bluuebunny/crossref_metadata_2025_split huggingface dataset:
1374. Utilizing Genomic Epidemiology to Explore SARS CoV-2 Transmission Patterns and Support Outbreak Investigations in Long Term Care Facilities, Washington State, April-October 2021
Authors: Douglas Peggy , Burns Veronica , Prather Cassie , Lunn Stephanie , Frisbie Lauren , Pratt Drew , MacAllister Trent , Templeton Allison A , Brezak Audrey , Smith Nailah , Kibiger Lynae 
Published: December 2022

Abstract

Background
In Washington State, COVID-19 cases in long-term care facilities (LTCF) have accounted for less than 3% of all cases, yet 30% of all COVID-19 deaths. Understanding transmission patterns and outbreak epidemiology informs outbreak management. From April to October 2021, two large LTCFs experienced COVID-19 outbreaks. Whole genome sequencing and phylogenetic analysis were leveraged to explore transmission patterns and complement outbreak epidemiology.

Methods
Epidemiologic data was exported from the Washington Disease Reporting System. Sequences, retrieved from GISAID, were aligned to the Wuhan-1 reference genome using Nextalign version 1.11.0. Pairwise single nucleotide polymorphism (SNP) distance matrices were calculated using SNP-Dists version 0.8.2. Phylogenetic trees for each outbreak were generated using IQ-Tree multicore version 2.2.0-beta COVID-edition using the GTR+F+G4 nucleotide substitution model with 1000 bootstrap replicates. MicrobeTrace was used to visualize the phylogeny, SNP heatmap, and identify clusters among sequences.

Results
Weekly, LTCF A tested 162 residents and 800 staff, and LTCF B tested 60 residents and 144 staff. Of all cases in LTCF A (n= 119), 23% (n =27) were residents and 77% (n = 92) were staff, compared to 78% (n =28) residents and 22% (n =7) staff among total LTCF B cases (n=36). In LTCF A, 34% (n=40) of the cases had high-quality sequences available. Seven clusters of two or more genetically related sequences and thirteen genetically unrelated sequences were identified. Five of the clusters involved resident and staff cases, linked by unit. Two clusters and remaining unrelated sequences were among staff. In LTCF B, 40% (n=14) of the cases had high-quality sequences available. One cluster of genetically related sequences was identified, all from residents of two floors. The SNP differences between sequences from LTCF A ranged from 0 to 70, whereas SNP differences between LTCF B sequences ranged from 0 to 6.

Conclusion
Phylogenetic analysis of the two outbreaks confirms differences in disease transmission patterns. Multiple independent introductions of SARS-CoV-2 were identified in LTCF A, compared to a single introduction in LTCF B. Genomic epidemiology is a valuable resource for outbreak investigation and management.

Disclosures
All Authors: No reported disclosures.
1389. A Comparison of a Telephone versus In-Person HIV Linkage to Care Intervention in a Large Health Care System
Authors: Leonard Michael , Polk Christopher , Zhao Jing , Zhao Jing , Zhao Jing , Hetherington Timothy , Gohs Frank , McCurdy Lewis 
Published: December 2022

Abstract

Background
Evidence suggests linkage to care (LTC) should occur immediately after HIV diagnosis improves retention in care and viral suppression. Established protocol for newly diagnosed or out of care people living with HIV (PLwH) with hospital admission in our healthcare system is for an in person LTC encounter for outpatient care including clinic follow up. We compared whether an in-person versus phone encounter intervention, were equally effective LTC methods.

Methods
PLwH admitted to any of three hospitals in our vertically integrated healthcare system were identified through the electronic health record (EHR) daily by the LTC coordinator for further screening. Inclusion criteria included: inpatient status with ICD9/10 code in EHR for HIV, no self-reported combination anti-retroviral therapy (cART) in the 30 days prior to admission, and not engaged in HIV care in greater than 12 months. Patients were randomized to either an in-person visit or a phone-call LTC encounter. Primary outcomes included follow up with an HIV provider within 30 days of discharge, and cART prescription 90 days of being discharged. Viral load suppression, CD4 count and readmission rates were secondary outcomes. Results were analyzed using an intent to treat model. All tests were two-sided at the significance level of 0.05

Results
2750 patients were screened for eligibility, 260 randomized during an 18-month period to an in-person visit (n=131) or telephone visit (n=129). The median age was 45 years, 67% were male, and 78% Black/African American. 15% of patients were newly diagnosed during admission. (Table 1) No differences were observed between the two LTC groups in follow up within 30 days (41% total), cART prescription within 90 days (76%), viral load suppression at 6 months (45%), CD4 count (57%), and readmission within 30 days of discharge (34%). (Table 2).

