bluuebunny/crossref_metadata_2025_split huggingface dataset:
1253. Acceptability and feasibility of long-acting injectable antiretroviral therapy for persons who inject drugs in Vietnam: using the Consolidated Framework on Implementation Research to identify determinants and inform implementation strategies
Authors: Rutstein Sarah E , Sibley Adams L , Nguyen Trang Thu Do , Tran Ha Viet , Giang Le Minh , Sripaipan Teerada , Nguyen Minh , Huffstetler Hanna E , Miller William C , Eron Joseph J , Gay Cynthia L , Go Vivian F 
Published: December 2022

Abstract

Background
Long-acting injectable antiretroviral therapy (LAI) is an exciting alternative to daily oral ART. Less frequent dosing afforded by LAI may be especially pertinent for persons who inject drugs (PWID), who experience more HIV-related mortality largely driven by inadequate ART adherence. We used the Consolidated Framework on Implementation Research (CFIR) to characterize determinants of LAI implementation, focusing on use among PWID, in Hanoi, Vietnam.

Methods
We conducted in-depth interviews with HIV-infected PWID, ART providers, and policymakers using purposive sampling, recruiting respondents with diverse ART experience from public HIV/ART clinics and national regulatory agencies. Participants were briefed regarding LAI ART, including administration, effectiveness, side effects, and dosing frequency. Data were coded and analyzed using thematic analysis.

Results
We interviewed 19 PWID, 14 providers, and five policymakers (February-November, 2021). We identified recurrent themes in CFIR domains. Intervention: All informants were excited about LAI, citing convenience and discrete dosing as major facilitators. Surprisingly, provider concerns, including more frequent clinic visits and injection reactions, were rarely voiced by PWID who described monthly injections as similar to current visit frequency and cited “high pain tolerance.” Outer: Providers and policymakers were eager to offer patients ART choice but were divided as to if LAI distribution should proceed with sub-population prioritization. Inner: Providers described personnel and clinic logistic concerns but were confident these could be addressed. Individual: Providers were motivated and confident in their ability to deliver LAI. Process: Transitions to new ART and provision of COVID-19 vaccines were frequently invoked by providers and policymakers as interventions informing LAI implementation. FigureDeterminants of LAI ART implementation in Vietnam using the domains of the Consolidated Framework on Implementation Research

Conclusion
Using CFIR, we identified multiple determinants of LAI implementation in Vietnam. Stakeholders agreed that LAI was feasible and acceptable. Medication tolerance and efficacy concerns highlight the importance of patient and provider education. Areas where stakeholders diverge should be considered in designing LAI implementation strategies.

Disclosures
Joseph J. Eron, MD, Adagio Therapeutics: data safety monitoring committee|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Glaxo Smith Kline: Advisor/Consultant|Merck: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support.
1271. HIV-1 Drug Resistance in Patients Failing Integrase Strand Transfer Inhibitor-Based Regimens in Rhode Island, USA
Authors: Nagel Katherine E , Novitsky Vladimir , Aung Su , Solomon Matthew , Won Cindy , Brotherton Amy , Howison Mark , Gillani Fizza S , Kantor Rami 
Published: December 2022

Abstract

Background
Integrase Strand Transfer Inhibitors (INSTIs) are the most common antiretroviral therapy (ART) anchor drugs. Despite reassuring clinical trial data, real-life extent and characteristics of resistance at failure of INSTI-based regimens are unclear and can inform care.

Methods
We investigated drug resistance upon failure of INSTI-based regimens at the largest HIV program in Rhode Island (RI), caring for &gt; 80% of the state’s people with HIV. Eligible patients had full ART history, were on INSTI-based regimens, and had available protease-reverse transcriptase-integrase sequences from clinical care. Resistance interpretation was done with Stanford Database tools.

