bluuebunny/crossref_metadata_2025_split huggingface dataset:
2058. Effect of Covid-19 lockdowns on identification of advanced HIV disease in outpatient clinics in Uganda
Authors: Sekar Preethiya , Nalintya Elizabeth , Kavuma Paul , Kigozi Joanita , Ssuna Martin , Kirumira Paul , Naluyima Rose , Namuli Teopista , Skipper Caleb , Hullsiek Kathy Huppler , Boulware David R , Meya David , Rajasingham Radha 
Published: December 2022

Abstract

Background
Despite HIV test and treat initiatives, the World Health Organization (WHO) estimates that 25% to 40% of persons living with HIV (PLWH) have advanced HIV disease (CD4&lt; 200 cells/mcL). The objective of this study is to understand how the Covid-19 pandemic affected identification of persons with advanced HIV disease in Ugandan HIV clinics.

Methods
We retrospectively reviewed data from 67 HIV clinics surrounding Kampala, Uganda. As part of routine data collection for PEPFAR reporting, number of persons entering care by clinic and number of persons presenting with CD4&lt; 200 cells/mcL were summarized by month between July 2019 and January 2022. We used the Johns Hopkins Coronavirus Resource Center website to summarize Ugandan Covid-19 cases by month. Covid-19 lockdown dates were taken from the Ugandan government’s COVID-19 information website. Specifically, between March and May 2020, there was a period of strict lockdown where public transportation was halted. Between May and July 2020 there was a less stringent lockdown (public transportation was available, but schools and many businesses remained closed). Again between June and July 2021 a strict lockdown occurred.

Results
Prior to the Covid-19 pandemic, between July 2019 and February 2020, an average of 16% (265/1675) of PLWH presented monthly with advanced HIV disease. During Covid-19 lockdowns from March 2020 to July 2020, only 9% (102/1124) of PLWH presented with advanced HIV disease. During the period of lockdown, there was a 33% reduction in the monthly average number of PLWH presenting to HIV clinics, and a 62% reduction in the monthly average number of PLWH presenting with advanced HIV disease. From February 2021 to January 2022, 18% (185/987) of PLWH presented with advanced HIV disease. During this period, there was a 42% reduction in the number of persons presenting to HIV care; of those who presented, a larger portion presented with advanced HIV disease.

Conclusion
The Covid-19 lockdowns negatively affected presentation of PLWH to care, most significantly among persons with advanced HIV disease. This reduction in presentation to care has persisted and not recovered to pre-Covid levels. In the past year, 18% of PLWH presented with advanced HIV disease.

Disclosures
All Authors: No reported disclosures.
2065. Increasing the HIV screening rates in Rural Syringes Service Programs
Authors: Collins Jana , Soria Jaime , Thacker James , Corby-Lee Greg , White Connie , Johnson Tisha , Hoven Ardis , Thornton Alice C 
Published: December 2022

Abstract

Background
The Kentucky Income Reinvestment Program (KIRP) is a statewide reinvestment of income generated by the Ryan White HIV/AIDS Program (RWHAP) Kentucky AIDS Drug Assistance Program, which provides comprehensive early intervention services targeting those at the highest risk for HIV infection. The objective of this study was to compare the HIV screening rates in persons who inject drugs (PWID) at Syringe Service Programs (SSP) supported by KIRP versus SSPs not supported by KIRP in Kentucky

Methods
A cross-sectional study was conducted on 54 SSPs. We compared the HIV screening rates in the first quarter of 2020, 2021, and 2022. Fisher's exact test compared the HIV screening rates between the KIRP supported SSPs (KSSP) versus Non-KIRP supported SSPs (NKSSP). Study data were collected and managed using REDCap electronic data capture tools hosted at Kentucky Department for Public Health. The statistical analyses were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results
The analysis included data of 21,072 PWID who attended the SSPs utilizing the REDCap electronic data capture tool during the study timeframe. In the first quarter of 2022, a total of 1,607/4795 (33.5%) PWID were screened for HIV at KSSP vs 12/482 (2.5%) at NKSSP (p=&lt; 0.001). The difference in the screening rates has increased over the years since the KIRP began in 2019 (Figure 1).

Conclusion
The HIV screening rate in PWID has increased significantly in the SSPs supported by KIRP through RWHAP program income early intervention funds. This increase has occurred mainly in rural counties where people who inject drugs remain a significant population at risk for new HIV infections.

