bluuebunny/crossref_metadata_2025_split huggingface dataset:
1514. Evaluating Missed Opportunities for Confirmatory HIV Testing at a Midwest Medical Center
Authors: Caster Lauryn E , Sayles Harlan R , Fey Paul D , Bares Sara H 
Published: November 2023

Abstract

Background
Current recommendations for HIV testing begin with a 4th generation antigen/antibody (Ag/Ab) combination immunoassay followed by an antibody differentiation confirmatory assay. Discordant results may represent a false positive on the screening test or early HIV infection and must be followed up by a confirmatory HIV RNA test, but this is not done reflexively. As a result, there is a potential for missed opportunities for this confirmatory testing.

Methods
We conducted a retrospective chart review of adult patients at a Midwest academic medical center with discordant results on the screeningHIV-1/2 Ag/Ab combination assay between Jan. 2017 and Feb. 2021. We assessed if appropriate confirmatory testing was performed, identified barriers to missed opportunities for confirmatory testing, and used Wilcoxon rank sum tests, chi-square tests, and Fisher’s exact tests to evaluate differences between those who did and did not receive confirmatory testing.

Results
Of the 64 patients with a positive HIV antibody component of the Ag-Ab immunoassay and a negative confirmatory test, 35 (55%) patients completed a HIV RNA viral load. Of the 35 patients receiving the test, 3 (9%) patients tested positive for HIV. Younger age was significantly associated with completion of appropriate confirmatory testing (p=0.03), but other factors including sex, race, insurance status, having a primary care provider, specialty of ordering provider, encounter location, and test indication were not.

Conclusion
Our review identified multiple missed opportunities for confirmatory HIV testing following a positive antibody component on the HIV screening test, with younger age being a significant factor in whether an RNA test was completed or not. Our results suggest that missed opportunities to diagnose patients with HIV is occurring over a heterogenous group of patients and providers. Therefore, systemic interventions are needed to address both provider and patient centered factors preventing early diagnosis of HIV. The findings of this study emphasize the need for reflexive HIV RNA viral loads on patients when the results of the HIV Ag-Ab immunoassay and confirmatory test are discordant.

Disclosures
Sara H. Bares, MD, Gilead Sciences: Expert Testimony|GSK ViiV Healthcare: Grant/Research Support|Janssen: Grant/Research Support
2065. Efficacy of D-peptide-conjugated Antisense Compounds Against Pseudomonas aeruginosa
Authors: Koch Rachelle E , Moustafa Dina A , Pybus Christine A , Goldberg Joanna B , Greenberg David E 
Published: November 2023

Abstract

Background
Pseudomonas aeruginosa (PA) causes significant morbidity and mortality in immunocompromised hosts and those with cystic fibrosis. Peptide-conjugated phosphorodiamidate morpholino oligomers (PPMOs) are antisense compounds designed to target specific genes and prevent translation. PPMOs with L-isomer peptides (L-PPMOs) were previously shown to have in vitro and in vivo activity. However, L-PPMOs are vulnerable to degradation by host proteases. We hypothesize that PPMOs with a D-isomer peptide (D-PPMOs) may be a more stable and potent alternative. We aimed to characterize the activity of L- and D-isomers in PA strains using planktonic and biofilm assays as well as an infected mouse model.

Methods
All L- and D-PPMOs were synthesized by Sarepta Therapeutics, Inc. We tested L- and D-isomers of the (RXR)4XB (X for 6-aminohexanoic acid and B for β-Ala) and R6G peptide [(Arg)6-Gly]. PMOs for rpsJ (ribosomal protein) and acpP (fatty acid synthesis protein) were conjugated to the 3’ end of each peptide. Minimum inhibitory concentration (MIC) assays were performed in unique lab and clinical (including MDR) isolates using MOPS medium. Strain PAO1 biofilms were grown in MBEC plates for 24 hours, with PPMOs then dosed every 8 hours for 24 hours, followed by colony enumeration. For in vivo studies, mice were infected with strain PA103 intratracheally and given intranasal PPMO at 6 hours post-infection. Lung burden was determined at 24 hours post-infection.

Results
MIC values of D-R6G-RpsJ and D-R6G-AcpP were comparable to their L-isomers, but D-RXR-RpsJ showed an improved MIC90 of 0.5 μM compared to the L-RXR-RpsJ MIC90 of 16 μM (Table 1). Both isomers demonstrated reduction of 48-hour biofilm to various degrees. D-PPMO biofilm reduction ranged from 1.5 logs to &gt; 3 logs (D-R6G-AcpP and D-RXR-RpsJ, respectively). L-PPMO biofilm reduction ranged from 2 logs to &gt; 4 logs. D-PPMOs were superior to their L-PPMO counterparts in our delayed in vivo acute pneumonia model, with most D-PPMOs resulting in an additional 50% decrease in lung burden.

