bluuebunny/crossref_metadata_2025_split huggingface dataset:
1802. Reconstructing Twelve Years of Dengue Outbreaks in the Caribbean Using Travel Surveillance
Authors: Taylor-Salmon Emma , Morrison Andrea , Grubaugh Nathan D 
Published: November 2023

Abstract

Background
Dengue is the most common arboviral disease worldwide and the leading cause of febrile illness among US travelers returning from the Caribbean. Infectious disease surveillance of international travelers is an effective method for detecting pathogens circulating in resource-limited areas. Due to the large number of infected travelers diagnosed in Florida, we hypothesized that we could use travel surveillance data to reconstruct local outbreaks in the Caribbean, focusing on Cuba, Dominican Republic, Haiti, Jamaica, and Puerto Rico.

Methods
We obtained reports of international travel-associated dengue virus infections diagnosed in Florida between 2009-2022 from the Florida Department of Health (FL DOH) mosquito-borne disease surveillance system. We calculated travel incidence rates using the yearly number of air travel passengers arriving in Florida from international destinations. We calculated local incidence rates from yearly dengue case counts from Caribbean countries and territories with local transmission, provided by the Pan-American Health Organization (PAHO).

Results
Most infected travelers recently arrived from Cuba; however, travel dengue incidence poorly correlated with local dengue incidence there (R = 0.502), raising concerns about the accuracy of local surveillance. Conversely, travel dengue incidence from the Dominican Republic, Jamaica and Puerto Rico strongly correlated with local incidence (R = 0.744, 0.942, and 0.930), implying that travel data is a good predictor of local outbreaks in these countries. We discovered that during outbreak years different dengue virus (DENV) serotypes were responsible for outbreaks on each island, demonstrating that regional outbreaks are likely due to overall favorable conditions, such as mosquito abundance, and not due to a new introduction or mutation.

Conclusion
Travel surveillance data provides a good approximation of local dengue incidence in some Caribbean countries but does not correlate strongly with local case reporting from Cuba and Haiti. This raises the possibility of using real-time tracking and sequencing of dengue cases in Florida, paired with travel surveillance data, to detect Caribbean outbreaks as they are occurring to inform public health policy in resource-limited countries.

Disclosures
All Authors: No reported disclosures
1805. Tennessee’s Drug Diversion Investigation Team: A Collaborative Approach to a Growing Public Health Problem
Authors: Wren Callyn , Evans Christopher D , Godwin Simone , Gambrell Ashley , Patel Dipen , Nation Michelle , Talley Pamela , Wilson Christopher 
Published: November 2023

Abstract

Background
Injection drug use using nonsterile equipment can lead to transmission of viral, bacterial, and fungal infections. Frontline healthcare workers (HCW) are at high risk for substance use disorder due to unprecedented job stress and access to injectable controlled substances. The Tennessee Department of Health (TDH) developed a collaborative investigative process to determine the risk of bloodborne pathogen (BBP) transmission from licensed HCWs engaging in drug diversion. This program recommends public health action and provides consultation to improve drug diversion programs.

Methods
In 2019 TDH formed a drug diversion investigation team (DDIT) consisting of pharmacists, epidemiologists and medical directors from the HAI and HIV/STI/Viral Hepatitis programs. The DDIT responds to notification by the Health-Related Boards (HRB) of a licensed HCW under investigation for diversion of injectable products. The DDIT interviews the investigator and meets the facility drug diversion program to review drug diversion policies and processes. Based on the suspected method(s) and, if known, the individual’s Hepatitis B/C and HIV status, recommendations are made regarding the need for patient notification and testing.

Results
From 2020–2022 the DDIT received notification of 49 licensed HCWs under investigation for diversion of injectable products. Patient notification and testing was recommended in seven facilities for CDC Category A infection control breaches; in two cases, later HCW testing negated the need for further action. Among the 34 facilities queried, only five (14.7%) had existing policies for for-cause BBP testing. Other recommendations to improve diversion programs include infection prevention participation and releasing “not eligible for rehire” status to other facilities.

Conclusion
The TDH DDIT facilitates communication with HRB on reported cases of injectable drug diversion. Joint investigations with facilities raise awareness of the risk of BBP transmission and improve facility diversion programs. Tennessee facilities are adding for-cause BBP testing to their investigation procedures. The TDH DDIT model receives mostly positive responses from facility and health system drug diversion teams and may be considered by other public health jurisdictions.