Results
Of 1,169 eligible patients (55% of clinic population), 102 (9%) were failing INSTI-based regimens; mean age at genotyping 39 years, CD4 377 cells/µL, and 11 years on ART; 67% male; 53% white, 44% Black, 63% non-Hispanic; 58% US born; with prior exposure to 8 drugs and 4 regimens. Of these 102, 55% were on 1st-generation INSTI (41% elvitegravir (EVG); 14% raltegravir (RAL)), and 45% on 2nd-generation INSTI (23% bictegravir (BIC); 22% dolutegravir (DTG)); most (73%) with only 2 NRTIs. Overall, 57% had any intermediate-high level predicted resistance (55% on 1st-, 45% on 2nd-generation INSTI); NRTI 37%; NNRTI 40%; PI 3%; INSTI 22% (EVG 22%, RAL 21%, DTG/BIC/cabotegravir 8% each). Common INSTI mutations were N155H (n=7); E92Q, Q148H/R, S147G (5 each); T66I/K, E138A/K/T (4 each); G140A/S (3), R263K (2), Y143R (1). Multi (≥ 3) class resistance occurred in 12%, a third of whom had intermediate-high resistance to all five INSTIs (50% on 1st-, 50% on 2nd-generation). Resistance trends were stable over 2014-2021, and 2nd-generation INSTI resistance was only seen in those with prior exposure to 1st-generation INSTI.

Conclusion
At the largest RI HIV clinic, 9% of eligible patients were failing INSTI-based regimens, most with clinically relevant resistance that was stable over time, and 1% had multi-class resistance including some to all available INSTIs. Though low resistance levels to 2nd-generation INSTIs are encouraging, they exist; and continued ADR monitoring is important, particularly with increasing incorporation of INSTIs in HIV treatment and prevention and use of 2-drug regimens.

Disclosures
All Authors: No reported disclosures.
1274. Implementation of Pharmacist-led Medication Reconciliation in Older PLHIV
Authors: Karris Maile Y , Mazonson Peter J , Hill Lucas , Yin Jeffrey , Abulhosn Kari , Huang Emily , Berko Jeff 
Published: December 2022

Abstract

Background
Older (age ≥ 50) people living with HIV (PLHIV) have a higher prevalence of non-AIDS associated comorbidities and polypharmacy. Optimal care requires accurate knowledge of the number and types of medications older PLHIV take. Most providers use the electronic health record (EHR) to obtain this information, despite reported inaccuracy in other cohorts. Recent efforts have focused on engaging pharmacists to assist with EHR medication reconciliation. This abstract describes the results of a pilot study of phone-based, pharmacist-driven EHR medication reconciliation.

Methods
Older PLHIV reported via an online questionnaire the number of prescription medications they took, with response options ranging from “0” to “11 or more.” Then, a clinic-based pharmacist called each participant to review the daily and prn prescription medications they were taking. Finally, a physician reviewed EHR pharmacy data to count the number of daily and prn prescription medications listed. Wilcoxon rank sum tests compared the medians between the phone review, the self-reported questionnaire, and the EHR review.

Results
Forty participants were offered the intervention, and 26 (65%) were reachable by phone and agreed. Of those, the mean age was 61 years (range 51-73), 89% were male, 67% were White, and the mean number of self-reported comorbid conditions was 11.7 (SD=7.7). In 25/26 (96%) cases, both the number and type of HIV medications in the EHR matched what the pharmacist verified on the phone call. Median number of non-HIV medications are reported in Table 1. Assuming that pharmacist phone calls provided the most accurate data, the EHR overestimated the number of non-HIV medications by 5 medications (P = 0.01), whereas patients’ self-report underestimated by 1.5 medications (P &lt; 0.01).

Conclusion
Among older PLHIV, EHR pharmacy data significantly overestimated, and patient self-report significantly underestimated, the number of non-HIV prescription medications. Phone-based, pharmacy-driven medication reconciliation improved upon both EHR-based and self-reported medication accuracy. Based on these findings, future interventions designed to decrease polypharmacy in older PLWHIV can rely upon pharmacist-led, phone-based outreach to ensure that baseline medication information is accurate.

