bluuebunny/crossref_metadata_2025_split huggingface dataset:
1269. End HIV with DOT: Maybe?
Authors: Garcia Bismarck Bisono , Bengualid Victoria , Dahdouh Michelle , Marinello Carla , Salazar Hernando , Berger Judy 
Published: December 2022

Abstract

Background
Directly observed Therapy (DOT) has proven to be a valuable asset used in ascertaining adherence to tuberculosis (TB) medications, methadone, psychiatric medications and HIV medications. Both HIV and TB share the need of adherence to treatment to avoid resistance. However, unlike TB, HIV treatment must be taken for life.
Argus Community (Argus DOT) provides Directly Observed Therapy to assist with medication adherence to HIV positive patients with medication adherence barriers who are not virally suppressed as long as the patient is from an affiliated medical provider network which includes St. Barnabas Designated AIDS Center (SBH DAC).

Methods
SBH DAC started referring patients who have not been virally suppressed to Argus DOT March 2021 to help reach our goal of 90% virally suppressed rate (viral load &lt; 200 copies/ml) by the end of 2021. Those who agreed to DOT were referred, accepted and enrolled in Argus. Argus DOT calls patients daily Monday to Friday to remind them to take their medications.
We performed a retrospective chart review of SBH DAC/Argus DOT patients to see if this intervention improved our suppression rate from March 2021 to December 2021 and if there were any barriers for our patients in regards to receiving these benefits.

Results
18 patients were approached by the DAC team to enroll in Argus DOT; of those 15 originally agreed to the program. 3 patients declined the enrollment.
Of the 15 patients who agreed to the program, 6 patients discontinued the program and none of these 6 patients achieved viral load suppression. Results of 9 patients who stayed with Argus DOT: 8 out of 9 patients achieved a viral load &lt; 200 copies/ml and one achieved 230 copies/ml from 2200 copies/ml. 2 patients achieve a viral load &lt; 20 copies/ml (undetectable).

Conclusion
This small study shows Argus DOT as valuable asset in achieving decrease HIV viral load in patients with medication adherence barriers. 50% accepting and staying with the program achieved 89% viral suppression; close to the 90% needed to End the Epidemic. 9 out of 18 who did not agree or discontinued Argus DOT due to uncontrolled psychiatric, substance use, nonworking phones and distrust did not achieve viral suppression. Co-located psychiatric, substance use as well as in-house SBH DOT personnel is needed to achieve viral load suppression.

Disclosures
All Authors: No reported disclosures.
1270. HIV Drug Resistance and Viral Outcomes after 2nd-line Antiretroviral Failure in Kenya
Authors: Ali Shamim M , Humphrey John , Novitsky Vladimir , Sang Edwin , DeLong Allison , Jawed Bilal , Kemboi Emmanuel , Goodrich Suzanne , Gardner Adrian , Hogan Joseph W , Kantor Rami 
Published: December 2022

Abstract

Background
Program data on HIV drug resistance and clinical outcomes after 2nd-line antiretroviral therapy (ART) failure in resource-limited settings are limited, yet can inform care, particularly with better ART access and options.

Methods
We examined resistance upon 2nd-line failure and subsequent viral outcomes at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya. Charts of people with genotypes upon 2nd-line failure up to 6/2021 were reviewed; and associations with viral suppression (&lt; 1000 copies/mL) closest to 12 months post-genotyping were determined using bi- and multivariate analyses, adjusting for age, sex, time on ART, switch to 3rd-line (darunavir-, dolutegravir-, and/or raltegravir-based ART), and any resistance to regimens upon viral load (VL) testing.

Results
Of 194 participants (53% female; median age 41 years; median 3.3 and 4.1 years on 1st- and 2nd-line), 60% were on lopinavir/ritonavir and 40% on atazanavir/ritonavir-based regimens. Overall, 178 (92%) had any resistance: 19% mono-, 40% dual-, 41% triple-class; 79% to NRTIs; 81% NNRTIs; and 43% PIs - 33% of those on lopinavir/ritonavir; 58% on atazanavir/ritonavir (p&lt; 0.001); 24% with intermediate-high predicted resistance to darunavir/ritonavir (12 upon LPV/ritonavir, and 8 upon atazanavir/ritonavir failure; p=0.98). Of 140/194 people with post-genotype VLs, 55% stayed on 2nd-line, and 45% switched to 3rd-line. Of those 140, 72% virally suppressed (89% who switched to 3rd-line; 58% who didn't), and 75% had any resistance to their regimen at post-genotype VL (90% who switched to 3rd-line; 62% who didn't). In bivariate analysis, suppression was associated with switching to 3rd-line, and with resistance upon VL testing (Table). In multivariate analysis, suppression remained more likely among those who switched to 3rd-line, and association with resistance was less pronounced.