Disclosures
All Authors: No reported disclosures
1824. Impact of Social Determinants of Health on Preferred Treatment of Trichomonas vaginalis and Chlamydia trachomatis
Authors: Arena Christen , Kenney Rachel M , Eriksson Erin , Brar Indira , Veve Michael 
Published: November 2023

Abstract

Background
The 2021 CDC Sexually Transmitted Infections (STI) Treatment Guideline modified preferred therapy for Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) from single dose to a 7-day course. Social Determinants of Health (SDOH) are non-medical factors that influence a person’s life; little is known regarding the association between SDOH and TV and CT treatment. The study objective was to evaluate treatment of TV and CT infections after the guideline update and determine if health inequities exist with use of preferred therapy.

Methods
IRB approved, retrospective cohort of patients ≥ 15 years with confirmed diagnosis of uncomplicated TV or CT in outpatient settings. Excluded: pregnant/nursing, allergy to preferred therapy, unable to take oral. Primary outcome: proportion who received guideline preferred vs non-preferred (alternative, discordant, or null) antibiotic therapy. Logistic regression was used to identify variables associated with preferred treatment; SDOH were exposures of interest. Secondary outcomes: test of cure (≤ 3 months), any repeat positive test (recurrence/reinfection), any retreatment, expedited partner therapy (EPT) offered. A sample of 712 patients was needed to detect a 10% difference between two exposures (α=0.05, β=0.2).

Results
473 (66%) patients received preferred therapy; patient characteristics are in Table 1. Patients &lt; 25 years had more asymptomatic disease compared to older patients (198 [54%] vs 150 [44%], P=0.01). Patients who received Emergency Department (ED) care were more likely to receive preferred therapy compared to outpatient clinics (201/264 [76%] vs 272/448 [61%], P=&lt; 0.001). Black race, lower median income, and public insurance covaried with ED care. After adjusting for female sex, receipt of ED care was independently associated with preferred therapy (Table 2). 181 (25%) patients had 3-month test of cure performed; repeat positive test/retreatment was more frequent in patients who received non-preferred therapy (25 [11%] vs 24 [5%], P=0.01). EPT was offered in 35 (7%) and 8 (3%) patients in the preferred and non-preferred groups (P=0.03).Table 2:Variables Associated with Receipt of Preferred Therapy. Abbreviations: ED, Emergency Department; UnAdjOR, unadjusted odds ratio; AdjOR, adjusted odds ratio

Conclusion
Preferred therapy was more frequent in patients who received ED care. EDs represent an important safety net and provide high-level care for patients with SDOH barriers.

Disclosures
Erin Eriksson, PharmD, BCPS, BCIDP, Stryker Corp: Stocks/Bonds Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria Michael Veve, PharmD, MPH, National Institutes of Health: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support
1826. Demographics and Risk Factors Associated with HIV Testing among Uninsured Patients Accessing a Free PrEP Program in Northwest Florida
Authors: Boney Colton , Park Erin G 
Published: November 2023

Abstract

Background
Underserved communities in the south are disproportionally affected by the Human Immunodeficiency Virus (HIV). Despite highly effective prevention methods, communities such as sexual minority men (SMM), persons of color (POC) and individuals experiencing multiple social determinants of health (e.g. lack of insurance, poverty) face many obstacles to HIV testing and Pre-Exposure Prophylaxis (PrEP). This study describes demographic characteristics and risk factors associated with HIV testing within the context of a no-cost PrEP program for uninsured persons living in Escambia County, FL.

Methods
Enrollment data from the program was used to characterize the relationship between HIV testing, race/ethnicity, prior PrEP use, among other factors. Chi-square and Fisher Exact tests between HIV testing and risk factors were examined, and program demographics were compared to the county’s census data to see if the program reached more POC. With approval from the Florida Department of Health, OASIS provided a limited data set containing all HIPAA compliant information in their enrollment and HIV test forms. Statistical analysis was conducted using Stata v16.

