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Results. 138 (76%) respondents were aware that PrEP is approved for adolescents. 866. Adherence to F/TDF for PrEP in Dried Blood Spots and HIV Infection Rates: er Th e was no significant difference across specialties or between residents and attend - A Pooled Analysis of Global PrEP Studies 1 1 2 ings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had Albert Liu, MD, MPH ; Albert Liu, MD, MPH ; Robert Grant, MD, MPH ; 3 3 never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adoles- Raphael J. Landovitz, MD, MSc ; Raphael J. Landovitz, MD, MSc ; 4 5 cents who qualify (n=80), not having enough training (66), confidentiality concerns Beatriz Grinsztejn, MD, PhD ; Connie Celum, MD, MPH ; Jared Baeten, MD, 6 6 6 6 (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to rec- PHD ; David Magnuson, PharmD ; Moupali Das, MD ; Christoph C. Carter, MD ; 7 8 1 ommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pedi- Dawn Smith, MD, MS, MPH ; Li Tao, MD, PhD ; Bridge HIV, San Francisco atrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents Department of Public Health, CA; University of California, San Francisco, San reported universal HIV testing for patients 15 years and older (p < 0.05). Residents Francisco, CA; UCLA Center for Clinical AIDS Research & Education, Los Angeles, were more likely to test for HIV than attendings (33.3% versus 16%, p < 0.05). 111 CA; 15. Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, participants completed the “test your knowledge” section. 31.5% correctly named two Rio de Janiero, Rio de Janeiro, Brazil; University of Washington, Seattle, Washington; 6 7 approved PrEP medications. There were 183 responses to the survey (49% response Gilead Sciences Inc., Foster City, CA; Division of HIV/AIDS Prevention (DHAP), rate). Atlanta, Georgia; Gilead Science, Inc, Foster City, CA Conclusion. Adolescent primary care providers are aware that PrEP is FDA Session: P-49. HIV: Prevention approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that provid- Background. e u Th se of daily F/TDF for HIV pre-exposure prophylaxis (PrEP) ers are not seeing patients who qualify. Next steps include developing an institutional substantially reduces HIV acquisition. Dried blood spot (DBS) tenofovir-diphos- PrEP guideline and creating an electronic medical record order set to facilitate PrEP phate (TFV-DP) levels reflect TDF use over the past 6-8 weeks, providing an objective prescribing. measure of adherence in people taking PrEP. Disclosures. All Authors: No reported disclosures Methods. In a pooled analysis of 19 PrEP demonstration projects and clin- ical studies, 6,613 participants had at least one TFV-DP measurement in DBS and followed for at least 48 weeks and up to 96 weeks. We used a piecewise 865. Social Media Secret Facebook Groups for HIV Pre-Exposure Prophylaxis linear mixed-effects model to plot the least-square means with corresponding Awareness among Female Sex Workers in Cameroon 95% confidence intervals (CI) of TFV-DP for adherence over time, and Poisson 1 2 2 Laia Jimena Vazquez Guillamet, MD ; Mary Mah Babey, n/a ; Njah Mercy, n/a ; regressions to calculate HIV incidence rates (IR) by level of weighted average of 3 3 2 Hassanatu Blake, MBA MPH ; Amy Jasani, n/a ; Rahel Kyeng, n/a ; TFV-DP. 2 2 3 Pius Tih, Professor ; Eveline Mboh Khan, PhD ; Jodie Dionne, MD MSPH ; Results. Of 6,613 participants, median age was 30 years (interquartile range 1 2 ISGlobal, Terrassa, Catalonia, Spain; Cameroon Baptist Convention Health 24−38), 5,449 (82%) were cisgender men, 806 (12%) were cisgender women, and 349 Services, Bamenda, Nord-Ouest, Cameroon; University of Alabama at Birmingham, (5%) were transgender (316 transgender women, 2 transgender men, 31 unspecified). Birmingham, Alabama Adherence based on TFV-DP in DBS was consistently higher among participants who did not acquire HIV compared to those who did (Figure). Among all participants, Session: P-49. HIV: Prevention 21%, 14%, 36%, and 29% has DBS consistent with taking < 2, 2−3, 4−6, and ≥7 tablets Background. About 25% of Cameroonian female sex workers (FSW) lived with of F/TDF PrEP per week (Table). Sixty-nine participants acquired HIV, with a median HIV in 2018. PrEP was introduced in Cameroon in 2019, with minimal uptake as of PrEP exposure of 0.82 years and an overall HIV IR (95% CI) of 1.16 (0.92, 1.47) per 100 2021. The goal of this pilot project was to evaluate the potential of a novel social media person years. There was a strong association between adherence and HIV incidence intervention to raise Pre-Exposure Prophylaxis (PrEP) awareness and complement [among individuals who took < 2, 2−3, 4−6, and ≥7 tablets/week, the HIV IRs (95% HIV prevention strategies among FSW, a key risk population. CI) were 5.20 (4.03, 6.71), 0.38 (0.12, 1.18), 0.28 (0.12, 0.61), and 0.06 (0.01, 0.39), re- Methods. From October 2020 to April 2021, sixty adult HIV-negative FSW who spectively. Overall IR (95% CI) of HIV infection among cisgender men was 1.25 (0.98, owned a phone with