bluuebunny/crossref_metadata_2025_split huggingface dataset:
1246. Prevalence of Hepatitis C Antibodies (Ab) in people at risk for HIV infection in Kentucky
Authors: Soria Jaime , Collins Jana , Thacker James , Hoven Ardis , Thornton Alice C 
Published: December 2022

Abstract

Background
The Kentucky Income Reinvestment Program (KIRP) provides comprehensive early intervention services targeting those at the highest risk for HIV infection. The objective of this study was to evaluate the prevalence of Hepatitis C Antibodies (HCV Ab) in people at risk for HIV infections in Kentucky.

Methods
A cross-sectional study was conducted using the KIRP Outreach database, including data from people at risk for HIV infections from January 2021 to March 2022. A screening tool was used to identify the people at risk. A Point-of-Care rapid test was used for the detection of HCV Ab. We compared the frequency of HCV Ab in People who inject drugs (PWID) versus people who denied the use of injected drugs. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Kentucky. Logistic Regression was performed, and the OR was reported. The statistical analyses were performed with Stata 17 (College Station, TX: Stata Corp LLC).

Results
The analysis included data of 8,225 people tested for Hepatitis C concomitant to screening for HIV; of them, 4,203 (51.1%) were female, and the median age was 41 years old (Range: 17 – 76). No previous test for HCV Ab detection was reported in 3,966 (48.2%).
A total of 1,180 (14.3%) tests were positive. HIV infection was detected in 14 (0.2%) people; of them 3 (21.5%) were in people with detectable HCV Ab. The prevalence of HCV Ab in PWID was 36.6%, and the prevalence in people who denied the use of injected drugs was 5.0% (p&lt; 0.001). Most people with detectable HCV Ab (68.0%) were younger than 45. After being adjusted by age, HCV Ab was strongly associated with PWID (OR: 9.3; 95% CI 7.9 – 11.0; p&lt; 0.001).

Conclusion
The prevalence of the Hepatitis C virus in Kentucky remains higher, mainly in PWID; it was not associated with age. HCV/HIV Coinfection was identified in more than 20% of the Clients. Efforts to continue screening both HIV and HCV infections in PWID are necessary.

Disclosures
All Authors: No reported disclosures.
1254. An Increase in Single-tablet Regimen (STR) Utilization for People Living with HIV (PLWH) Enrolled in Medicaid had Minimal Impact on Pharmacy Costs
Authors: Brogan Andrew P , Garris Cindy , Priest Julie , Divino Victoria , He Jing , Chen Justin , DeKoven Mitch 
Published: December 2022

Abstract

Background
The shift to antiretroviral single-tablet regimens (STR) from multiple-tablet regimens (MTR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines STR and MTR utilization and pharmacy costs over a 5-year period for PLWH enrolled in Medicaid.

Methods
This retrospective study used IQVIA’s Prescription Claims (Rx) data to identify two mutually exclusive cohorts based on STR or MTR use within each of 5 calendar years (2016-2020). For the STR cohort, the date of the first STR claim in each calendar year was termed the index date. For the MTR cohort, the date of the first MTR drug in the first observed complete MTR regimen in each calendar year was termed the index date; a window of 5 days between prescription fills for the agents used in an MTR regimen was allowed. The regimen received on the index date was used to assign the study cohort for each year and study measures were reported for each of the 5 calendar years. Additional eligibility criteria are provided in Table 1.

Results
The final STR cohort was 47,140 (14.5% of the initial sample) in 2016 and 73,111 (13.5%) in 2020 (Table 1). The final MTR cohort was 36,007 (15.5%) in 2016 and 20,264 (13.5%) in 2020. The distribution of PLWH with Medicaid Fee-For-Service (FFS) or Medicaid managed care was generally similar by year for both STR and MTR cohorts from 2016 to 2019 (Figure 1); Medicaid managed care enrollment for both cohorts increased in 2020 (62.4-62.9%). Among PLWH, STR use increased annually from 56.7% in 2016 to 78.3% in 2020 (Figure 2). Conversely, MTR use decreased from 43.3% to 21.7% over the same time period. The increase in STR utilization over time was consistent for both plan types. Mean HIV-specific per member per month (PMPM) pharmacy costs were similar across years for both STR and MTR cohorts, ranging from $2,016-$2,342 for STR cohorts and $2,247-$2,380 for MTR cohorts (Figure 3).

Conclusion
Between 2019 and 2020, PLWH enrolled in Medicaid shifted from FFS towards managed care. STR use among PLWH enrolled in Medicaid increased from 2016 to 2020 with minimal differences in PMPM pharmacy costs compared with PLWH enrolled in Medicaid receiving MTR.