Disclosures
All Authors: No reported disclosures.
2069. Prevalence of Cabotegravir and Rilpivirine Resistance Associated Mutations Among Treatment Experienced Patients in a South Carolina Outpatient Clinic
Authors: Vivian Tsai Y , Pizzuti Morgan , Deaney Michael , Bookstaver P Brandon , Ahuja Divya , Derrick Caroline 
Published: December 2022

Abstract

Background
Cabotegravir/rilpivirine (CAB/RPV) long-acting (LA) injectable was recently approved as a switch therapy for people living with HIV (PLWHIV) who are virologically suppressed on oral combination antiretroviral therapy (cART). Data demonstrates RPV resistance associated mutations (RAMs) correlated with CAB/RPV treatment failure. This is the first real-world retrospective, observational study evaluating epidemiology of RPV and CAB RAMs in a heavily treatment experienced population of PLWHIV.

Methods
A cohort of PLWHIV were screened for transition eligibility to CAB/RPV therapy in a large clinic in the Southeastern U.S. between April 1, 2021 and January 31, 2022. The following baseline characteristics were collected: gender, age, race, Charlson Comorbidity Index, current cART, and prior cART exposure. The Stanford University HIV Drug Resistance Database was utilized to evaluate the inferred resistance level for reverse transcriptase (RT), integrase strand transfer inhibitor (INSTI), and protease inhibitor (PI) sequences.

Results
Among 115 patients included, 64.3% were males who were predominately African American (83.4%), with a median age of 37 years old and Charlson Comorbidity Index of 1.65. Ten (8.69%) individuals had at least one RPV or CAB RAM. Among these, 7 (6%) and 3 (2.6%) displayed RPV and CAB resistance, respectively. The most prevalent types of RAMs for RPV specifically were Y181I/C (n = 4) and E138A (n = 2). Five of 7 individuals with RPV RAMs had history of cART use without documented exposure to RPV-containing regimens. Moreover, 2 of 3 individuals with CAB RAMs had history of cART with exposure to an integrase-containing regimen.

Conclusion
This is the first study that characterizes susceptibility patterns that may affect CAB/RPV in clinical practice. Within this rural Southeastern population, prevalence of RPV RAMs is higher than CAB RAMs, and RPV RAMs were commonly observed as transmitted resistance whereas CAB RAMs were typically associated with prior history of exposure to INSTI-containing regimen. It is pertinent to assess the genotypic resistance profile of RTs and history of cART exposure prior to transitioning to CAB/RPV to decrease the risk of virologic failure due to RAMs.

Disclosures
P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.
2074. Analysis of Current Pharmacy Statutes and Regulations Governing Pharmacists' Authority to Administer Cabotegravir (CAB) for PrEP in the United States (US)
Authors: Colangeli Hailey 
Published: December 2022

Abstract

Background
The Ending the HIV Epidemic initiative aims to increase PrEP use among eligible Americans to 50% by 2030. As one of the most widely accessible healthcare providers, pharmacists are well positioned to support these efforts. The latest advancement in HIV prevention—long-acting injectable CAB for PrEP—offers a novel solution to the adherence challenges of oral regimens. Understanding the current landscape of medication administration privileges for pharmacists is critical to facilitating uptake of CABr and preventing HIV transmission.

Methods
This was a cross sectional analysis of state pharmacy statues and regulations from 50 US states and the District of Columbia (States). Data were obtained from publicly accessible, official websites of the regulatory agencies with jurisdiction over the practice of pharmacy in each respective state. We analyzed current laws in effect as of February, 2022 in accordance with best practices for legal mapping. Using a standardized analysis algorithm, we determined the impact of state laws on pharmacists’ ability to administer CAB.

Results
Current state legislature allows administration of CAB by pharmacists in 44 States (80.3%). Broad authority is granted in 28 states (55.0%) where administration is defined within scope of practice. In 5 states, pharmacists can administer injectable medications if the prescription order contains explicit instructions for pharmacist administration, or a standing protocol. Among 8 states that require a collaborative practice agreement for CAB administration, 3 currently allow pharmacists to administer other long acting injectable medications without restrictions. Of the 6 states where pharmacist administration of CAB is prohibited, 2 allow administration of similar formulations. Private rooms for gluteal injections are only required in 13 states. Furthermore, treatment-specific training is only required in 3 laws, while 11 require completion of relevant continuing education.

