14.3%; p= 0.329). Additionally, REM patients were more likely to develop sepsis and severe sepsis (45.2% vs. 25.0%; p= 0.13 and 40.6% vs 35.7%, p=0.804), respectively, though there was no difference in mortality.

Conclusion
Ultimately, further research is needed to understand the confluence of race/ethnicity and social vulnerability factors on PMB clinical outcomes.

Disclosures
Jacinda C. Abdul-Mutakabbir, PharmD, MPH, Entasis: Advisor/Consultant|Entasis: Honoraria|Shionogi: Advisor/Consultant|Shionogi: Honoraria
1860. Long COVID Incidence by Sociodemographic Factors in a Large National Payor Database
Authors: Craig K J , Zaleski Amanda , Wiggins Michael , Altieri-Alger Leah , Verbrugge Dorothea , Watkins Richard R 
Published: November 2023

Abstract

Background
Race/ethnicity (R/E) may be an independent risk factor for developing long COVID or post-acute sequelae SARS-CoV-2 infection (PASC). Evaluation of real-world data will likely reveal PASC-related sociodemographic (e.g., R/E and insurance type) disparities.

Methods
A retrospective claims cohort analysis of Medicare, Medicaid, and Commercial fully-insured members (N=8,447,882) between October 2021 to December 2022 was conducted to identify members with PASC (ICD-10, U09.9). Overall differences in PASC estimated incidence and symptomatology and its duration were explored with post-hoc analyses to examine the influence of R/E and insurance type.

Results
Overall PASC estimated incidence (n = 51,649) was 0.61% and was highest among American Indian/Alaskan Native (AI/AN, 0.91%) members, followed by White (0.78%), Black or Hispanic (0.49%), Pacific Islander (PI, 0.41%), and Asian or Unknown (0.34%) R/E groups. Compared to White members, all other R/E groups except AI/AN (P = 1.0) had lower incidence (all P &lt; .01). Post-hoc analyses by R/E and insurance type indicated this trend persisted for Asian or Unknown members across all insurance types (all P &lt; .001). Furthermore, compared to White members, lower PASC incidence (P &lt; .001) was observed for a) Black Medicaid and Medicare; b) Hispanic Medicaid; and c) AI/AN Medicare members. The most frequent PASC symptoms identified by claims were pulmonary (36%), neurologic (17%), and cardiac (15%). Compared to White members (all P &lt; .001), Black members had more cardiac symptoms in Medicaid and Medicare groups and more pulmonary symptoms in Commercially insured; and Hispanic or Unknown members had fewer pulmonary, neurologic, and cardiac symptoms among all insured. There were no differences in PASC symptom duration by R/E within insurance type (all P &gt; .053).

Conclusion
Hispanic and Unknown members had fewer claims for PASC than White members, which may indicate a lower disease burden or disparities in care access. Despite having overall less PASC estimated incidence than White members, Black members had more cardiac and pulmonary symptoms. Pulmonary symptoms were most frequently identified in all R/E groups. There was no association of PASC symptom duration between R/E within insurance type.

Disclosures
KJ Craig, PhD, cvs Health Inc: employment|cvs Health Inc: Stocks/Bonds Amanda Zaleski, PhD, CVS: Employee|CVS: Stocks/Bonds Michael Wiggins, MPH, CVS: Employee|CVS: Stocks/Bonds Leah Altieri-Alger, MPH, CVS: Employee|CVS: Stocks/Bonds Dorothea Verbrugge, MD, CVS: Employee|CVS: Stocks/Bonds Richard R. Watkins, MD, MS, FACP, FIDSA, FISAC, bioMerieux: Advisor/Consultant|CVS: Employee|CVS: Stocks/Bonds
2898. PrEP Inequity Across Geographic, Racial and Sex Groups in a Nationwide US Veteran Cohort
Authors: Musoke Lewis S , Shumaker Amy , Wilson Brigid , Van Epps Puja 
Published: November 2023

Abstract

Background
Despite increasing uptake of Pre-exposure prophylaxis (PrEP) for HIV prevention, gains have been disparate across groups in non-Veteran populations. PrEP to need ratio (PnR), a measure of PrEP use relative to HIV incidence in a population, has been shown to be a useful indicator of PrEP equity. Veterans Health Administration (VHA) is the largest integrated health care system in the US and offers an opportunity to aim for PrEP equity in the Veteran population.