Conclusion
D-PPMOs show similar or improved activity in vitro and in vivo when compared to L-PPMOs at the same dosage. Future studies will investigate the pharmacology of D-PPMOs, as they may represent a more biologically robust alternative to L-PPMOs for PA infections.

Disclosures
David E. Greenberg, MD, University of Texas Southwestern Medical Center: Dr. Greenberg has numerous patents on PPMOs
1516. High Incidence of Newly Infected Syphilis, Hepatitis B and C Virus among People Living with HIV Who Have Reached U=U
Authors: Ge lingyun , Peng Qiaoli , He Yun , Liu Jiaye 
Published: November 2023

Abstract

Background
The concept of “Undetectable equals Untransmittable (U=U)” has been widely accepted. However the risk of acquiring other sexually transmitted diseases (STDs) such as syphilis (TP), hepatitis B virus (HBV) and hepatitis C virus (HCV) in people living with HIV (PLWH) in the context of “U=U” remains unclear. This study evaluated the incidence of newly STDs in PLWH in Shenzhen, China.

Methods
128 virally suppressed PLWH were investigated from March 21 to April 7 2023 at the Third People’s Hospital of Shenzhen. Information on sexual behavior, the awareness rate of U=U and clinical records were collected. Results of HBSAg, HCV RNA, TP antibody before ART(calculating baseline prevalence) and in follow-up(calculating incidence) were collected. The STD incidences among various subgroups were compared.

Results
At baseline, the prevalence of TP, HBV and HCV were 29.7%(38/128), 15.6%(20/128), and 1.56%(2/128). 78(60.9%) PLWH were not coinfected with any STDs, of which were male with a median age of 36.8 years (IQR 29, 42) and median duration of ART 4.9 years (IQR 2.3, 7), 75(96.2%) were men who have sex with men(MSM). Twelve TP, six HBV and five HCV new infections occurred over 382.9 person-years; the corresponding incidences were 3.13/100 person-years, 1.57/100 person-years and 1.31/100 person-years, respectively. One participant had TP/HBV co-infection, one had HBV/HCV, and one had TP/HCV. Surprisingly, all six newly HBV-infected PWLH received a TDF/TAF+XTC-based regimen. Among the 45 participants who had reached the awareness of U=U and 33 who had not, the new TP incidence were 2.35/100 and 4.11/100 person-years, the new HBV incidence were 1.88/100 and 1.76/100 person-yearsand, the new HCV incidence were 1.88/100 and 1.17/100 person-years(p &gt; 0.05), respectively.

Conclusion
The high incidence of newly acquired TP, HBV and HCV infection after reaching U=U highlights the necessity of STD screening and prevention in viral suppression population in PWLH.

Disclosures
All Authors: No reported disclosures
1532. Guideline Adherence to Hepatitis B Virus (HBV) Screening and Vaccination in Patients Prescribed Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis (PrEP)
Authors: Awad Reham S , Badowski Melissa E , Michienzi Sarah M 
Published: November 2023

Abstract

Background
HIV PrEP with daily oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or emtricitabine/tenofovir alafenamide (FTC/TAF) has been found to be safe and effective in reducing HIV acquisition. The US Public Health Service PrEP guideline offers recommendations for the screening and vaccination for HBV in patients prescribed oral PrEP. The purpose of offering HBV screening and vaccination is twofold. One is to reduce HBV transmission, the other is to ensure appropriate treatment and monitoring for patients with HBV infection, as abrupt discontinuation of FTC/TDF and FTC/TAF could lead to an acute flare of HBV. The goal of this study was to compare guideline adherence to the rate of HBV screening and vaccination.

Methods
This study was a retrospective comparative study evaluating the rate of HBV screening and vaccination in patients ≥ 18 years who received a prescription for oral PrEP at the University of Illinois Hospital and Health Sciences System (UI Health) during two time periods, 07/01/2014 - 09/30/2018 and 10/01/2018 - 10/01/2022. Patients receiving HBV treatment or with a positive HIV immunoassay blood test at baseline screening were excluded. The primary outcome compared appropriate screening and vaccination rates for HBV according to the US Public Health Service PrEP guideline. Secondary outcomes included documentation of immunity and/or vaccination to hepatitis A virus, human papilloma virus, and meningitis. The primary outcome was analyzed using a chi-square test.