Results
Of the 107 participants, 13% reported never been tested for HIV and 63.5% reported never been on PrEP. Findings suggest that HIV testing differed by gender, ethnicity, sexual orientation, number of sexual partners, prior STI diagnosis, and sex with an anonymous partner (p&lt; 0.05). For example, White patients were more likely to have never had an HIV test as compared to Black participants (p&lt; 0.05). When reviewed, the program's profile contains 5.53% more people of color as compared to Escambia County's Census demographics for 2020.

Conclusion
Our findings suggest that many factors are associated with HIV testing uptake in this population of uninsured patients served by the OASIS program. Understanding the demographic and health factors associated with lower uptake can help clinicians target populations who can benefit from HIV education and testing.

Disclosures
All Authors: No reported disclosures
1828. The Stratification of HIV Viral Suppression Rates and Related Health Outcomes of UNMC HIV Clinic Patients by Local Zip Code in Omaha, NE
Authors: Carter Mark , Fadul Nada , Liu Jennifer , Tarfa Adati , Cordon Brent , Lyden Elizabeth 
Published: November 2023

Abstract

Background
Previous research has established associations between self-reported racial/ethnic identity and poorer HIV outcomes; Black patients have disproportionately higher prevalence and poorer viral suppression rates compared to White patients. Expanding upon this research by identifying local Nebraska zip codes with poorer health outcomes will further characterize the concept of “structural racism” which refers to the perpetuation of racial discrimination by reinforcing systems of oppression related to housing, healthcare, and other social determinants of health.

Methods
Within the patient database at the UNMC HIV specialty clinic, 1,261 adult patients 19 years and older with HIV-1 infection were recruited. The analysis was done with 1097 patients who reside in Nebraska and have SVI data available. Demographic and clinical data were obtained through the patient database. Weighted-average SVI calculations were completed for each patient zip code by using the ratio of total addresses in each census tract to total addresses in the zip code. The SVI score range is 0-1, 0 being lowest risk and 1 being highest risk. Areas with SVI scores ≥ 0.9 have been characterized as being particularly high risk. Fisher’s exact test was used to look at the association of sociodemographic characteristics with the SVI (dichotomized &lt; 0.9 vs. ≥ 0.9). A p-value &lt; 0.05 was considered statistically significant.

Results
There is a statistically significant association between poverty level and SVI group (p = 0.0073). Among patients with SVI &lt; 0.9, 48.1% of patients at or below 100% poverty level compared to 60.9% of patients who have SVI ≥ 0.9 (very high risk). A statistically significant association between race and SVI group (p &lt; 0.0001) is seen; the proportion of Black patients is higher in areas with very high SVI (51.3%) compared to areas with SVI &lt; 0.9 (28.0%). There is a statistically significant association between poor viral suppression and SVI group (p = 0.0076). 11.7% of those who reside in areas with SVI ≥ 0.9 have viral loads ≥ 200 copies/ml compared to 5.6% of those who live in areas with SVI &lt; 0.9.

Map of SVI Score by Zip Code in Omaha, NE

Conclusion
The results are consistent with the study hypotheses that racial minority patients are more likely to reside in areas with high SVI and that high SVI is associated with poverty and poorer clinical outcomes.

Disclosures
All Authors: No reported disclosures
1830. Social determinants of cardiovascular disease risk factor control among people living with HIV
Authors: Cutshaw Melissa Klein , Jones Kelley , Longenecker Chris , Okeke Nwora Lance 
Published: November 2023

Abstract

Background
HIV is associated with an elevated risk of cardiovascular disease, yet hypertension and high cholesterol are often sub-optimally treated in people with HIV. The role of racial disparities and social determinants of health in the management of these cardiovascular risk factors is poorly understood.
Average systolic blood pressures vs TIS score (hypertension treatment intensity), by Black race
TIS (therapeutic intensity score) was calculated by dividing the patient’s antihypertensive medication dosage by the maximum daily dosage approved by the US Food and Drug Administration, then summing this proportion for each antihypertensive medication prescribed. For example, if a patient was prescribed two antihypertensive medications each at 75% of the maximum approved dosage, the TIS score would be calculated as 1.5 (0.75 + 0.75).