internet access joined the study; 40 in the intervention arm and 20 1.60) per 100 patient-years. Four cisgender women and 2 transgender participants in the control arm. The intervention had a Secret Facebook Group (SFG) platform for acquired HIV, corresponding to IRs (95% CI) of 0.71 (0.27, 1.90) and 0.63 (0.16, 2.53). confidentiality. It included 12 videos on HIV prevention in the local dialect, released Adherence by TFV-DP in DBS for F/TDF users who acquired HIV compared to over 8 weeks. In-person surveys were administered before and aer t ft he intervention, those who did not. and three months later. Likert scale was used to evaluate the main outcome: PrEP awareness. Data was analyzed using Stata IC/version 14.2. Results. Demographic characteristics were similar between intervention and control groups for age (29 years, SD7.3), literacy (45% secondary school), parity (1.9, SD1.5), and years as sex worker (7.8, SD5.1). One FSW had heard about PrEP before the intervention. Aer a b ft rief introduction, 39% (15/38) of FSW in the intervention group and 50% (10/20) in the control group strongly agreed to be interested in taking PrEP (p=0.2). Baseline PrEP knowledge was poor in the intervention group (15/40, 38%) and very poor in the control group (19/20,95%) (p=0.0001). In the second survey, the intervention and control groups’ PrEP knowledge improved (p=0.0001 and p=0.02, respectively). It was more significant in the intervention group, with all FSW reporting good level of knowledge (p=0.0001) (Figure 1). In addition, more FSW in the interven- tion group (67%,27/40) strongly agreed to be interested in taking PrEP (p=0.01), while numbers remained similar in the control group (55%, 11/20, p=0.8). Three months aer t ft he intervention, 31.5% (12/38) of participants reported excellent PrEP know- ledge, a significant improvement since the second survey (p=0.02). Figure 1. Self-reported Pre-Exposure Prophylaxis knowledge before and aer in ft ter - vention in the intervention and control groups. Note: ‘x’ on the Figure represents visit week when a new HIV infection was detected. HIV incidence rates (95% confidence intervals) by adherence to PrEP measured by level of TFV-DP in DBS up to 96 weeks aer P ft rEP Initiation Conclusion. This diverse, multi-national pooled analysis of F/TDF PrEP Conclusion. e u Th se of a social media HIV prevention tool tailored to FSW in use provides the largest assessment to date of the adherence-HIV incidence rela- Cameroon improved PrEP awareness with good retention of knowledge. Cross con- tionship in people taking F/TDF for PrEP. The results suggest a high background tamination between groups might have hindered the differential impact of the brief HIV incidence in the pooled cohort and high efficacy in those adherent to PrEP. intervention. These findings support ongoing efforts to increase PrEP use among people who Disclosures. All Authors: No reported disclosures would benefit. S524 • OFID 2021:8 (Suppl 1) • Abstracts 2 5 Disclosures. Albert Liu, MD, MPH, Gilead Sciences (Individual(s) Involved: Jillian S. Catalanotti, MD., MPH ; Irene Kuo, PhD, MPH ; 2 2 2 Self): Gilead has donated study drug for studies I have led., Grant/Research Keanan McGonigle, MD, MPP ; William Mai, MD ; Melissa Notis, MD ; 6 7 7 1 Support, Other Financial or Material Support, Research Grant or Support; IAS-USA Kaylee W. Burgan, MA ; Joseph Carpenter, MD ; Alaina Steck, MD ; Ellen Eaton, MD ; 1 1 (Individual(s) Involved: Self): Honorarium for manuscript writing, Other Financial Ellen Eaton, MD ; University of Alabama at Birmingham, Birmingham, Alabama; or Material Support; Viiv Healthcare (Individual(s) Involved: Self): Grant/Research e G Th eorge Washington University of Medicine and Health Sciences, Washington, 3 4 Support, Research Grant or Support Raphael J. Landovitz, MD, MSc, Gilead Sciences District of Columbia; University of Maryland, Washington, DC; University (Individual(s) Involved: Self): Consultant; Janssen (Individual(s) Involved: Self): of Maryland School of Medicine, Boston, Massachusetts; George Washington Consultant; Merck Inc (Individual(s) Involved: Self ): Consultant; Roche (Individual(s) University Milken Institute School of Public Health, Washington, DC; University Involved: Self ): Consultant Jared Baeten, MD, PHD, Gilead Sciences Inc. (Employee, of Alabama Birmingham, Birmingham, Alabama; Emory University School of Shareholder) David Magnuson, PharmD, Gilead Sciences Inc (Employee, Medicine, Atlanta, Georgia Shareholder) Moupali Das, MD, Gilead Sciences Inc. (Employee, Shareholder) e C Th ontinuum of Care in Hospitalized Patients with Opioid Use Disorder (OUD) Christoph C. Carter, MD, Gilead Sciences Inc. (Employee, Shareholder) Li Tao, MD, and Infectious Complications of Drug Use (CHOICE) Study PhD, Gilead Sciences Inc (Employee, Shareholder) Session: P-50. HIV: Social Determinants of Health Background. Because hospitals are a safety net for persons with injection drug 867. Telehealth and HIV Care During the COVID-19 Pandemic 1 2 2 use (IDU), they play a valuable role towards