Disclosures
Maile Y. Karris, MD, Gilead Sciences: Grant/Research Support|Gilead Sciences: I have received honorarium to speak at conferences|ViiV Healthcare: Grant/Research Support Peter J. Mazonson, MD, MBA, ViiV Healthcare: Grant/Research Support Lucas Hill, PharmD, AAHIVP, Gilead Sciences: Speakers Bureau Emily Huang, MPH, ViiV Healthcare: Grant/Research Support Jeff Berko, MPH, ViiV Healthcare: Grant/Research Support.
1588. Epidemiology of Chronic High Level (CHL) Epstein-Barr virus (EBV) DNAemia in Pediatric Solid Organ Transplant Recipients (SOTR) at Texas Children’s Hospital (TCH)
Authors: Valencia Deray Kristen G , Hosek Kathleen , Ruderfer Daniel , Buffaloe Leanne M , Munoz Flor M , Moulton Elizabeth A , Bocchini Claire 
Published: December 2022

Abstract

Background
EBV infections cause significant morbidity and mortality in pediatric SOTR and can be complicated by post-transplant lymphoproliferative disorder (PTLD). Contemporary data on CHL EBV DNAemia and the development of PTLD are limited.

Methods
A retrospective cohort study of patients ≤ 21 years of age who received heart, lung, liver, kidney, or multi-organ transplants at TCH between 2011–2018 was conducted. Primary outcome was CHL EBV DNAemia, defined as peripheral blood lymphocyte EBV values ≥ 500 copies/ug or whole blood EBV values ≥ 10,000 IU/mL for ≥ 6 months. Associations with CHL EBV DNAemia were measured using chi-squared or Fisher exact test and multivariate logistic regression. Time to CHL EBV DNAemia was assessed using Kaplan-Meier method.

Results
Among 687 SOTR (152 heart, 87 lung, 259 liver, 175 kidney, 14 multi-organ), 87 (13%) developed CHL EBV DNAemia; this included 15 (9%) heart, 9 (10%) lung, 59 (22%) liver, 2 (1%) kidney, and 2 (14%) multi-organ recipients. Receiving a heart [OR 2.1, 95% CI (2.1 – 62.4)], lung [7.7, 95% CI (1.5 – 39.3)], liver [OR 31.8, 95% CI (4.9 – 208.7)], or multi-organ [OR 18.3, 95% CI (2.0 – 170)] transplant and being 1–5 years of age [OR 4.0, 95% CI (1.6 – 9.8)] were associated with CHL EBV DNAemia. SOTR transplanted from 2015–2018 were less likely to develop CHL EBV DNAemia than those transplanted from 2011–2014 [OR 0.5, 95% CI (0.3 – 0.8)]. EBV risk status, CMV risk status, gender, and induction therapy were not associated with developing CHL EBV DNAemia.
The median maximum peripheral blood lymphocyte and whole blood EBV values for those with CHL EBV DNAemia were 9475 (993 – 258151) copies/ug and 22093 (564 – 550000) IU/mL, respectively. Organ transplanted (p&lt; 0.01), age (p&lt; 0.01), and EBV risk status (p&lt; 0.01) were associated with time to CHL EBV DNAemia (Figure 1). PTLD occurred in 28 (4%) of SOTR; 14 (50%) had preceding CHL EBV DNAemia (p&lt; 0.01).
Figure 1 Time to CHL EBV DNAemia.

Conclusion
This cohort of pediatric SOTR demonstrates a low prevalence of CHL EBV DNAemia and PTLD. Receiving a heart, lung, liver, or multi-organ transplant and being 1–5 years of age were associated with developing CHL EBV DNAemia. SOTR who developed CHL EBV DNAemia were more likely to develop PTLD, suggesting that further interventions targeting this group may be warranted.

Disclosures
Flor M. Munoz, MD, MSc, Gilead: Grant/Research Support Elizabeth A. Moulton, MD, PhD, Pfizer: Co-investigator for SARS-CoV-2 pediatric vaccine trials.
1287. Understanding Factors Associated with Polypharmacy and Differential Medication Adherence in People with HIV
Authors: Schwartz Rebecca M , Charlton Jessica , Gorlin Margaret , Weinberg Amy , Wallach Frances , McGowan Joseph 
Published: December 2022

Abstract

Background
For people with HIV (PWH), number of chronic medications (meds) used to treat comorbidities may impact quality of life (QoL), illness perception, medication beliefs, and clinical outcomes. Factors associated with adherence to antiretrovirals (ARVs) may differ from adherence to other chronic meds. This study aims to assess these factors to promote better med management and adherence among PWH taking chronic meds and ARVs.