Conclusion
In a large Kenyan HIV program, high resistance upon 2nd-line failure, high failure rates, and suppression association with 3rd-line switch suggest the need for dedicated management of this vulnerable population. Potential association between resistance and better viral outcomes, similar to reports upon 1st-line failure, needs further data and suggests significance of inadequate adherence.

Disclosures
All Authors: No reported disclosures.
1281. Rifampicin and Tenofovir Alafenamide Containing Regimen Drug Interaction in People Living with HIV: Case Series Report
Authors: Mohzari Yahya , Musawa Mohammed A L , Alrashed Ahmad , Alamer Ahmad , Almulhim Abdulaziz S 
Published: December 2022

Abstract

Background
Owing to the excellent safety and efficacy profile of the tenofovir alafenamide (TAF) over tenofovir disoproxil fumarate (TDF), it is the preferred prodrug of tenofovir (TFV) implicated in the management of people living with HIV (PLWH). PLWH are more susceptible to having tuberculosis (TB) and therefore, rifampicin (RIF) use as a key component of antituberculosis therapy is frequently indicated. However, since TAF is a substrate for drug transporters such as P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) and RIF being an inducer for these transporters, the concomitant use of RIF and TAF is not recommended. The magnitude of this drug-drug interaction in PLWH is not known. Hence, the objective of this study was to

Methods
We retrospectively reviewed the charts of PLWH (≥ 18 years old) seen in our center and who received the TAF-containing regimens and RIF together for ≥ 4 weeks. Demographic data were described using descriptive statistics. We defined the clinical impact as the following: 1- maintaining viral suppression (&lt; 20 copies/mL) for those with suppressed viral load at baseline, 2- the attainment of the viral load suppression (&lt; 20 copies/mL) for those with unsuppressed viral load at baseline. The clinical impact was assessed from the RIF initiation to the end of the therapy.

Results
A total of 6 PLWH were identified, 5 (83.3%) of them were males. The median (IQR) age was 41.5 years old (49.25 to 36). All patients received dolutegravir 50 mg twice daily (DTG) plus the combination of TAF 25 mg and emtricitabine 200 mg (FTC) once daily as their antiretroviral regimen. Pulmonary tuberculosis was the indication for RIF in all the cases. The RIF dose of 600 mg was the most frequently prescribed (83.3%). The mean (±SD) duration of RIF-TAF co-administration was 30 weeks (2.8). Four patients had suppressed viral load levels at baseline, which was maintained throughout the course of TB treatment. Two patients had unsuppressed viral load levels at baseline and attained viral load suppression throughout the treatment course.

Conclusion
This case series study demonstrated the possibility of RIF-TAF co-administration, without attenuation the efficacy of TAF, however further work on a large sample is needed to confirm our findings.

Disclosures
All Authors: No reported disclosures.
1292. Accessible Antibiotic Stewardship: Development of an Open-Source, Interactive Online Curriculum
Authors: Rendell Sara , Goren Eric , Degnan Kathleen , Hamilton Keith W 
Published: December 2022

Abstract

Background
Significant gaps exist at all levels of medical training with regards to knowledge and confidence in antimicrobial prescribing and stewardship. Studies of antimicrobial prescribing perceptions have also noted that trainees and physicians desire further education on antibiotics and antimicrobial stewardship. Although courses in antimicrobial stewardship exist, these have generally been limited in scope and accessibility.

Methods
We first performed a needs assessment by reviewing all existing online antibiotic curricula. We then developed an open-source, comprehensive online antibiotic curriculum comprising educational modules for adult clinical learners to build expertise at their own pace, without financial burden. We based the curriculum on a previously validated framework for learning principles of antibiotics and drew on cognitive-load theory. Our intended learners were medical students, medical and surgical residents, and advanced practice provider trainees.