Conclusion
Considerable variation exists among state laws governing the practice of pharmacy. Differences in scope of practice definition, medications expressly discussed, and continuing education and training requirements limit the ability of pharmacists to facilitate PrEP uptake through administration of cabotegravir.

Disclosures
All Authors: No reported disclosures.
2076. Increased awareness but persistently restricted access to pre-exposure prophylaxis against HIV (PrEP) in an urban midwestern community
Authors: Uhlar Adrianna , Lewis Steven A , Bogorodskaya Milana , Avery Ann A 
Published: December 2022

Abstract

Background
Pre-exposure HIV prophylaxis (PrEP) was approved by the United States Food and Drug Administration in 2012, but uptake of PrEP by individuals in the community has been slow, especially among populations at high risk for HIV. Our study aims to assess changes in PrEP awareness and access between 2015 and 2020, during which a major community-wide PrEP awareness campaign was initiated in our community.

Methods
We surveyed patients at three sexually transmitted infection clinics in Cleveland, Ohio in 2015 and 2020. The participants’ involvement was voluntary and anonymous. Participants were asked questions regarding demographics, sexual behavior, and awareness and access to PrEP.

Results
Of the 910 and 262 patients surveyed in 2015 and 2020, 31.4% and 20.9% were ≥ 24 years old, 54.2% and 83.2% were Black, and 11.3% and 7.6% were men who have sex with men (MSM), respectively. PrEP awareness increased from 2015 to 2020 (18.0% vs. 57.7%, p&lt; 0.001) while knowledge on how to access PrEP improved but remained low (18.1% vs. 32.0%, p&lt; 0.001). PrEP awareness among Black MSM increased from 41.9% to 72.7% (p=0.02) and in 2020, there was no significant difference in PrEP awareness between Black and non-Black MSM (72.7% vs. 88.9%, p=0.56). Knowledge of access to PrEP was similar among Black and non-Black MSM (44.4% vs. 54.6%). Among Black women who have sex with men (WSM), PrEP awareness increased from 12.9% to 62.0% (p&lt; 0.001) and knowledge of access to PrEP increased from 19.0% to 38.2% (p = 0.001). However, there remained a non-significant difference in knowledge of PrEP access between Black and non-Black WSM in 2020 (38.2% vs. 62.5%, p=0.07). Logistic regression adjusted for year, age, and MSM population showed Blacks were still less likely to be aware of PrEP compared with non-Blacks (OR 0.69, 95% CI 0.49, 0.98).
Differences in PrEP awareness and access between Black and non-Black men who have sex with men (MSM) in 2015 and 2020.
* p&lt; 0.05
Difference in PrEP awareness and access between Black and non-Black women who have sex with men (WSM) in 2015 and 2020.

Conclusion
We observed an increase in PrEP awareness and knowledge of how to access PrEP between 2015 and 2020, especially among the Black population. However, when adjusted for year, age, and sexual preference, Blacks were still less likely to be aware of PrEP compared with non-Blacks. Knowledge on how to access PrEP remains low in the community regardless of race. With increased awareness of PrEP, novel approaches to increase knowledge of PrEP access are needed to address health disparities in our community.

Disclosures
All Authors: No reported disclosures.
2363. Clinician Educators within Infectious Diseases Society of America (IDSA): Who We Are, What We Do, and What We Need to Succeed
Authors: Zimmer Andrea J , Barsoumian Alice E , Hsu Jennifer , Walker Jeremey , Summers Nathan A , Derber Catherine , Allen Bradley L , Ressner Roseanne , Kershaw Colleen , Luther Vera 
Published: December 2022

Abstract

Background
To best support, its membership, the IDSA Medical Education Community of Practice (Med Ed CoP) must know the spectrum of educational duties, common challenges, and needs among its clinician educators (CE). Further, benchmark data for medical education is lacking, including average time to perform duties, salary support, and other resources. Therefore, we conducted a survey to help identify opportunities for institutions and IDSA to support Infectious Disease (ID) CE.

Methods
We conducted an anonymous electronic mixed-methods survey of ID CE faculty in the United States. The survey link was distributed through the IDSA Med Ed CoP and Program Director discussion forums and receptions at IDWeek 2021.