Methods
174 participants (pts) were enrolled from an HIV program in a large health system. Inclusion criteria were age &gt; 18 years, English speaking, prescribed ARVs, and having &gt; 1 comorbidity requiring a chronic med (non-ARV). Measures included validated scales of QoL, illness perceptions, med beliefs, and adherence barriers (e.g., forgot, too many pills, avoiding side effects); and past 6-month emergency department (ED) use and hospitalization. Generalized linear models, ANOVA, and Wilcoxon sum rank tests assessed associations between number of chronic meds (&lt; 4 vs &gt; 5) and outcomes. Multivariable logistic regression models using backwards elimination were used to assess factors associated with adherence (overall, HIV-meds, non-HIV meds).

Results
Complete data from 160 pts were analyzed: 50% male; 84% US-born; 46% taking &gt; 5 chronic meds. Pts taking &gt; 5 meds were older, less likely to be employed, had significantly lower QoL (mean difference=5.23, 95%CI=0.19-10.27. p&lt; .05), significantly higher med side effects (mean ranks=88.51 vs 73.77, p&lt; .05), and 3-fold greater ED visits (mean estimate=2.99, 95%CI=1.52-5.89, p&lt; .05). Regression models indicated that number of adherence barriers (but not other predictors) was consistently associated with lower adherence after controlling for demographics: (overall adherence: OR=0.85, 95%CI=0.79=0.91; HIV med adherence: OR=0.88, 95%CI=0.81-0.94; non-HIV med adherence: OR=0.86, 95%CI=0.80-0.92).

Conclusion
Adverse events (i.e., ED use, poor QoL, med side effects) are associated with number of chronic meds. Number of adherence barriers is associated with poor adherence across med type, highlighting the importance of interventions to address polypharmacy and the complexities of managing HIV and comorbidities. Assessment of barriers can contribute to the promotion of adherence for both HIV and non-HIV meds.

Disclosures
Amy Weinberg, DNP, MS, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds.
1291. Acceptability and Perceptions towards an International Infectious Disease Videoconferencing Program among medical students and physicians-in-training in Miami.
Authors: Fernandez Anmary A , Lima Daniela De , Lichtenberger Paola , Alave Jorge , Solar Sebastian , Kaswan Daniel , Lopez-Medrano Francisco , Gonzales-Zamora Jose A 
Published: December 2022

Abstract

Background
Tele-education has emerged as an excellent alternative for traditional face-to-face education. It has allowed to connect first-world countries to developing countries for learning about low prevalent pathologies, such as tropical diseases, parasite infections, etc.

Methods
The Division of Infectious Diseases at University of Miami started an international videoconferencing program in 2018 in collaboration with 4 teaching sites (Miami, Peru, Chile, and Spain), in which 2 challenging cases were presented via Skype TM or Zoom TM. The cases were discussed by a partner institution member; all sites were invited to comment about the cases. After each conference, the medical students and physicians-in-training were asked to fill out a survey to evaluate their acceptance and perceptions towards this program.

Results
54 participants completed the survey. 50% were residents or fellows, 18.5% were medical students, and 27.7% were visiting trainees. The overall acceptance was favorable, 64.9 % of participants reported that videoconferencing was as effective or more effective than face-to-face conferences, 96.3% wanted to continue participating in this program, and 87.04% would recommend it as an educational tool. Regarding the collaboration with international sites, 87% of participants felt they learned about diseases not commonly encountered in their countries, 85.2% considered that this program allowed them to learn about different treatment approaches, and 68.5% believed that it helped to learn about novel diagnostic tests. In terms of the content, 85.2% considered that the cases were interesting and 83.3 % believed that the cases were presented in an organized fashion. Regarding the software performance, 75.9 % believed that images were above average or outstanding, but only 48.1% felt the same about the audio. In terms of participation, 57.4% believed that interaction between the local audience and physicians from different sites was easily accomplished.