Results
There are 24 currently accessible online antibiotic learning materials, 4% of which are comprehensive, 25% of which include interactive content, and &gt;40% of which include inaccuracies. We designed a curriculum to address these gaps. Our curriculum consists of 22 modules including videos lasting 8 minutes or less and accompanied by activities to apply and reinforce content. We partnered with a student in graphic design to create visually appealing and memorable animated videos. The modules reinforce the “3Ps and 3Ds”: 1) from what place is the infection coming, 2) what pathogens tend to live in the place of the infection and should be empirically covered with antibiotics, 3) are there patient-specific factors that affect antibiotic choice, and ) what are the drug, dose, and duration of antibiotic therapy.

Conclusion
To our knowledge, this would be the first open-source, comprehensive online curriculum targeting appropriate antibiotic selection using a novel framework for choosing antimicrobials: the “3Ps and 3Ds”. Our antibiotic curriculum is also novel in that we have built short, interactive learner-friendly modules that incorporate microbiology concepts as well as fundamentals of antimicrobial stewardship to facilitate antibiotic learning.

Disclosures
Kathleen Degnan, MD, Gilead: Grant/Research Support.
1299. Effectiveness of Educational Interventions to Reduce Incidence of Occupational Exposure to Blood and Body Fluid in First-clinical-year Medical Students of A Thai University-based Medical School
Authors: Khawcharoenporn Thana , Boonruang Krittapol 
Published: December 2022

Abstract

Background
Occupational exposures to patients’ blood and body fluid are not uncommon and increase risk of blood-borne infections among medical students during their clinical clerkship. However, existing data on interventions to prevent such exposures are limited in Thailand. We conducted this study to evaluate effectiveness of the study interventions in decreasing incidences of the occupational exposures among first-clinical-year medical students (4th-year students) in a Thai university-based medical school.

Methods
A quasi-experimental study was conducted to compare the incidence of the occupational exposures between the pre-intervention period (2019 academic year) and the intervention period (2020 academic year). The interventions included an orientation session about occupation exposure prevention and procedure review for the medical students on the first day of each major department rotation and the use of LINE application to send video clips and articles for procedure review, weekly remind the students how to prevent themselves from common occupational exposures via short messages and provide Q&A sessions between the researchers and medical students regarding procedures and occupational exposure prevention.

Results
A total of 63 medical students, men (57%) and women (43%), and 66 medical students, men (47%) and women (53%) participated in the study during the pre-intervention and intervention periods, respectively. The incidence of occupational exposure among the students was significantly lower in the intervention period compared to the pre-intervention period (7.9 vs. 35.86 per 100 person-years; P&lt; 0.001). The most common exposures were mucosal exposure (44%), needle stick injury (25%), and sharp object injuries (25%). After the exposures, there was no acquisition of syphilis and infections due to human immunodeficiency virus, hepatitis B virus and hepatitis C virus among the students in both periods.

Conclusion
The study interventions that included focused orientation and the use of LINE application to communicate with the students regarding procedure review and occupational exposure prevention were associated with significant decrease in the incidence of occupational exposure during their clinical clerkship.

Disclosures
All Authors: No reported disclosures.
1303. Making Infectious Disease Fellowship More Rashional: A Needs Assessment of Program Directors
Authors: Rockney Danica , Tackett Sean , Melia Michael T 
Published: December 2022

Abstract

Background
Many infectious diseases present with rashes. Despite this, limited data have been published regarding dermatology training in infectious disease (ID) fellowships. We aimed to understand the perceived importance, current effectiveness, and existence of dermatology curricula for ID fellows in the United States (US).

Methods
Over four weeks in March-April 2022, we emailed US ID fellowship program directors (PDs) individualized links to a Qualtrics survey. Up to two reminder emails were sent. Using NRMP Match Results and Data, we identified 151 PDs. Email addresses were found for 147 PDs. Descriptive data analysis was performed. This study was IRB exempt.