Disclosures
Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.
1262. Dolutegravir Plus 3TC In Antiretroviral Experienced Adults: Immunovirological Outcomes In a Multicenter Retrospective Cohort In Spain
Authors: Buzón-Martín Luis , Dueñas Gutierrez Carlos , Iribarren José Antonio , de los Santos Ignacio , Santiago Alberto Diaz-De , Morán-Rodríguez Miguel Ángel , Pousada Guillermo , Rico Claudia González , García Estela Moreno , Ferreira Eva , Gómez Alicia Iglesias , gómez Cristina Martín , Barquero Julia gómez , Egido Murciano Miguel V , Troya Jesús 
Published: December 2022

Abstract

Background
Dolutegravir-based dual therapies for treating people living with HIV (PLHIV) are strategies strongly recommended in several practice guidelines. The safety and efficacy combination of Dolutegravir (DTG) plus 3TC as a switching strategy in virologically suppressed patients was demonstrated in the TANGO study. Wide multicenter real life data supporting this treatment is needed. The aim of the current study was to describe the efficacy in terms of immunovirological outcomes in patients treated with this antiretroviral combination.

Methods
From November 1st 2020 to August 1st 2021, data from 1062 PLHIV collected from 13 Spanish institutions were recorded in a multicenter, retrospective study; After discarding cases in which relevant variables were missing, finally 694 cases underwent statistical analysis. Inclusion criteria were age &gt;18 years, and to receive treatment with DTG/3TC as a switch strategy. Immunovirological impact of this strategy ( CD4+, CD8+ and CD4+/CD8+ cell count, as well as HIV plasma viral load through weeks 24, 48 and 96 of follow up) was evaluated using multivariable mixed models where the individual was considered as a random effect. Sex and age were added as demographic covariables.

Results
78% of patients were men, 16% had been previously diagnosed of AIDS. Mean age was 48 years old. Mean CD4 T cell count nadir was 300 cell/ml (160-480). We found a significant increase in CD4+ counts at 24, 48 and 96 weeks after switching drug strategy. We also detected a small increase in the CD4+/CD8+ count rate at 48 and 96 weeks. No significant change was found in CD8+ count. No differences were found on behalf of sex, between backbone drugs (73% switched from a TDF/FTC backbone and 26.9% from ABC/3TC) or amongst the different third agents used (62% switched from integrase inhibitors). We identified a strong and negative effect of having AIDS in the CD4+ count. However, this effect did not interact with the effect of switching drug strategies.
CD4, CD8 and CD4/CD8 after switch at 24, 48 and 96w
Log OR

Conclusion
PLHIV who, being virologically suppressed, switched to dual therapy based on DTG/3TC, experienced a statistically significant increase of CD4+ T cell count at weeks 24, 48 and 96, as well as an increase in CD4/CD8 T cell ratio, as well as high efficacy in terms of viral replication suppression, independently of the stage of HIV infection.

Disclosures
Luis Buzón-Martín, MD, ViiV, GILEAD, Jannsen, MSD: Lecture fees Carlos Dueñas Gutierrez, MD, ViIV, GILEAD, Jannsen, MSD: Lecture fees Jesús Troya, Staff, ViiV, GILEAD, Jannsen, MSD: Lecture fees.
1266. Effects of Rapid Initiation of Antiretroviral Therapy in an Urban Clinic Setting
Authors: Mesa Daniel , Kim Yae Ji 
Published: December 2022

Abstract

Background
Rapid initiation of antiretroviral therapy (ART), i.e. within 72 hours of diagnosis, in people living with HIV (PLWH) has shown improved viral suppression, medication adherence, and retention in care, compared to deferral until initial labs have resulted. More real-world experience with rapid ART programs is needed, however, particularly among clinics in resource-limited settings that serve a complex and largely uninsured or underinsured population, such as the HIV clinic at SUNY Downstate Medical Center. In 2017, the clinic implemented rapid ART in select PLWH.

Methods
This was a single-center retrospective chart review of patients seen at our HIV clinic between January 2015 and June 2021. Patients were included if they were ART-naïve or off ART for &gt; 3 months. Exclusion criteria included baseline undetectable viral load (VL) and perinatal HIV infection. Patients were assigned to standard or rapid start groups based on time from intake to initiation of ART. The primary outcome was proportion of patients with VL &lt; 50 copies/mL at week 52. Secondary outcomes were proportion of patients with VL &lt; 200 copies/mL, retention in care, and mean weight change from baseline, all at week 52; time from intake to ART; and time to viral suppression.