Conclusion
Telephone and in-person encounters for LTC had similar outcomes regarding HIV follow up, ART prescribing, viral suppression, and hospital readmission at our institution. Improvements in the linkage process do need to be made in all outcome categories to further improve care with and ultimately viral suppression. Telephone visits provide opportunity to make LTC more efficient and with less human resource needs.

Disclosures
Christopher Polk, MD, Gilead: Advisor/Consultant.
1391. Association between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) scores and HIV care cascade outcomes in newly diagnosed people with HIV (PWH) in the US South
Authors: Ahmed Manal , Nijhawan Ank E , Chow Jeremy Y , Gao Ang , Ahn Chul 
Published: December 2022

Abstract

Background
Mental illness (MI) and substance use (SU) among people with HIV (PWH) impact multiple stages of the care cascade. Little is known about baseline mental illness and substance use as defined by the Substance Abuse and Mental Illness Symptoms Screener (SAMISS), a common tool used at entry into care, and subsequent care cascade outcomes.

Methods
A retrospective chart review was conducted of individuals newly diagnosed with HIV between 2016-2019 in an urban HIV clinic in Dallas, Texas. Baseline demographic, HIV labs, socio-economic variables and availability of rapid ART (implemented 10/2018) were collected. Patients were screened for MI and SU using the SAMISS. Outcomes included retention in care (2 encounters within 12 months, 90 days apart), probability of achieving virologic suppression (VS = viral load (VL) ≤200 copies/mL), and sustained VS at 12 months. Data analyses included stepwise Cox and logistic multivariate regression modeling conducted in SAS, version 9.4. Covariates with p&lt; 0.2 in univariate analyses were entered as candidate variables for stepwise selections.

Results
Among the 530 newly diagnosed PWH, mean age was 35, 79% were male, 46% non-Hispanic Black, 37% Hispanic. Overall, 34% screened positive for SU and 41% for MI; 46% received rapid ART. In univariate analyses, those screening MI-positive were less likely to be retained in care (OR 0.68, p=0.035), or to have continuous VS (OR 0.61, p=0.005), though neither remained significant once controlling for rapid ART initiation and other covariates. In univariate analysis, those screening SU-positive were less likely to achieve VS (HR 0.80, p=0.030), and in multivariate analyses, they were less likely to be retained in care (OR 0.60, p=0.015) or to have continuous VS (OR 0.61, p=0.015) after adjusting for rapid ART initiation and covariates.

Conclusion
In a safety-net southern US clinic, baseline SAMISS MI and SU scores were associated with worse 12-month retention in care and virologic suppression. Given widespread adoption of rapid ART initiation soon after HIV diagnosis, further studies should explore how initial assessment scores like SAMISS could be used to both identify and direct interventions to at-risk, newly diagnosed PWH to impact long-term retention and VS.

Disclosures
Ank E. Nijhawan, MD, MPH, MSCS, Gilead Sciences: Grant/Research Support Jeremy Y. Chow, M.D., M.S., Gilead Sciences: Grant/Research Support.
1392. Associations between Stigma and Physical and Mental Health in the U.S. Military HIV Natural History Study
Authors: Schvey Natasha , Hsieh Hsing-Chuan , Illinik Luca , Chu Xiuping , Ganesan Anuradha , Schofield Christina , Colombo Rhonda E , Berjohn Catherine M , Okulicz Jason , Agan Brian 
Published: December 2022

Abstract

Background
Despite increasing attention to HIV-related stigma within the DoD, to date, the majority of research has focused on civilians, up to half of whom report perceived or experienced stigma. However, military service members and retirees with HIV may be particularly vulnerable to stigma and its adverse correlates.

Methods
The current study utilized cross-sectional data collected within the U.S. Military HIV Natural History Study. Participants completed questionnaires, including the Center for Epidemiologic Studies Depression scale, the Short Form Health Survey, the Internalization Subscale of the HIV Stigma Scale, and a measure of stigma experienced in the past year. Experiences of stigma were dichotomized to indicate presence or absence. Linear and logistic regressions were used to examine associations between internalized stigma and psychosocial functioning. All analyses were adjusted for age, race, sex, marital status, military rank, and duty status (i.e., active duty or retired).