Methods
VHA’s nationwide databases were queried to identify PrEP users and new HIV diagnoses at each facility from 2019-2022. Unique PrEP users were defined as persons with ≥1 fill of PrEP during the calendar year (CY), excluding those with a diagnosis for HIV or chronic hepatitis B prior to the first fill in CY. A new HIV diagnosis was defined as a first ever positive HIV confirmatory test or detectable HIV viral load prior to first ever antiretroviral fill in a CY. For each region and CY, data was stratified by birth sex, self-reported race and ethnicity and the PnR was calculated as the ratio of PrEP users in a group divided by the number of new diagnoses in that group.

Results
In the VHA, overall PnR increased from 2019 to 2022 (6.8 to 20.2), with the highest in the West at 18.9 and lowest in the South at 8.9 in 2022 (Figures 1 & 2). While gains were made across both Black and White racial groups, with West (W) and Northeast (NE) erasing racial disparities, PrEP use remained inequitable among Black Veterans compared to White Veterans in the Midwest (MW) and South, with the most pronounced disparities observed in the South (Black 5.7 vs. White 12.0). Non-white Hispanics had comparable PnR to White Veterans across most regions. Nationwide, PnR in males (birth sex) was double that observed in females (birth sex), but this differed by region with MW and W erasing disparities by 2022 while gaps worsened in the South and (8.9 vs. 5.3) and NE by 2022 (16.4 vs. 4.4).

Conclusion
Despite gains over the last four years, racial and sex-based disparities exist in PrEP use along geographic lines. VHA should continue to expand PrEP access across all groups, with a special focus on the South, particularly among Blacks and birth sex females. PnR can serve as a helpful metric for PrEP programs to identify areas of greatest need.

Disclosures
All Authors: No reported disclosures
1870. Changes of Tuberculosis Incidence and Mortality after COVID-19 Pandemic: A Interrupted Time-series Analysis
Authors: Lee Jungju , Chun Byung Chul 
Published: November 2023

Abstract

Background
The objective of this study is to investigate how the incidence and mortality levels and trends of tuberculosis changed before and after the COVID-19 pandemic in Korea.

Methods
To estimate the incidence rate of tuberculosis in Korea, we calculated the number of reported cases per year from 2015 to 2021 and divided it by the corresponding mid-year population. Data on reported cases were obtained from the Korea Centers for Disease Control and Prevention, which mandates the reporting of tuberculosis. Descriptive epidemiology was used to analyze monthly incidence and mortality rates, and the Durbin-Watson test was employed to assess seasonality and time-series autocorrelation. Interrupted time series analysis (ITS) using ARIMA models was performed on both the incidence and mortality rates, with the starting point of the COVID-19 pandemic set at February 2020, when the first cases emerged in the community. The tuberculosis mortality was analyzed separately for two age groups: those aged 65 and above, and those under 65.

Results
During the study period, a total of 204,190 tuberculosis cases were reported, with 12,407 deaths identified. The ITS results showed that the incidence had a significant decreasing trend before the COVID-19 pandemic (b=-0.024, p&lt; 0.01) and a significant decrease in the level of incidence after the pandemic (b=-0.72, p&lt; 0.01). The decreasing trend of incidence was not statistically significant after the pandemic. The mortality had a continuous decreasing trend before the pandemic (b=-0.002, p&lt; 0.01), and the level of mortality significantly decreased after the pandemic (b=-0.029, p&lt; 0.01). However, the trend of mortality increased significantly after the pandemic (b=0.003, p&lt; 0.01). When analyzed by age group, the increase in mortality rate was significantly evident in those aged 65 and above (b=0.016, p&lt; 0.01), while it was not significant in those under 65 (b=0.002, p=7.08).

Conclusion
After the COVID-19 pandemic, there was a decrease in the incidence of tuberculosis, which resulted in a decrease in the tuberculosis mortality rate. However, in contrast to the pre-pandemic period, the tuberculosis mortality rate has shown a significant increasing trend since the pandemic, indicating collateral damage to tuberculosis patients due to the COVID-19 pandemic.