Results
A total of 145 patients were included in cohort 1 and served as historical control data. Of 230 patients screened for in cohort 2, 145 were included. Baseline characteristics are presented in Table 1. HBV screening prior to PrEP initiation occurred in 78.6% of patients in cohort 1 compared to 67.6% of patients in cohort 2 (p = 0.034). HBV vaccination was initiated by or at first follow-up in 37.9% of patients in cohort 1 compared to 21.8% of patients in cohort 2 (p = 0.035). Secondary outcomes are outlined in Table 2.

Conclusion
HBV screening and rates of vaccination declined over time in patients prescribed oral PrEP. Overall, there is an increased need for education among providers prescribing oral PrEP to ensure pre-treatment HBV serologies are obtained.

Disclosures
All Authors: No reported disclosures
1534. A Quality Improvement Initiative for HIV Prevention in Underserved Communities
Authors: Clement Meredith E , Settle Angie D , Martorell Claudia T , Carter Jeffrey D , Rodriguez Melissa , Chadha Chelsie Anderson , Douglas Bonnie , Simone Laura , Molloy Leah 
Published: November 2023

Abstract

Background
HIV prevention services like pre-exposure prophylaxis (PrEP) remain underutilized. This project aimed to support health care professionals (HCPs) in settings like federally qualified or community health centers and free and charitable clinics in expanding HIV prevention services for underserved populations, including immigrant communities.

Methods
Baseline surveys were administered to interdisciplinary care teams in 6 clinics across the eastern US from January – March 2022. Survey data informed 4 live virtual education sessions featuring pre- and post-program surveys and team-based action planning. To promote exchange of clinical strategies, clinics with different levels of HIV prevention experience were paired together. Content was extended nationwide in an on-demand video.

Results
Baseline survey respondents (N = 121) noted the greatest challenges in PrEP implementation were limited HCP knowledge/awareness (47%) and lack of training on PrEP workflows (33%). HCPs identified common barriers to patient PrEP uptake as lack of PrEP knowledge/awareness (58%), low perception of self-risk (47%), and low health literacy (38%). HCPs felt training was most needed in patient outreach/engagement (36%) and sexual history taking (32%), and 65% reported their team could most improve on normalizing sexual health conversations. 119 HCPs attended the education sessions (Table 1). HCP knowledge of laboratory monitoring for patients on PrEP rose from 40% to 57% (p = .037), as did the proportion of HCPs reporting high confidence in initiating/monitoring PrEP use (65% vs 93%, p &lt; .001). Action plans included improving communication/care coordination (46%), increasing staff training/education (35%), and increasing patient outreach (35%) and education (35%). System champions from each clinic reporting 90-day outcomes (n = 16) agreed their clinics had improved in identifying patients for PrEP (94%) and evidence-based PrEP use (69%). As of March 2023, 1,531 HCPs had accessed the online video.Table 1.Education Session Attendees by Health Care Profession.

Conclusion
HCPs gained confidence and knowledge in patient engagement and PrEP use and made action plans that helped improve PrEP implementation, emphasizing the potential impact of targeted education on HIV prevention services in underserved communities.

Disclosures
Meredith E. Clement, MD, Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant Claudia T. Martorell, MD MPH, AbbVie: Honoraria|Gilead Sciences: Honoraria|GSK: Grant/Research Support|Theratechnologies: Grant/Research Support|ViiV: Honoraria
1543. Elevated HIV Risk/Low Risk Perception in Rural Colorado
Authors: Rivera Amanda , Epern Alexa Van , Fiorillo Suzanne , Lawrence Lisa , Litzau Shynia , Allen Lorna , Frasca Katherine , Castillo-Mancilla Jose , McGregor Donna V 
Published: November 2023

Abstract

Background
The increasing impact of HIV in rural populations highlights the need for expanding HIV Pre-exposure Prophylaxis (PrEP) access in rural communities. Little is known about HIV risk perception, or PrEP awareness, and acceptability in rural populations.

Methods
We analyzed baseline survey data from 69 residents as part of a larger study aiming to increase PrEP utilization in rural Colorado with virtual PrEP visits (TelePrEP) and mailed lab kits. The baseline survey on HIV risk, PrEP awareness, and access was conducted in 3 low-income rural Colorado counties from March 2022-February 2023. Residents were recruited from rural community settings, including a syringe service program, a substance treatment program, a migrant housing complex, a Native American Pow Wow, a college campus, and a public health clinic. All survey respondents were given the opportunity to enroll in TelePrEP services if eligible. Respondent demographics, HIV risk factors, risk perception, PrEP awareness, and access were examined. Descriptive statistics were used to characterize the cohort.