Results
Approximately 90/552 (16%) participants completed a majority of the survey. Respondents were evenly distributed by gender and geographic region. A majority of respondents were Caucasian, aged 30 – 49 years, and at the Assistant or Associate Professor level (Table 1). Overall breakdown of allocated duties is as follows; median education full-time equivalent (FTE) was 0.25, clinical FTE=0.50, administrative FTE=0.16, and research FTE=0 (Table 1). Faculty most commonly taught medical students (95%), physician residents (92%), and fellows (88%) and held positions within ID fellowship programs (69%) and medical schools (50%, Table 2). CE's common challenges included competing responsibilities (69%), lack of medical education mentorship (51%), and inexperience in medical education publication (67%). In addition, 77% reported burnout in the past year, frequently due to an increased pandemic-related workload. CEs would like to see opportunities for IDSA grants, advocacy for salary support, and increased opportunities to publish within IDSA journals. CEs report finding reward in their educational work related to: teaching the next generation, developing relationships with learners and colleagues, and promoting others’ success.

Conclusion
In our study, ID CEs identified common challenges including educational work often requiring more time than allocated FTE, lack of mentors, publishing educational activities, recognition of CE work for promotion, and burnout. Additionally, ID CEs identified practical strategies in which their institutions and IDSA can offer support.

Disclosures
All Authors: No reported disclosures.
2083. HIV Testing Rates in NC Emergency Departments Before and During Covid Mitigation
Authors: Leonard Michael , Thomas Jeremy , Tapp Hazel , Ludden Thomas 
Published: December 2022

Abstract

Background
During the early stages of the COVID-19 pandemic, non-emergent services were limited or suspended in multiple ways. Restrictions in primary care may have limited STI testing, such as HIV, where timely access to testing and care is critical to mitigation efforts. Conversely, Emergency Departments (ED) operated with fewer restrictions and more in-person options. Even though patient census numbers decreased in some areas from those seen pre-covid lockdown, EDs and hospitals often became overwhelmed with patients seeking care for both severe acute illness but just importantly services that might normally have been received in outpatient settings.

Methods
Observational study of HIV screening year-over-year in four EDs that are part of a large healthcare system located in the Southeast. Screenings of individuals 18 and over seen in the EDs were normalized per 1000 patients. Rates were also compared to two primary care clinics, located in the same metropolitan area, serving mainly Medicaid and uninsured patients.

Results
From March 2019 through February 2020 there were 33.47 tests per 1000 patients at two community clinics and 7.79 tests per 1000 patient at four EDs located in the same region during that span. From March 2020 to February 2021, screening numbers in the primary care clinics dropped to an average of 22.7/1000; however, screenings in the ED remained stable and slightly increased to 10.7/1000. From March 2021 to February 2022, screenings in the primary care clinics returned to an average 36.9/1000 with screenings in the ED still above pre-covid levels at 9.48/1000. These trends in the ED screening remained consistent across gender, race, and ethnicity.
Patient census at four ED sites located in the southwestern region of North Carolina dropped significantly during the first year of physical distancing covid-19 mitigation measures when compared to the two years prior. These census numbers increased during the second year of covid-19 but failed to return to previous levels.
During the first year of physical distancing covid-19 mitigation measures HIV testing rates in the emergency department remained constant, and even increased in more urban areas, despite the significant decrease in overall patient census.

Conclusion
With the observation that HIV screening decreased in primary care settings during the beginning of the covid-19 pandemic, there exists the possibility that new HIV infections may yet remain undiagnosed. That HIV testing remained constant in the ED, however, reinforces the importance of having embedded procedures in place for screening and linking both newly positive and at-risk patients into care to help mitigate the HIV epidemic.

Disclosures
All Authors: No reported disclosures.
2086. PrEP Knowledge and Use among Reproductive Age Women in Miami, Florida
Authors: Nogueira Nicholas Fonseca , Luisi Nicole , Salazar Zetina Ana S , Raccamarich Patricia , Klatt Nichole R , Jones Deborah L , Alcaide Maria L L 
Published: December 2022

Abstract

Background
Miami, FL is the epicenter of the HIV epidemic in the US, with 20% of new HIV infections occurring in women. Despite the effectiveness of PrEP, only 10% of eligible women benefit from its use. This study evaluates PrEP awareness and use, and factors associated with PrEP awareness among reproductive age sexually active women in Miami.