Disclosures
All Authors: No reported disclosures
2899. Integrating HIV Partner Services and Molecular Epidemiology Data to Enhance HIV Transmission Disruption in Rhode Island: Findings from a Public Health-Academic Partnership
Authors: Khanna Aditya , Novitsky Vladimir , Guang August , Howison Mark , Gillani Fizza S , Steingrimsson Jon , Dunn Casey , Fulton John , Bertrand Thomas , Howe Katharine , Bhattarai Lila , Ronquillo Guillermo , MacAskill Meghan , Bandy Utpala , Kantor Rami 
Published: November 2023

Abstract

Background
HIV remains a significant public health concern. Both contact tracing (identifying and notifying partners of people diagnosed with HIV) and molecular epidemiology (phylogenetic inference and cluster detection), are used to disrupt transmission. Integration of both modalities may be synergistic, though it is not evaluated or implemented routinely.

Methods
To assess whether integrating HIV contact tracing and molecular epidemiology data are more informative for public health than using each separately, we evaluated concordance between a statewide public health contact tracing database (CTDB) collected in 2008-2021 and handled by the Rhode Island Department of Health, and a statewide individual-level HIV-1 pol sequence database (SDB) collected in 2004-2021 by Brown University investigators. Molecular clusters were identified using at least one of seven common phylogenetic methods. Concordance (overlap in persons appearing in both databases) was evaluated using the Jaccard Similarity Coefficient (JSC).

Results
The CTDB included disease intervention specialist interview data from 2469 unique persons (2468 newly diagnosed; 1458 named partners) and the SDB included sequences from 3266 persons. There were 920 persons who appeared in both databases, while 2346/3266 (72%) appeared in the SDB but not CTDB, and 1549/2469 (63%) appeared in the CTDB but not SDB. Of the 351 molecular clusters identified, 156 (44%) consisted of persons also in the CTDB. The JSC between the SDB and CTDB was 0.19. Of the 920 persons in both databases, 509 newly diagnosed persons provided partner data and 63% (320/509) of those clustered phylogenetically. Of the 156 named partners of these 509, 76% (118/156) clustered phylogenetically. Cluster sizes ranged from 2-31 (mean = 3.4), of which a mean of 0.20 partners were named in the CTDB.

Conclusion
Integration between molecular epidemiology and contact tracing data may be synergistic to disrupt HIV transmission given the only moderate concordance between them. The existing concordance between the databases allows better characterization of the local HIV epidemic, while the discordance suggests data incompleteness in both databases, informing public health towards investigations to disrupt transmission.

Disclosures
All Authors: No reported disclosures
1873. The role of electronic health record note templates to improve screening for tuberculosis risk factors in children
Authors: Fink Julia , Burrough William , Hsieh Charlotte , Tamerat Mariamawit , Noor Zarin , Chitnis Amit S , Lewis Gena , Jaganath Devan 
Published: November 2023

Abstract

Background
Children should be evaluated annually for tuberculosis (TB) risk factors to detect and treat latent TB infection (LTBI), but there are gaps in screening and documentation. Embedding TB questions in an electronic health record (EHR) note template may increase screening.

Methods
TB risk assessment questions were added to the well-child and -adolescent note templates at a Federally Qualified Health Center in Oakland, California in 2014. We extracted EHR data from all well patient visits from individuals 1-19 years old without a past medical history of latent or active TB over a 7-year period. We compared the proportion of visits that documented TB risk factor screening, before and after introduction of the note template and annually.

Results
We examined 18,681 visits from 2014-2020, of which 7,071 (38%) were for children 1-4 years old, and 3,556 (19%) preferred a language other than English. One year after embedding TB risk factor questions in the note template, TB risk assessment increased from 76% to 92% (p = 0.02). In the subsequent six years, TB risk factor screening remained high ( &gt;90%) and sustained (Figure 1). This trend was also seen among visits for those whose primary language spoken was not English. Screening for adolescents ≥12 years old improved over time (63% to 86%) but had lower overall screening than children 1-4 years old (≥90%) (Figure 1, p &lt; 0.01).

The lines represent the proportion of well-child or -adolescent visits that have documentation of a TB risk assessment, overall and for children who prefer a language other than English, as well as for children aged 1-4 years old and those older than 12. The red horizontal line indicates that assessments for TB risk factors were completed in 90% of visits during the given year.

Conclusion
A simple EHR-based intervention can significantly improve screening and documentation for TB risk factors in the primary care setting and suggests that additional EHR solutions may address other gaps in the LTBI care cascade.