Results
As shown in Table 1, of the 190 patients that were included, 133 were rapid start while 77 were standard start. 103 patients had baseline resistance data; only 1 had integrase stand inhibitor resistance. Median time to ART was 0 days and 2.5 weeks in the rapid and standard groups, respectively. The most common initial regimen was BIC/FTC/TAF in both groups (49.6%, 31.2%). As described in Tables 2 and 3, 62.1% and 73.7% of patients had VL &lt; 50 and &lt; 200 copies/mL at week 52, respectively. Nearly 73% of patients remained in care at week 52, with similar rates between groups. Time from ART to viral suppression was similar between groups.

Conclusion
Rapid ART was well-tolerated but resulted in similar viral suppression and retention in care at week 52 compared to standard ART. However, rapid ART resulted in quicker viral suppression, although further evaluation of the clinical impact of this finding is needed. This study highlights the need for a multifaceted approach to engaging patients with HIV throughout the care continuum to ensure retention in care.

Disclosures
All Authors: No reported disclosures.
1268. Efficacy, safety, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in adults with HIV-HBV infection - preliminary results
Authors: Kwakwa Helena , Bran Jacqueline , Ruff Julia , Choe Sunny , Chua Joel V 
Published: December 2022

Abstract

Background
Coinfection with HIV and hepatitis B (HBV) has been associated with higher risk of morbidity and mortality, especially acceleration of liver disease. HBV-active antiretroviral (ARV) regimens have significantly improved the outcome of people with HIV-HBV coinfection. B/F/TAF has been shown to be highly effective in the treatment of HIV infection based on treatment naïve and switch trials. Although it is an HBV-active regimen, there is scant data on the use of B/F/TAF for people with HIV-HBV coinfection. We hypothesize that B/F/TAF is both safe and efficacious in the treatment of coinfected adults.

Methods
This open label, single-arm, switch study enrolled HIV/HBV-coinfected adults from two clinical centers (Baltimore, MD and Philadelphia, PA). Patients were switched from their current ARV regimen (regardless of viral suppression) to fixed dose combination B/F/TAF taken once daily for 48 weeks. Primary efficacy endpoints were proportion of patients with HIV RNA &lt; 50 copies/mL by FDA Snapshot Algorithm and HBV DNA &lt; 29 IU/mL at Week 24 by missing = failure method.

Results
A total of 28 eligible participants were enrolled between May 2019 to December 2021. Median age was 51 years (range 34-71), majority were Black (89%), male gender (86%), and non-Hispanic (96%), 65% HIV and HBV virally suppressed. Two participants, one lost to follow-up and the other removed due to non-adherence prior to week 24, were excluded in the efficacy analysis. At baseline, 73% were HIV suppressed and 81% were HBV suppressed. Of the 21 patients with week 24 data, 20 (95%) had HIV RNA &lt; 50 copies/mL and 19 (90%) had HBV DNA &lt; 29 IU/mL. Eighteen (86%) were HIV and HBV suppressed, which was higher than prior to B/F/TAF use. There were ten treatment-related adverse events (AE), all of which were mild (grade 1) and transient. Most common treatment related AE was nausea (2 of 28). Four patients had elevated alanine aminotransferase at baseline, all of which normalized at week 24. There were no serious adverse events or hepatitis flare. No participants discontinued study treatment due to an AE.

Conclusion
B/F/TAF is efficacious and safe for patients coinfected with HIV and HBV after 6 months of treatment.

Disclosures
Helena Kwakwa, M.D., Viiv Healthcare: Grant/Research Support Sunny Choe, PhD, Gilead Sciences: Employee.
1273. Implementation of a Mobile Phone Intervention Method to Improve Clinical Outcomes in Patients with HIV
Authors: Cummings Bailee , Bordelon Stacie , Dare Ryan K , Crescencio Juan Carlos Rico 
Published: December 2022

Abstract

Background
Antiretroviral therapy (ART) adherence decreases morbidity and mortality; however, this is often complicated by various external factors. Strategies implementing cellular technology have demonstrated improved medication adherence. The objective of this pilot study was to assess the effectiveness of utilizing weekly mobile phone calls or text messages to improve clinical outcomes among patients with HIV.

Methods
This study was conducted at an infectious disease clinic at an academic medical center 2019-21. Twenty-two patients were selected based on a history of poor ART adherence. For a period of 6 months, patients were contacted weekly by text message or phone call to determine medication adherence and to encourage continued adherence. Outcomes during the 12-month intervention period (6m intervention and subsequent 6m) were compared to the 12-month pre-intervention period and included viral load, CD4 count, clinic visits, emergency department (ED) visits, hospitalizations, and new-onset opportunistic infections (OI). Wilcoxon signed rank test and McNemar’s test were performed, though study is not powered for true analysis.