Results
Response rate was 91/147 (62%). Most PDs (79/91, 87%) felt like it was very-to-extremely important for ID fellows to know basic dermatologic manifestations of infections (Image 1), though 91% (82/90) felt that they were only slightly-to-moderately effective at preparing fellows for this (Image 2). Most (55/90; 61%) programs do not have a formal dermatology curriculum for their fellows. Lack of faculty capacity, lack of reliable resources, and other topics taking priority were most commonly selected as significant barriers to implementing a dermatology curriculum (Image 3). Of the programs that do not have a dermatology curriculum, 76% (41/54) of PDs were interested in incorporating an externally produced dermatology curriculum with synchronous lectures (81%), asynchronous content (78%), and flipped classroom guides (72%) being the most favored educational strategies. For programs that currently have a dermatology curriculum (35/90, 39%), 67% (22/33) of PDs felt their fellows found their current dermatology curriculum very-to-extremely valuable.

Conclusion
These data indicate that current ID training often does not include formal dermatology-ID training. This data, along with a planned focus group of fellows, will help inform the development of a dermatology-ID curriculum to help address this content gap and improve ID fellowship education.

Disclosures
All Authors: No reported disclosures.
1307. The Success of ID Carnival in Achieving Doctor of Pharmacy Educational Outcomes
Authors: Lee Yuman , Bradley Nicole 
Published: December 2022

Abstract

Background
ID Carnival was established as a term project in the infectious disease (ID) elective for pharmacy students in their third professional year. In small groups and with frequent faculty feedback, students designed, developed, and created games based on an ID topic. At the end of the semester, students presented their development process and played each other’s games during ID Carnival. The goal of ID carnival was to engage and motivate students to reinforce the foundational knowledge taught in the course and challenge students to develop personally and professionally. The purpose of this study was to assess the impact of ID Carnival on achieving the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes and evaluate students’ perception of ID Carnival.

Methods
From 2019 to 2022, student feedback was anonymously collected via an electronic survey. Students evaluated the impact of ID Carnival based on the 4 domains of the CAPE 2013 Educational Outcomes (Foundational Knowledge, Essentials for Practice and Care, Approach to Practice and Care, and Personal and Professional Development) on a Likert scale from strongly disagree (1) to strongly agree (5).

Results
125 students responded. Majority strongly agreed or agreed that ID Carnival allowed them to build foundational knowledge (122/125, 98%), apply drug information skills (120/125, 96%), develop problem solving skills (121/125, 97%), improve effective communication skills (124/125, 99%), become self-aware in their ability to enhance personal and professional growth (120/125, 96%), hone their leadership skills (123/125, 98%), and creatively think of ways to accomplish professional goals (125/125, 100%). Additionally, students expressed that ID Carnival enhanced their desire to learn ID, provided a fun, engaging, and rewarding environment to learn, and felt motivated to participate in ID Carnival.

Conclusion
ID Carnival was positively received and provided an opportunity for students to expand beyond foundational knowledge and skills, and develop on the affective domain, including self-awareness, innovation, leadership, and professionalism. Opportunities like ID Carnival are important in the education of pharmacy students to prepare them to practice at the highest level of the profession.

Disclosures
All Authors: No reported disclosures.
1312. Clinical and Economic Burden of Otitis Media in Children under 5 in the United States
Authors: Debba Lilia Ben , Derreumaux Dominique , Pickett Jessica , Taddei Laura , Beck Ekkehard , Scherbakov Michael 
Published: December 2022

Abstract

Background
Otitis media (OM) is one of the most common childhood illnesses and frequent cause of antibiotic use among patients under 5 years old.
Pneumococcal conjugate vaccines (PCVs) led to a reduction in the burden of OM caused by Streptococcus pneumoniae (Spn) strains in the United State (US).
Overall, OM incidence was reduced after introduction of PCV7 and plateaued in the late PCV13 era, though there was an increase in OM episodes caused by non-typeable Haemophilus influenzae and non-vaccine-type Spn.
The objectives of this study were to assess the incidence and treatment costs of OM episodes and their complications in the US.

Methods
This retrospective observational study used data from IBM MarketScan to study pediatric OM incidence and complications (tympanostomy tube placement [TTP], hearing loss [HL] and hospitalizations) by age groups and their associated costs. OM episodes occurring between January 1, 2016, and December 31, 2017, were considered in this analysis. Results of the total cost are weighted by the proportion of children covered under commercial insurance and Medicaid, respectively.