Results
Seventy-five % of the rural cohort identified as female; 23.2% as male; and 1.5% as other gender. Thirty-three % of the cohort were White; 34.8% were Hispanic; 26.1% were Native American; and 2.9% were Black. Seventy-eight % self-identified as heterosexual; 13% as bisexual; 8.7% as homosexual. Sixty-seven % self–rated personal HIV risk as low, though almost a third of the cohort reported 2 or more sexual partners, 58% reported condomless sex, and 59% reported heavy alcohol or drug use, in the prior six months. Almost 40% of the cohort reported that they or a partner had a history of incarceration. Sixty-three % reported seeing a regular health care provider (HCP). Forty-two % had heard of PrEP previously, but only 5 respondents had heard of PrEP from an HCP. Seventy-two % of the cohort felt that taking PrEP was a good way to protect themselves from HIV; however, none of the respondents chose to enroll in PrEP services.

Conclusion
Despite elevated risk for HIV acquisition and the majority having regular access to a health care provider, PrEP awareness and utilization was low in this cohort of rural residents. A gap in perceived versus objective HIV risk exists.

Disclosures
Lorna Allen, FNP-C, MERCK: Grant/Research Support Donna V. McGregor, MSN, ANP-BC, Gilead Sciences: Grant/Research Support
1545. Evaluation of Pre-exposure Prophylaxis Re-engagement Outreach Initiative for the Prevention of Human Immunodeficiency Virus Transmission
Authors: Molino Suzanne , Ramnarain Justin 
Published: November 2023

Abstract

Background
Pre-exposure prophylaxis (PrEP) is an effective method for preventing Human Immunodeficiency Virus (HIV) transmission through sex and injection drug use. However, studies have shown that HIV prevention services are limited in underserved populations. Nationally in non-research settings, data estimates 15-62% PrEP retention in care. At our clinic, approximately 15% of patients were retained in PrEP care between 2018 and 2022, with limited data on reasons why. The objective of this study is to provide data on PrEP patients lost to follow-up.

Methods
This was a single-center, retrospective, descriptive study of PrEP patients seen at the clinic who received at least one PrEP prescription and were lost to follow-up between September 2018 and June 2022. Between July and December 2022, patients lost to follow-up were contacted via telephone to re-engage in care and administered a patient questionnaire. Patients were included if they were 18 years or older, at high risk for HIV acquisition per the Centers for Disease Control, and were lost to follow up for PrEP services, defined as at least three months' time from last clinic visit. Patients were excluded if they had a previous HIV diagnosis or a clinic encounter for HIV post-exposure or HIV/sexually transmitted infection screening only. Endpoints included baseline demographics for all patients and questionnaire results from those who consented to participate. Data collection via EPIC™ chart review and statistical analysis via Microsoft Excel. Descriptive statistics were used to present results.

Results
Sixty-one patients were included. Patients had an average age of 37 years, 70% were male, and 77% were Black/African American. Most patients engaged in high-risk heterosexual behavior with multiple sexual partners of unknown HIV status and inconsistent condom use. Thirty-five patients participated in the questionnaire. Twenty-four patients endorsed self-discontinuing PrEP therapy due to: medication cost/access (6/24); difficulty adhering to clinic visits (8/24); changes to perceived risk of HIV transmission (9/24).

Conclusion
Medication cost/access, adherence to clinic visits, and perceived risk were the top three reasons for PrEP discontinuation. Further research is needed to address barriers to retaining PrEP patients in care.

Disclosures
All Authors: No reported disclosures
1549. Risk Factors, Risk Perception, and Long-acting PrEP Awareness and Interest among US Women: A National Survey
Authors: Poteat Tonia , Sarkar Supriya , Ragone Leigh , Bogan Danielle , Gallington Kyli , Coyne Karin S , Daniele Patrick , Rawlings Keith , Rinehart Alex R , Vannappagari Vani 
Published: November 2023

Abstract

Background
Cisgender women account for approximately 20% of incident HIV diagnoses in the US. However, only 10% of women who could benefit from HIV pre-exposure prophylaxis (PrEP) have been prescribed PrEP. US women face several challenges that may affect their seeking HIV prevention services, such as lack of PrEP awareness. Understanding these challenges may improve PrEP uptake, especially as innovative PrEP options, such as long-acting (LA) injectable PrEP, become available. This study explored interest in using LA-PrEP by factors that may increase risk of HIV acquisition.