ending the HIV epidemic. The objective of Smitha Gudipati, MD ; Monica Lee, BA ; Indira Brar, MD ; 2 1 2 this study is to evaluate the hospital outcomes of persons with HIV (PWH) and opioid Norman Markowitz, MD ; Henry Ford Health System, Detroit, Michigan; Henry use disorder (OUD). Ford Hospital, detroit, Michigan Methods. CHOICE is a retrospective review of hospitalized persons with Session: P-50. HIV: Social Determinants of Health an infectious complication of OUD and IDU at University of Maryland, George Washington University, University of Alabama at Birmingham, and Grady Background. e C Th OVID-19 Pandemic led to many restrictions in health care Memorial Hospital. Participants were hospitalized between 1/2/2018-12/21/2018, services, and as a consequence, an expansion of telehealth capabilities. In order to meet had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal in- the needs of PLWH along the Care Continuum, we developed a process to promote the fection, and verification of OUD-associated infection. HIV was defined by chart use of our MyChart app. This HIPAA-compliant app allows patients to view their med - review. We explored HIV viral load (VL), antiretroviral therapy (ART) and med- ical records, communicate with their providers, make appointments, and have video ications for opioid use disorder (MOUD) on admission, discharge, consultation, visits on their smart devices. This report describes our preliminary findings. and community care. Methods. PLWH enrolled in the Ryan White Program, in the Infectious Diseases Overall CHOICE Study Enrollment Clinic at Henry Ford Hospital who had not used telehealth services were asked to sign up for our MyChart (electronic medical record software) initiative. A telehealth Navigator interviewed and taught PLWH how to download and use MyChart, and supplied pre-loaded phones, as needed, to make virtual visits accessible. We collected demographic and clinical information and reasons for not using telehealth services. Results. From October 2020 to May 2021, 209 PLWH were enrolled into our pilot program (Table 1). Of these: 48% were 45-64 years old (yo), while 21% were >/+ 60 yo and 3% < 25 yo; 75% were male, 85% Black; 48% MSM, and 84% virally suppressed (HIV RNA < 200 copies/mm ). When asked why they were not using telehealth services, 29% reported a lack of technology or capability to install MyChart on their phones, 27% needed further education, and 18% and had not prioritized installation of the application. Results. Overall, 287 were admitted with OUD and infections over the study period; 22 had HIV of whom 3 (14%) were diagnosed during the admission. Of the HIV negative, 1 was discharged on PrEP. Of PWH, most were Black (55%), male (68%), and Medicaid recipients (77%); median age was 48. Median length of stay was 10 days. Common bacterial infections were skin/soft tissue (55%), Bacteremia (41%), and Osteomyelitis (18%). On admission, few were on antiretroviral therapy (ART; 32%) or MOUD (23%). Of the 13 with a VL during admission, 100% had viremia (median VL 6,226 copies/mL). During the admission, 81% were evaluated by Infectious Diseases consultant and 50% by Addiction Medicine. At discharge, 11 and 6 had documentation of an ART plan and MOUD receipt, respectively. In the year following the admission, of 21 with follow up data, a majority were evaluated in the emergency department (68%) and readmitted (57%). HIV Outcomes for Hospitalized Persons with Injection Related Bacterial Infections Conclusion. e cr Th ises created by the COVID-19 pandemic revealed a new role for Conclusion. For patients with IDU, hospitalization is a missed opportunity to telehealth services. Although available to all PLWH in our RW program, many had never address HIV treatment and prevention through PrEP, VL surveillance, and ART link- used telehealth services. Over half lacked compatible devices or needed help to download age. Because addiction treatment improves HIV outcomes, Addiction consultation or use the app. Compared to younger PLWH, older individuals were more likely to need should be standard of care but was under-utilized. Subsequent ED visits and readmis- assistance. Further work is needed to understand and promote digital parity. sions suggest that hospitals provide continuity of care for patients with IDU who would Disclosures. All Authors: No reported disclosures benefit from HIV, HCV, and other services in acute settings. Disclosures. Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or 868. HIV, Opioid Use Disorder, and Injection related Infections: Clinical Support)Merck (Research Grant or Support) Ellen Eaton, MD , Gilead (Grant/ Outcomes in 4 Academic Hospitals 1 2 Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self ): Research John R. Bassler, MS ; Hana Akselrod, MD, MPH ; Greer A. Burkholder, MD, 1 3 4 Grant or Support MSPH ; Elana S. Rosenthal, MD ; Christopher J. Brokus, BA ; Abstracts • OFID 2021:8 (Suppl 1) • S525
Open Forum Infectious Diseases – Oxford University Press
Published: Dec 4, 2021
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