Results
Twenty-two patients were selected for inclusion and 13 (55%) maintained persistent communication throughout the intervention. For all 22 enrolled participants, this intervention resulted in increased mean yearly clinic visits (2.6 vs 3.8), decreased median viral load (32,979 vs 852 copies/mL, p=0.017), and increased median CD4 (142.5 vs 249 cells/uL). This also led to a decrease in patients with &gt; 1 ED visit (54.6% vs 36.4%), &gt; 1 inpatient hospitalization (36.4% vs 13.6%), and diagnosis of an OI (18.2% vs 13.6%). These outcomes were most remarkable in the 13 patients who maintained scheduled communication [mean yearly clinic visits (2.9 vs 5.2), median viral load (27,633 vs 118 copies/mL, p=0.0248), median CD4 cells/uL (76 vs 253), &gt; 1 ED visit (61.5% vs 30.8%), &gt; 1 inpatient hospitalization (38.5% vs 23.1%), and new OI (23.1% vs 7.7%)].
Impact of Intensifying Outpatient HIV Management
Clinical outcomes for the pre-intervention year (routine communication) and the intervention year (enhanced communication) for all 22 patients initially selected for the study are compared to outcomes for the 13 patients who maintained persistent communication throughout the intervention period.

Conclusion
Enhanced communication through weekly mobile phone reminders may serve as a useful tool in the outpatient setting to improve ART adherence and reduce morbidity among adults with HIV. The findings of this small pilot study provide support for the need of a larger study to prove the benefit of this care model.

Disclosures
All Authors: No reported disclosures.
1289. A Practical Approach to Antimicrobial Stewardship Education: Engaging Infectious Diseases Trainees in Targeted Outpatient Provider Feedback Program
Authors: Khan Parisa , Xu Teena , Xu Teena , Rodriguez-Barradas Maria C 
Published: December 2022

Abstract

Background
A 2016 needs assessment survey of infectious diseases (ID) training program directors revealed gaps in ID fellows’ education including the application of antimicrobial stewardship into clinical practice. Direct involvement of ID trainees in inpatient antimicrobial stewardship (AS) activities has previously been described with favorable outcomes and achievement of program goals. Engagement of ID fellows in outpatient (OP) AS activities including targeted provider feedback has not been well described and may provide opportunity for more hands-on OP AS experience for trainees.

Methods
Our OP AS program developed a 4-week virtual rotation experience for ID fellows to meet organizational needs for AS education during the COVID-19 pandemic. Acute respiratory tract infection (ARI) was chosen as a disease state priority. The expected progression of the ID fellow was as follows: Week 1: Review Core Elements of outpatient AS, regulatory requirements, and disease state priorities; review available stewardship tracking data sources; Week 2: Review facility-level antibiotic use data for a single outpatient clinic, and identify top 3 antibiotic prescribers in the clinic; Week 3: Deliver a virtual outpatient AS presentation to all providers at a single clinic, and create antibiotic report cards (See Figure 1) for top antibiotic prescribers; Week 4: Conduct 15-min targeted provider feedback sessions using antibiotic report cards for top 3 providers.
Example Antibiotic Report Card

Results
Between September 2021-April 2022, three ID fellows completed the OP AS rotation experience. All fellows completed each week of the rotation successfully. Solicitation of feedback from providers receiving targeted feedback sessions (See Figure 2) is ongoing, and a standardized feedback form will be sent to all ID fellows completing the rotation at the end of the academic year to evaluate the program’s success in meeting pre-specified learning objectives. The rate of antibiotic prescribing for uncomplicated acute respiratory tract infection will be re-evaluated post-intervention for providers receiving targeted education.
Targeted Provider Feedback Survey

Conclusion
Direct involvement of ID fellows in OP AS activities may be mutually beneficial for trainees and OP AS programs. A virtual format for AS education and intervention was practical and feasible.

Disclosures
All Authors: No reported disclosures.
1298. Donor Call Simulation: A Novel Medical Education Tool to Evaluate Trainees’ Clinical Decision-Making in Transplant Infectious Disease
Authors: Sigler Rachel , Wooten Darcy , Kumar Rebecca , Hand Jonathan , Marschalk Nicholas , Go Roderick , Prakash Katya , Stohs Erica J , Law Nancy 
Published: December 2022

Abstract

Background
Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations.

Methods
We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness.

Results
Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2).

Conclusion
ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning.

Disclosures
Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.