Conclusion
This videoconferencing program was widely accepted among trainees. The collaboration with international sites was perceived as one of the program assets. We believe that implementation of programs like this would be highly beneficial in Infectious Disease education.

Disclosures
Daniela De Lima, MD, Astra Zeneca: Stocks/Bonds|Pfizer: Stocks/Bonds.
1294. Covid-19: Impacts on Medical Students’ Mental Health in Medical Education Center of Chaophya Abhaibhubejhr Hospital
Authors: Pinsai Subencha , Klaipim Chalalai 
Published: December 2022

Abstract

Background
Thailand has experienced a repeated pandemic of COVID-19, which placed overwhelming demands on health care services. Medical students are affected by the pandemics of COVID-19, and adjustments are needed to produce medical providers for health care services as planned. Medical students have experienced consequences, especially on their mental health, due to a fear of COVID-19 infection adjustments to new learning styles.

Methods
A cross-sectional study was conducted among medical students in our hospital. We used an online platform to assess knowledge, sources of information and evaluate anxiety levels using the generalized anxiety disorder 7 (GAD-7) scale.

Results
Thirty-seven patients (20 women (54.1%), mean age 22.9 years) were included. The majority of students demonstrated average levels of knowledge and utilized reliable sources of information.
51.35% of students reported anxiety levels ranging from mild to severe, with sixth-year medical students whom on-site study reporting higher anxiety than the fourth and fifth-year medical students whom hybrid study (online and On-site study) (OR=5.9, P=0.02).

Conclusion
This study provides essential information in our hospital on the initial response and anxiety levels in medical students during a clinical rotation in the COVID-19 pandemic. In the COVID-19 pandemic or any other public health emergencies, we need to provide clinical knowledge support and psychological support for our medical students.
Essential knowledge and prompt screening and response for anxiety and stress during the COVID-19 pandemic are necessary for the medical student.

Disclosures
All Authors: No reported disclosures.
1297. Design and Testing of an Interactive Module for Improving Understanding and Application of Institutional Antibiograms
Authors: MacDougall Conan 
Published: December 2022

Abstract

Background
Many infectious diseases treatment guidelines recommend incorporating local antibiograms (ABs) into treatment decisionmaking. However, studies suggest many healthcare provider trainees are uncomfortable using ABs and rarely incorporate them into their decisionmaking. Our purpose was to develop a brief online module to develop skills in locating and utilizing an institutional AB and to gather feedback on its utility.
Interactive Module for Understanding and Interpreting Antibiograms
Screen captures displaying initial framing case with learner response (upper left), stepwise navigation of an antibiogram (upper right), embedded task practice (lower left) , and question from final competency assessment (lower right).

Methods
We developed and tested the module at the University of California San Francisco, with initial testing among 340 pharmacy students during microbiology instruction. We used the Four-Component Instructional Design framework to inform our design approach. Using the Articulate Storyline platform, we developed an interactive online learning module (Figure 1). The module began with a patient case to introduce the whole task and activate prior knowledge, with learners required to enter a freetext answer to the case prompt. Using visuals and narration with captions, the module then reviewed the basics of an AB and how to use an AB for therapy with known pathogens and for empiric therapy, and use of location-specific and combination ABs. Task practice was provided by case-based questions requiring learner response and providing immediate feedback. The module ended with competency assessment questions including revisiting the original case and the learner's initial answer. Learners completing the module were directed to complete a survey to provide feedback on the module; we report quantitative and qualitative feedback from the survey.

Results
We received 131 survey responses (38.5%). 111/131 (85%) rated the educational value of the module as “Extremely valuable”, and 103/131 (79%) rated the module as having “Excellent usability”. Primary themes among positive feedback included the interactive elements, stepwise approach, and questions with feedback; constructive feedback included desire for speed control of the narration and sound quality.

Conclusion
An interactive online module for learning about ABs was highly rated by learners and may be valuable to help clinicians apply ABs in practice. Future studies should include other health professions learners, delayed assessment to measure retention, and customization for different institutional ABs.

Disclosures
Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.