Disclosures
All Authors: No reported disclosures
1876. Characterization of patients with active drug-sensitive tuberculosis on synchronous and asynchronous video monitoring treatment in Cali - Colombia during 2019-2022
Authors: García-Goez José Fernando , Montes-Tello Sofía Alexandra , Rios-Pineda David A , Uribe-Romero Esteban , Rojas-Ramirez Mayra A 
Published: November 2023

Abstract

Background
Tuberculosis (TB) is an infectious disease with a high burden of morbidity and mortality, potentially curable in up to 85% of cases with first-line treatment, when adherence is over 90%. Direct observed treatment (DOTS) guarantees treatment adherence. However, barriers such as the time and cost of travel to the supply site, social stigma have weakened its efficiency. As an alternative, video monitoring of tuberculosis treatment (VDOT), had been evaluated with favorable results compared to DOTS, making it a promising strategy.Table 1.Clinical and demographic characteristics and risk factors

Methods
A quasi-experimental study was conducted in Cali, Colombia. Patients aged ≥ 18 years with TB sensitive to first-line drugs were included. Patients were allocated in synchronous VDOT, where remote and real-time video calls were daily, while in asynchronous VDOT, patients sent video messages of the daily dose intake using the WhatsApp app mobile application. The characteristics of both groups were described, and the comparison was made according to the intervention (VDOT) using Cox regression.

Results
A total of 133 were included, 66 in synchronous VDOT and 67 in asynchronous VDOT . The mean age was similar in both groups and, the 60% of the patients were male. Patients in the asynchronous VDOT group had more comorbidities. Pulmonary tuberculosis was the most frequent presentation in both groups. Treatment was completed in 43.9% in synchronous VDOT, and 28.3% in asynchronous VDOT. Loss to follow-up was higher in the asynchronous VDOT. Four deaths occurred in synchronous VDOT and one in asynchronous VDOT. The mean follow-up time was 198 days. Also, Cox regression showed that the synchronous strategy has 88% risk of completing antituberculosis treatment in less time than the asynchronous monitoring group, HR: 1.88 IC95%: 1.26 - 2.81, p= 0.002.

Conclusion
Asynchronous VDOT seems to have a higher risk of desertion than synchronous VDOT, as opposed to literature finds. A relationship between comorbidities or risk factors that have not been evidenced in our study is not ruled out. Further studies are needed to compare the effectiveness of synchronous vs asynchronous VDOT in challenging scenarios, such as low income, poor internet connectivity, poor technology, and limited logistical capacity of the TB group.

Disclosures
All Authors: No reported disclosures
1881. Costs of Treating Multidrug Resistant Tuberculosis in California, 2022
Authors: Katrak Shereen , Wang Rebecca , Barry Pennan 
Published: November 2023

Abstract

Background
New, shorter regimens containing bedaquiline, pretomanid, and linezolid (BPaL) are entering clinical use for treating multidrug-resistant tuberculosis (MDR TB). Using a micro-costing approach, we estimated the direct cost of individual episodes of care for MDR TB for four different regimens and compared the cost of BPaL regimens with previously recommended, longer regimens.

Methods
We estimated the cost of four regimens: an 18-month 5-drug regimen with an injectable agent but no bedaquiline (INJ18), a U.S. guideline-based 18-month 5-drug all oral regimen with bedaquiline (BDQ18), and two 6-month regimens: BPaL and BPaL plus moxifloxacin (BPaLM). We established a standardized set of services for each regimen, assumed no treatment side effects or treatment failure, and summed cost components in 2022 dollars. Cost components included inpatient care costs based on published literature, medication costs (340B and wholesale acquisition prices) paid by California public health TB programs, outpatient laboratory, imaging and physician fees based on California Medicaid reimbursement schedule, and case management (e.g., nurse case manager or outreach worker time, adherence incentives) based on published literature.

Results
Total direct cost for MDR TB care was $86,000-94,000 for BPaL, $86,000-96,000 for BPaLM, $117,000-187,000 for INJ18, and $127,000-203,000 for BDQ18. Hospitalization costs comprised the largest proportion of direct costs for BPaL/BPaM, regardless of type of drug pricing (47-53%) but were also a substantial component of other regimens (22-39% for BDQ18 and INJ18). Bedaquiline was the largest contributor to cost of medications for BPaL and BPaLM even with public health pricing.

Conclusion
MDR TB care is costly. Despite high cost of medications, shorter BPaL/BPaLM regimens may provide cost savings.

Disclosures
All Authors: No reported disclosures