Methods
We performed a cross-sectional analysis of adult patients with HIV among three academic medical centers in the United States. We considered various social determinants of health including race, sex, measures of economic stability, education level, health insurance, health literacy, social deprivation index by zip code, and measures of psychosocial stress. We examined a hybridized outcome of risk factor control (poor or good) and treatment intensity (minimal or maximal) for two key cardiovascular risk factors, hypertension and hyperlipidemia. Multinomial logistic regressions were performed to identify factors associated with cardiovascular risk factor control and intensity, with “good control, maximal treatment” used as the reference group.

Results
Overall, 371 persons were included in the analysis. Participants were 23.5% female, 59.6% Black, 7.3% Hispanic/Latino, with a median age of 59 (interquartile range 53-64). Among study participants with hypertension, Black participants were more likely to have poor control despite maximal treatment (relative risk ratio [RRR] 2.95, 95% CI: 1.30-6.66). In our hyperlipidemia analysis, having the highest quartile of perceived stress was more common among participants with poor than good cholesterol control (27.0% vs 15.9%, p=0.032). Compared to participants with good control and maximal treatment of high cholesterol, participants with the highest quartile of perceived stress were more likely to have poor control with minimal (RRR: 2.80, 95% CI: 1.02-7.63) or maximal (RRR: 3.64, 95% CI: 1.20-11.1) treatment.

Conclusion
Race and social determinants of health, including perceived stress, appear to influence cardiovascular disease risk factors among persons with HIV.

Disclosures
Nwora Lance Okeke, MD MPH, Gilead Sciences: Advisor/Consultant
2895. Expanding PrEP by Embedding Navigators in High STI Testing Clinical Sites
Authors: Braithwaite R Scott , Pitts Robert , Kapadia Farzana , Ban Kaoon 
Published: November 2023

Abstract

Background
Opportunities for PrEP continue to be missed in key populations. We established a PrEP navigation program (“SNAPS”) with the goals to (1) increase PrEP uptake among groups disproportionately impacted by HIV and (2) preserve and improve PrEP adherence in an NYC safety-net hospital setting.Table 1:Demographic Profiles For Pre-SNAPS and Post-SNAPS Individuals.Chi-squared or t-test approximation may be incorrect due to small sample size.Table 2.MPR for Post-SNAPS Individuals After 1 Year of Follow-up. Chi-squared or t-test approximation may be incorrect due to small sample size.

Methods
SNAPS consisted of 5 components: (1) Surveillance of clinical sites where STI testing is high but PrEP use is rare e.g., ED and Women’s Health Clinic (WHC), (2) Navigation for PrEP-eligible individuals (3) Accelerated follow-up with PrEP experts, (4) Point-of-care counseling and lab testing, and (5) Seamless longitudinal care. SNAPS launched 6/2019 with 2 full-time navigators. One year pre- vs post-SNAPS implementation we compared the sociodemographic profiles of PrEP initiators, their site of enrollment, and their medication possession ratios (MPRs), a proxy for PrEP adherence. Those on PrEP were a mixture of urgent and continuity care adults initiating PrEP at a safety-net hospital system. Bivariable analyses, employing Chi-square and t-test statistics, were conducted to compare sociodemographic profiles and MPR pre- vs post-SNAPS.

Results
We analyzed data on 274 (n=147 pre-SNAPS and n=127 post-SNAPS) individuals on PrEP. Compared to the pre-SNAPS period, post-SNAPS individuals were more likely to be cisgender women (33.9% vs 13.6%), Black or Latinx (84.3% vs 49.6%), uninsured (35.4% vs 29.3%), and Spanish speaking (58.3% vs 17.0%) (Table 1). Post-SNAPS individuals were more likely to be started on PrEP from the ED (51.2% vs 0%) or WHC clinic (10.2% vs 0%). Mean MPR for post-SNAPS was significantly lower than pre-SNAPS, 0.64 vs 0.89 (p &lt; 0.001). Among post-SNAPS individuals, MSM were more likely to have higher MPRs compared to MSW and WSM individuals (Table 2). Furthermore, no difference in MPR was noted by race, preferred language, or insurance type.

Conclusion
SNAPS successfully identified and linked key populations historically missed for PrEP opportunities. Efforts to improve SNAPS should target medication adherence.