Results
The sample comprised 399 participants (93.5% male; 46.0% Black/African American; Mage: 50.8 ± 13.2 years; Mage at HIV diagnosis: 31.9 ± 8.2 years; 32.4% on active duty). The majority (94.4%) had an undetectable viral load at the time of the visit. Fourteen percent reported being teased, treated unfairly, or discriminated against in the past year due to their HIV status, and 8% reported discrimination specifically within healthcare. Adjusting for covariates, internalized stigma was associated with poor physical (p &lt; .001) and overall mental (p &lt; .001) health. Internalized stigma was also associated with greater odds of reporting elevated depression (p &lt; .001).

Conclusion
In this sample of service members and retirees with HIV, a small but significant minority of participants reported experiencing stigma. Rates of stigma were lower than those observed in some civilian samples, though heterogeneity in sampling and methodology preclude direct comparisons. Internalized stigma was associated with poor physical and mental health, signaling a need for continued efforts to assess both experienced and internalized stigma. Future research should explore associations between stigma, ART adherence, and other metrics of health, such as CD4 count, substance use, and cardiometabolic risk.

Disclosures
All Authors: No reported disclosures.
1394. Clinical and Sociodemographic Characteristics Associated with Poor Self-rated Health across Multiple Domains among Older North American Adults Living with HIV
Authors: Dominguez Megan , Okoli Chinyere , de los Rios Patricia , Prakash Manyu , Clark Andrew 
Published: December 2022

Abstract

Background
Older adults living with HIV (OALHIV) are a growing demographic in North America. We summarized baseline characteristics and associated self-rated suboptimal health in North American OALHIV.

Methods
OALHIV aged ≥ 50 years from the United States, Canada, and Mexico who participated in the 25-country 2019 Positive Perspectives survey were included. Self-rated health was assessed across 4 domains (physical, mental, sexual, overall); each was dichotomized as optimal (Good/Very good) or suboptimal (Neither good nor poor/Poor/Very poor). Multinomial logistic regression was measured for associations between domains and relevant sociodemographic and clinical characteristics.

Results
Of 583 participants from North America, 161 were aged ≥ 50 years and included in this analysis. Most were male (73%), 14% were aged ≥ 65 years, 66% were diagnosed with HIV ≥ 10 years ago, median disease duration was 20 years, and 55% took ≥ 5 non-HIV pills daily. Most OALHIV (n=128; 80%) had switched antiretroviral therapy (ART) at least once, 14% (18/128) because of potential drug-drug interactions and 22% (28/128) because it was no longer effective or for resistance, and 6% were very treatment experienced (changed ART ≥ 4 times, with ≥ 1 switch in the past year for resistance or poor tolerability). Among OALHIV, 86% reported ≥ 1 comorbidity; the most common were hypertension (42%), hypercholesterolemia (39%), mental illness (32%), and insomnia (29%). Overall, 48% (77/161) of OALHIV reported suboptimal physical health, 35% (56/161) suboptimal mental health, 60% (97/161) suboptimal sexual health, and 47% (75/161) suboptimal overall health. On all domains, 19% (31/161) reported suboptimal health; 24% (38/161) reported optimal health on all domains, 23% (37/161) on 3 domains only, 13% (21/161) on 2 domains only, and 21% (34/161) on 1 domain only. Comorbidities with a &gt; 15% difference between OALHIV reporting suboptimal health in all domains vs those reporting optimal health in at least 1 domain, respectively, were mental health (48% vs 28%), substance abuse (26% vs 5%, as self-reported in the survey), bone disease (26% vs 8%), and insomnia (42% vs 25%).

Conclusion
Most OALHIV in North America reported comorbidities and polypharmacy, with approximately one-quarter reporting suboptimal health on all domains.

Disclosures
Megan Dominguez, PharmD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Chinyere Okoli, MSc, DIP, ViiV Healthcare: I am an employee of ViiV healthcare|ViiV Healthcare: Stocks/Bonds Patricia de los Rios, MSc, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Manyu Prakash, PhD, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employee Andrew Clark, MD, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds.
1399. Dramatic Increase in Invasive Group A Streptococcal Infection in Persons Who Inject Drugs in an Urban Philadelphia Hospital
Authors: Altneu Eric , Metlay Jessica , Davis Hugh A , Spivack Stephanie , Sullivan Kaede Ota , Schultz Sara K 
Published: December 2022

Abstract

Background
Invasive infection from Group A streptococcus (iGAS) is rising nationally, and we report a significant increase in incidence at an urban, quaternary care health center, which serves the Kensington neighborhood, the epicenter of the opioid crisis in Philadelphia, PA. We examined iGAS infection in the Temple University Health System catchment area

Methods
iGAS was defined as an of streptococcus pyogenes cultured from a previously sterile site. Injection drug use (IDU) is a known risk factor for bacterial infection, including iGAS infection. All blood, sterile fluid, and/or tissue cultures that yielded S. pyogenes were identified using the laboratory information system at Temple University Hospital – Main Campus. Two cohorts were compared: January 1, 2021, to December 31, 2021, and January 1, 2019, to December 31, 2019. Electronic health records were reviewed and data pertaining to age, gender, and injection drug use were abstracted. Descriptive statistics were used to summarize findings.