Methods
From 2018 to 2022, cis-gender, HIV-negative, 18-45-year-old, sexually active women were recruited as part of a study evaluating HIV risk. Participants completed questionnaires assessing socio-demographics, HIV risk behaviors, prior HIV testing, PrEP awareness and use, and were tested for STIs (chlamydia, gonorrhea, trichomoniasis) and bacterial vaginosis (BV). Factors associated with PrEP awareness were analyzed by Chi-square, Fisher’s exact test, or studentized t-test. Multivariable logistic regression (MLR) was performed to identify factors associated with PrEP awareness.

Results
295 women were enrolled; median age 31 (24-38) years, 49% Black, 39% White, 34% Hispanic, 46% income below poverty line, 24% consistent condom use, 1.6 (±2.57) mean number of partners in the previous month, 80% heterosexual, 73% previously tested for HIV, 22% STI, and 50% BV. Of the 63% who knew about PrEP, only 5% were on PrEP. Women aware of PrEP were more likely to be Black, non-Hispanic, have income below poverty line, non-heterosexual, report prior HIV testing, and have a STI or BV (all p&lt; 0.05). Condom use and number of partners were not associated with PrEP awareness. In MLR, women with income below poverty line (OR=2.00 [1.04,3.87]; p=0.04), more sexual partners (OR=1.30 [1.01,1.68]; p=0.04), prior HIV testing (OR=6.42 [2.83,14.52]; p&lt; 0.01), and BV (OR=2.28 [1.18,4.40]; p=0.01) were more likely to be aware of PrEP. Lower odds of PrEP awareness were associated with being Black (OR=0.38 [0.15,0.96]; p=0.04), Hispanic (OR=0.18 [0.08,0.39]; p&lt; 0.01), Heterosexual (OR=0.29 [0.11,0.77]; p&lt; 0.01), and reporting occasional condom use (OR=0.21 [0.08,0.56]; p&lt; 0.01).

Conclusion
Despite broad PrEP awareness, PrEP use is alarming low among those women at greatest risk. HIV testing presents an opportunity to increase PrEP awareness, but interventions to increase PrEP uptake are needed to end the HIV epidemic among women.

Disclosures
Maria L L. Alcaide, MD, Gilead: Advisor/Consultant.
2091. Transgender Adolescents of Color and HIV: Unique Challenges in Preventing New Infections
Authors: Collins-Ogle Michelle , Garcia Matthew , Acevedo Sahara 
Published: December 2022

Abstract

Background
An estimated HIV prevalence of 9.2% for all transgender persons nationally with a significantly higher prevalence for transgender women at 14.1%. A paucity of published data exists defining the risk of HIV in transgender or non-binary (TGNB) youth of color. The Bronx has the highest incidence of homelessness and the highest unemployment rate in the country, which peaked at 24.6% during COVID19. We assessed SDOH in TGNB youth of color and the impact on their ability to prioritize and access HIV prevention.

Methods
An assessment of sexually active TGNB youth 14-27 years (N=101) in 2021-2022 was conducted to evaluate potential barriers to HIV prevention by querying the 4 U's: 1) Unemployed 2) Uninsured / Underinsured 3) Unstable housing and 4) substance Use disorder. The assessment also integrated questions about gender affirmation, HIV / STI prevention. Information obtained was used to assess knowledge gaps that affect their understanding of HIV risk. Based on the results, a research tool, ARTISTA (Assess Risk for Transmitted Infections in Sexually active Transgender Adolescents) was implemented to improve gaps in understanding HIV / STI risk in TGNB youth. Ultimately, ARTISTA can be used to influence policies for HIV Prevention in this population.

Results
Patient's mean (+sd) age was 20 (+ 2.7) years, 50% were trans female, 50% trans male, 66% were youth of color. Gender affirming care was associated with increased odds of STI testing (adjusted odds ratio = 1.90 95% confidence interval = 1.33-2.73 with no relation to gender identity. Despite awareness, initiation of PrEP and adherence among trans females was disappointing. Trans females, 24%(10/41) initiated PrEP, 2 seroconverted; 1 stopped and 7 are 70% adherent to daily oral PrEP. Unemployment (23%), Unstable housing (11%), Uninsured (10%) and Substance Use disorder (40%) were priorities over prevention.

Conclusion
Gender affirmation is associated with an opportunity to improve awareness of HIV / STI prevention. ARTISTA assessment reveals it's not just about PrEP, but about the social / structural barriers to access and uptake. SDOH must be addressed in this population if we are serious about ending the epidemic.

Disclosures
All Authors: No reported disclosures.