Results
The incidence of OM among children &lt; 5 increased gradually with age, reaching a peak of incidence between 1 and 2 years (figure 1) and more precisely between 6 and 15 months. Overall, most OM episodes were without HL and treated in an outpatient setting without TTP (∼ 94% of cases); OM episodes without HL requiring TTP represented only 4% and the vast majority were performed in an outpatient setting ( &gt; 99%). OM without HL leading to hospitalization was very rare (&lt; 0.025%) for both plans. OM leading to HL corresponds to 2% of all OM episodes.
The incidence rate and the mean cost per episode were used to extrapolate an overall economic burden of ∼5 billion USD in 2020, driven by outpatient episodes (50%) followed by OM episodes plus TTP (37%), and OM episodes plus HL (13%). Figure 1:Incidence rates by age groups for (A) Commercial/Medicare; (B) Medicaid

Conclusion
The burden associated with OM in children &lt; 5 reflects a significant and ongoing unmet need. Thus, prevention of OM not currently covered by existing vaccines is warranted to address the significant burden including the potential emergence of antimicrobial resistance.

Funding
GlaxoSmithKline Biologicals SA (GSK study identifier: VEO-000264])

Disclosures
Lilia Ben Debba, PharmaD, GlaxoSmithKline SA: Advisor/Consultant Dominique Derreumaux, M.Sc, GlaxoSmithKline SA: is employed by the GSK group of companies Jessica Pickett, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Laura Taddei, M.Sc, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Ekkehard Beck, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies Michael Scherbakov, PhD, GlaxoSmithKline SA: is employed by and hold shares in the GSK group of companies.
1321. Increased Prevalence of Group A Streptococcus (GAS) High Level Macrolide Resistance During the COVID-19 Pandemic
Authors: Patel Ami B , Guzman-Cottrill Judith A , Fleming-Dutra Katherine E , Chochua Sopio , Beall Bernard , Jaggi Preeti , Rippe Jason , Inguglia Christine L , Katsogridakis Yiannis L , Ozer Egon A , Shulman Stanford , Tanz Robert R 
Published: December 2022

Abstract

Background
COVID-19 affected the epidemiology of many respiratory pathogens including GAS. Assessing genetic heterogeneity (emm type, antimicrobial resistance, virulence factors) can inform treatment recommendations and targets for potential GAS vaccines. We assessed GAS clinical antibiotic susceptibility and performed whole genome sequencing (WGS) among pediatric pharyngeal isolates from 2020–2022.

Methods
From 1/2020–3/2022 we collected throat swabs in pediatric clinics and EDs from children aged 3-18 years in Chicago, IL; Atlanta, GA; Portland, OR; and Phoenix, AZ: 1) with acute GAS pharyngitis and 2) among a convenience sample of asymptomatic children to assess for GAS colonization. Swabs were plated on blood agar. E-tests were used to assess clinical susceptibility to erythromycin (ERY) and ciprofloxacin (CIP). emm type and antimicrobial resistance genes (ERY, Clindamycin (CLI), and fluoroquinolones) were assessed by WGS.

Results
1144 pharyngeal swabs were collected: 359/684 (52%) from children with GAS pharyngitis by rapid test and 20/460 (4.3%) from asymptomatic children yielded GAS on culture. Phenotypic resistance: 55/364 (15%) tested isolates were ERY resistant and 5/364 (1.4%) CIP resistant. The proportion of isolates with ERY resistance increased significantly from 2020 (6%) to 2021–2022 (25%) (χ2 = 23.70, p&lt; .00001) (Figure 1). MICs were high among ERY resistant GAS (Table 1). Genotypic resistance: Of 304 sequenced GAS isolates 40/304 (13%) were ERY resistant, 35/304 (11.5%) were both ERY resistant and CLI (inducible or constitutive) resistant, and 4/304 (1.3%) fluoroquinolone resistant. ermB (62%) was the most common gene for ERY resistance and constitutive CLI resistance, followed by ermTR (23%) and ermT (11%) both conferring inducible CLI resistance. Among the 20 isolates from asymptomatic children no ERY, CLI, or CIP resistance occurred, and no resistance genes were identified. emm types 11, 9, 77, 58 and 94 were associated with ERY and CLI resistance.

Conclusion
ERY resistance increased from 2020–2022. The high rate of CLI resistance among ERY resistant GAS was associated with erm genes. These results are important to inform treatment recommendations for GAS pharyngitis and targets for vaccine development that can reduce antimicrobial-resistant GAS disease.

Disclosures
All Authors: No reported disclosures.