Results
155 cases of iGAS were identified in 2021 (105 of which involved bacteremia) compared to 69 in 2019 (42 of which involved bacteremia), representing a 224% increase overall. Of the cases in 2021, 130 (84%) were Persons Who Inject Drugs (PWID) compared to only 39 (57%) in 2019. PWID with iGAS were younger (median age 35 vs 54 in 2019, 39 vs 53 in 2021) and more likely to be male (57% vs 43% in 2019, 68% vs 32% in 2021). Male patients also had a higher incidence of PWID than female patients (56% vs 44% in 2019 and 64% vs 36% in 2021).

Conclusion
During this same time period, the COVID-19 pandemic added to the ongoing opioid crisis in Philadelphia. The city of Philadelphia publicly reports opioid data, which shows that hospitalizations related to non-fatal opioid overdose have exponentially risen in the past two decades. This also coincides with an increase in the presence of xylazine, an adulterant in the Philadelphia fentanyl supply. Xylazine has been implicated in worsening wounds. Our data supports a concerning association between iGAS and PWID.

Disclosures
All Authors: No reported disclosures.
1400. Emergency Department (ED) Use among Persons With HIV (PWH) before and during the COVID-19 Pandemic
Authors: Agil Deana , Browne Lindsay , Davy-Mendez Thibaut , Durr Amy , Henderson Heather , Li Kuo-Ping , Farel Claire E , Eron Joseph J , Napravnik Sonia 
Published: December 2022

Abstract

Background
Substantial changes in access and delivery of primary HIV care occurred during the COVID-19 pandemic. To assess how care access changed during the COVID-19 pandemic, we estimated ED use among PWH in care 2017-2021 in the southeastern US.

Methods
For each calendar year, among PWH in care in the UNC CFAR HIV Clinical Cohort (defined as having a clinic visit in the current or prior year), we estimated the percent of patients with ≥ 1 ED visit in a given year, overall and by age, gender, race/ethnicity, HIV viral load (VL), and CD4 count. We estimated risk ratios (RRs) comparing patient characteristics and years 2020-2021 vs. 2017-2019, using Poisson regression with generalized estimating equations to account for repeated measures.

Results
Among 2129 PWH in care 2017-2021 (N≈1700-1800 in each year), 57% identified as Black, 31% White, 8% Hispanic, 26% women, with median age of 47 years (IQR 35-55). During the study period, there were 3645 ED visits over 8813 person-years, a rate of 41.4 ED visits-per 100 person-years(95% CI 36.8-46.5) per 100 person-years. The 845 PWH with at least one ED visit during the study period contributed a median of 2 visits each (IQR 1-5). The unadjusted probability of having ≥1 ED visit in a given year was higher among women vs. men (RR=1.14, 95% CI 0.99-1.32), Black vs. White PWH (1.31, 1.13-1.52), with VL ≥ 40 copies/mL (1.40, 1.20-1.64), and with CD4 &lt; 200 (1.66, 1.32-2.09) or 200-349 (1.50, 1.25-1.79) vs. ≥ 500 cells/μL; age was not associated with ED use. Compared with 2017-2019, the annual probability of having ≥ 1 ED visit was lower in 2020-2021, with RRs of 0.83 (95% CI 0.76-0.90) in unadjusted analyses and 0.80 (95% CI 0.71-0.90) after adjusting for demographics, VL, and CD4. There was also a significant unadjusted decrease for 2020-2021 vs. 2017-2019 among women, men, PWH who were Black, White, &lt; 40 or 50-59 years old, and with CD4 &gt;500 (Fig. B-F, all P&lt; 0.05).

Conclusion
Among PWH in HIV care, ED use was higher among women, Black PWH, and PWH with poorly controlled HIV. ED use decreased 2020-2021 in most groups, indicating that PWH during the COVID-19 pandemic may be delaying seeking care for acute conditions, or accessing care in other ways. Work is ongoing to characterize reasons for ED visits across calendar years and examine the impact of reduced ED utilization among PWH.