Methods
Cisgender women were recruited between November 2021 – March 2022 though targeted social media ads on Facebook, Instagram, and Tinder to complete an online, self-administered survey. Eligible participants were cisgender women who were: 18+ years, current US residents, reported penetrative sex in the past six months, and reported an unknown or negative HIV status. The survey included questions on demographics, sexual health and behavior, LA-PrEP awareness, and LA-PrEP interest. Descriptive statistics were calculated using SAS v9.4.

Results
1,834 eligible women completed the survey (median age: 28 years (IQR: 25, 33); Geography: South – 65%, West – 21%, Northeast – 7.3%, Midwest – 6.8%; Race: Black, non-Hispanic – 34%, White, non-Hispanic – 25%, Hispanic – 27%, Another race – 14%). Women were more likely to have heard of LA-PrEP if they had reported injection drug use in the past year (71%), had an STI diagnosis (70%) or HIV test (66%) in the past two years, and were currently using contraception (65%). Interest in using LA-PrEP was consistently high; the difference between LA-PrEP awareness and interest was greatest among women with non-private health insurance and those with perceived likelihood of future HIV acquisition.

Conclusion
Although interest in using LA-PrEP is high among US women, these results demonstrate the large gap between LA-PrEP awareness and interest in using it.

Disclosures
Tonia Poteat, PhD, MPH, PAC, Viiv Healthcare: Advisor/Consultant Supriya Sarkar, PhD, MPH, GlaxoSmithKline: Stocks/Bonds|Viiv Healthcare: Employee Leigh Ragone, MS, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Danielle Bogan, BSN, MPH,DrPH, ViiV Healthcare: Contract worker Keith Rawlings, MD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Employee Vani Vannappagari, MBBS, MPH, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee
1552. HIV Pre-Exposure Prophylaxis Awareness, Uptake, and Persistence Among People at Risk for HIV in Two Communities in Western Kenya
Authors: Romo Matthew L , Schluck Glenna , Gayle Britt , Kosgei Josphat , Akoth Christine , Bor Rael , Langat Deborah , Yacovone Margaret , Ake Julie A , Sawe Fred , Crowell Trevor A 
Published: November 2023

Abstract

Background
Despite the increasing availability of evidenced-based HIV prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa, especially among key populations. To inform the ongoing scale-up of PrEP in Kenya, we examined PrEP awareness, uptake, and persistence among participants at enrollment into an HIV incidence cohort.

Methods
For these cross-sectional analyses, we used interim data from the screening and enrollment visits for the ongoing longitudinal Multinational Observational Cohort of HIV and Other Infections (MOCHI) in Homa Bay and Kericho, Kenya. Participants were at risk for HIV based on recent history of sexually transmitted infection, transactional sex, condomless sex, and/or injection drug use. At enrollment, participants were asked about PrEP awareness and use, agreement with statements related to concerns about PrEP and interest in different types of PrEP, and reasons for stopping PrEP.

Results
Between December 2021 and March 2023, 384 participants were enrolled (213 in Homa Bay, 171 in Kericho). The mean age was 22 years (SD 4), 302 (79%) were female, and 242 (64%) were sex workers. All participants were eligible for PrEP based on national guidelines, 262 (68%) had heard of PrEP, 65 (17%) had taken PrEP, and 20 (5%) were currently using PrEP, with greater PrEP awareness and uptake in Homa Bay vs. Kericho (figure 1). Of the 197 participants who were aware of PrEP but never used it, 100 (51%) were concerned about side effects of taking a medication every day, 70 (36%) were concerned about PrEP costs, and 65 (33%) did not perceive themselves to be at risk for HIV. Among those aware of PrEP but never used it,115 (58%) had interest in daily oral PrEP and 146 (74%) had interest in long-acting injectable PrEP. Of the 65 participants who had taken PrEP, 36 (55%) reported ever stopping it, with ‘trusting my partner’ as the most common reason (figure 2).

Conclusion
We identified substantial gaps in PrEP awareness, uptake, and persistence among individuals in Kenya who were eligible for PrEP. Potential strategies to improve PrEP engagement include education about HIV risk, addressing concerns about daily oral PrEP, and implementing additional options including long-acting injectable cabotegravir.

Disclosures
All Authors: No reported disclosures