Disclosures
All Authors: No reported disclosures
1835. Factors impact Longevity in Persons Living with HIV
Authors: Gill Arshpal , Oehler Cassandra , Kodavatiganti Srivastava , Baker Samantha , Hsiao Chiu-Bin 
Published: November 2023

Abstract

Background
In contrast to high mortality including young patient in 1990’s, persons living with HIV (PLWHIV) can expect a near-normal life expectancy of 77 years. Recent mortality data suggests significant number of HIV positive patients pass before the age of 70 years. There is a current paucity of literature looking at characteristics of the elderly PLWHIV when comparing to patients who died from HIV at a younger age. The goal of this study was to compare factors between the current HIV population living longer than age 70 and the population that did not survive until age 70 at the Positive Health Clinic (PHC). PHC is an urban city Ryan White funded HIV Care Medical Home Clinic, at Pittsburgh, PA, that provides care to ∼920 PLWHIV

Methods
A retrospective chart review of patient records at PHC; with patients from period between 2015 -2022 was queried for HIV viral load, recent CD4 counts, and social history. Smoking, alcohol, and drug use were used as primary social measures due to their known impact in early development of prevalent chronic comorbidities. A Chi squared test was then employed to analyze for statistical significance of these factors (P &lt; 0.05) between the cohort of patients that are living beyond the age of 70 (longevity) and the cohort of patients who died prior to age of 70

Results
A total of 149 records were obtained (122M/ 27F, 95W/54B). The median age of HIV diagnosis and death was 44 and 60, respectively. There was no statistical difference between two groups in gender, race, and initial HIV transmission route, but being diagnosed with HIV after the age of 40 was associated with longevity. Unsurprisingly, patient with last viral load above 500 or CD4 below 200 were less likely to survive past age 70. HIV viral load &lt; 200, persistently, in past 5 years and absence of smoking in last 15 years were the 2 factors most strongly associated longevity. Alcohol abuse and drug use were less likely to survive age 70. Statistical data between the two groups are listed in Table attached.
Comparing factors associated with living beyond 70 versus dying before 70

Conclusion
Common comorbidities such as diseases of heart, lung, kidney and cancer are impacted by substance misuse, and as a result may serve as a barrier to reaching old age in PLWHIV. Counseling against tobacco use, treatment of alcohol and drug addiction while sustaining viral control with HAART can promote the longevity of PLWHIV.

Disclosures
Chiu-bin hsiao, MD, Gilead: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria
1851. ID Fellow Quality Improvement Project Shows Gains in Oral Health Exams for People with HIV
Authors: Park Terrence , Richey Lauren , Seal Paula 
Published: November 2023

Abstract

Background
Oral Health is important in people with HIV and remains an important HRSA performance measure. This HRSA measure is the percentage of people with HIV who had an oral health exam by a dentist in the performance year out of the people who had a medical visit in that same year. Our clinic is unique in that it has a Ryan White funded dental clinic with 3 full-time dentists on site. The percentage of patients receiving an oral health exam had decreased in recent years due to shutdowns and fear during the COVID-19 pandemic as well as the vaccine and testing requirements implemented for safety.

Methods
A quality improvement project was designed by an infectious diseases fellow to improve the number of patients receiving an oral health exam. The project was multipronged. The first step was educating the HIV providers about how to place a referral to the HIV dental clinic. The second was placing educational posters in each exam room to educate the patients about the importance of oral health and encourage them to ask for a referral. The last was giving each patient a questionnaire when they checked in for their visit. Each patient filled in the date of their last oral health exam, where it was received, and willingness to be referred for an oral health exam if not examined in the past 12 months. The questionnaires were collected by the provider and served as a reminder to refer. Our goal was a 40% improvement over our baseline, which was 23% in 2020 (goal &gt;32.2%). The intervention began in September of 2022.

Results
In 2019, 31% of our HIV primary care patients were seen in the attached dental clinic, this dropped to 23% in 2020 and 24% in 2021. In the three months prior to our intervention, 38% of patients were referred, and 286 patients had an oral health exam; during the intervention 56%(n=388) of patients were referred, and 329 had an oral health exam. In 2022, 33% of HIV primary care patients were seen in the attached dental clinic, showing an increase despite only three months of the intervention.

Conclusion
Early results indicate an increase in the referrals and an oral health exams with this quality improvement intervention. Outcomes were limited by significant no shows and confounded by removal of COVID vaccine and testing requirements.

Disclosures
All Authors: No reported disclosures