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.
1402. Expand accessibility of monoclonal antibody in COVID-19 among different ethnicities and races.
Authors: Farooq Hina , Shankaran Shivanjali 
Published: December 2022

Abstract

Background
Anti-SARS-CoV-2 monoclonal antibodies are administered to patients with mild-moderate COVID-19 who are at high risk of progression to severe disease. It has been shown that in addition to medical comorbidities, race or ethnicity may also place patients at high risk for progression to severe COVID-19 infection due to social disparities including limited access to care. The purpose of this study is to increase the accessibility of monoclonal antibody infusion to patients at high risk for severe outcomes of COVID-19, irrespective of race and ethnicity, by expanding outreach resources when availability of oral antiviral therapies was limited.

Methods
We performed a single-center retrospective analysis of patients with mild-moderate COVID-19 infection receiving sotrovimab, a monoclonal antibody, between December 2021 and January 2022. A total of 93 SARS-CoV-2-positive patients meeting EUA criteria for eligibility were infused with sotrovimab in different settings such as emergency department, outpatient setting including infusion clinics and cancer centers, home health as well as patients hospitalized due to reasons other than COVID-19 at RUSH medical center, Chicago. For context, during omicron surge, initially home health was set up followed by introduction to infusion clinics. Primary care provider could refer patients to the infusions clinics or home health.

Results
Out of 93 patients, 8 patients received mAb infusion in emergency department, 25 patients each in cancer center and infusion clinic, 17 patients in home health setting and 18 patients who were hospitalized due to reasons other than COVID-19. The median age of participants was 57 years and 61.2% were females. Overall, Hispanic patients received mAb less often than did non-Hispanic patients (33% vs 62%). Black, Asian and other racial groups received mAb 18.2%, 3.23%, 3.23% less often, respectively, than did White patients. Interestingly, in home health setting, Hispanic patients received infusion more often than non-Hispanic patients (12.9% vs 5.3%).

Conclusion
Implementation of programs centered around needs of community such as increase accessibility to COVID-19 medications through home health or infusion clinics may help mitigate the racial and ethnic disparities in COVID-19 and thus, promote health equity.

Disclosures
All Authors: No reported disclosures.
1408. Increasing Access to Medications for Opioid Use Disorder in Patients Hospitalized with Severe Injection Related Infections: A Single Center Experience
Authors: Keegan Jack , Bauer Rebecca , Peppard William 
Published: December 2022

Abstract

Background
Hospitalizations for severe injection related infections (SIRI) amongst persons who inject drugs (PWID) are often complicated by patient directed discharge (PDD), incomplete antibiotic treatment and 90-day readmission. Despite a strong association with improved clinical outcomes, medications for opioid use disorder (MOUD) remain significantly underutilized in this patient population. Beginning in January of 2022, our institution revised several key policies that had limited inpatient use of MOUD while also implementing a new order set to facilitate MOUD inductions. This study seeks to quantify the clinical impact of these interventions in PWID admitted with SIRI.

Methods
We first performed a retrospective analysis of all PWID hospitalized with SIRI between January 2018 and December 2020 to establish baseline rates of PDD, antibiotic completion and 90-day readmission in patients who received MOUD compared to those who did not. Subsequent analyses will utilize a quasi-experimental design to compare the same clinical outcomes in patients admitted before and after institutional guideline revision and MOUD order set implementation.

Results
A total of 97 patients were included in our baseline assessment, of which 21 (21.6%) received MOUD while hospitalized. Of patients receiving MOUD, 11 (52.4%) were new inductions. Use of MOUD was associated with significantly lower rates of PDD (5 [23.8%] MOUD patients vs 40 [53.3%] no MOUD patients; OR, 0.273 [95% CI, 0.091-0.823]) and significantly higher rates of antibiotic completion (17 [81.0%] MOUD patients vs 36 [48.0%] no MOUD patients; OR, 4.6 [95% CI, 1.41-14.98]).

Conclusion
Our baseline data agrees with existing literature in finding MOUD to be an effective way of reducing PDD and increasing antibiotic completion in PWID admitted with SIRI. However, overall MOUD utilization was low, particularly after accounting for the effect of individuals prescribed MOUD prior to admission. Forthcoming data will assess the impact of institutional guideline revision and MOUD order set implementation on PDD, antibiotic completion and hospital readmission in PWID admitted with SIRI.

Disclosures
All Authors: No reported disclosures.