Academic HIV Clinic Research Articles

Sleep, Sleep Apnea, and Fatigue in People Living With HIV

Background: People living with HIV (PLWH) often report fatigue even when viral load is suppressed. Obstructive sleep apnea (OSA), which is often associated with fatigue, is common in PLWH, but whether OSA explains fatigue in this population is unknown. Setting: Academic university-affiliated HIV and Sleep Medicine Clinics. Methods: PLWH, aged 18–65 years, with a body mass index of 20–35 kg/m2 and viral suppression (RNA <200 copies per mL), were recruited to undergo daytime questionnaires, including the Functional Assessment of Chronic Illness Therapy Fatigue Scale and Epworth Sleepiness Scale, 7 days of actigraphy (to determine daily sleep duration and activity amplitude and rhythms), and an in-laboratory polysomnography to assess for the presence and severity of OSA. Results: Of 120 subjects with evaluable data, 90 (75%) had OSA using the American Academy of Sleep Medicine 3% desaturation or arousal criteria, with an apnea–hypopnea index >5/h. There was no difference in Functional Assessment of Chronic Illness Therapy scores between those with and without OSA, although those with OSA did report more daytime sleepiness as measured using the Epworth Sleepiness Scale. In a multivariable model, predictors of fatigue included more variable daily sleep durations and decreased mean activity counts. Sleepiness was predicted by the presence of OSA. Conclusion: OSA was very common in our cohort of PLWH, with those with OSA reporting more sleepiness but not more fatigue. Variability in sleep duration was associated with increased fatigue. Further study is needed to determine if treatment of OSA, or an emphasis on sleep consistency and timing, improves symptoms of fatigue in PLWH.

Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of HIV primary care. To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol level in a diverse population of PWH receiving antiretroviral therapy (ART). This randomized clinical trial enrolled PWH at 3 academic HIV clinics in the US from September 2019 to January 2022 and conducted follow-up for 12 months until January 2023. Included patients were 18 years or older and had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. Participants were stratified by trial site and randomized 1:1 to either the multicomponent EXTRA-CVD (A Nurse-Led Intervention to Extend the HIV Treatment Cascade for Cardiovascular Disease Prevention) intervention group or the control group. Primary analyses were conducted according to the intention-to-treat principle. The EXTRA-CVD group received home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse at 4 in-person visits (baseline and 4, 8, and 12 months) and frequent telephone check-ins up to every 2 weeks as needed. The control group received general prevention education sessions from the prevention nurse at each of the 4 in-person visits. Study-measured SBP was the primary outcome, and non-HDL cholesterol level was the secondary outcome. Measurements were taken over 12 months and assessed by linear mixed models. Prespecified moderators tested were sex at birth, baseline ASCVD risk, and trial site. A total of 297 PWH were randomized to the EXTRA-CVD arm (n = 149) or control arm (n = 148). Participants had a median (IQR) age of 59.0 (53.0-65.0) years and included 234 males (78.8%). Baseline mean (SD) SBP was 135.0 (18.8) mm Hg and non-HDL cholesterol level was 139.9 (44.6) mg/dL. At 12 months, participants in the EXTRA-CVD arm had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control arm. There was a clinically meaningful but not statistically significant difference in SBP effect in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06). Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for PWH. ClinicalTrials.gov Identifier: NCT03643705.

1478. Evaluation Of Anal Cancer Screening Program in men who have sex with men (MSM) persons with HIV (PWH) At Two academic center HIV Clinics 2018-2022

Abstract Background Treatment of anal dysplasia has been shown to reduce incidence of squamous cell carcinoma of the anus (SCCA) in PWH, particularly in MSM. Annual anal cytology (PAP) has been offered for SCCA screening since ∼2010 at our urban academic center ambulatory HIV clinics, and those with abnormal PAP (atypical squamous cells of undetermined significance (ASCUS), or Anal Intraepithelial Neoplasia (AIN) 1-3) are referred for high-resolution anoscopy (HRA) and dysplasia treatment. Evaluation of screening cascade can help better understand and improve SCCA screening protocols. Methods We performed a retrospective chart review (2018-2022) on MSM PWH, age 35 and older, enrolled at our two HIV clinics who had at least one clinic visit by 12/31/2019. Of total eligible for SCCA screening, we calculated proportion of those engaged (received at least one screening (PAP or HRA)) and retained (received at least one subsequent screening) in care. Characteristics of people who did not engage in screening were evaluated by logistic regression. Results A total of 432 individuals were eligible for SCCA screening. The median [interquartile range] age was 57 [48-62] years, 97% were on antiretroviral therapy, 28% were Blacks, 62% had history of smoking, and 24% had a prior history of anal dysplasia. A total of 219 (50.7%) engaged in screening, and only 113 (26%) were retained (Figure-1). Seventy-four individuals had at least one abnormal PAP during follow-up, of which 35 (47%) received HRA at least once. In multivariable analysis, older age and history of smoking negatively correlated with engagement while history of anal dysplasia positively correlated with engagement (table-1). Race (Blacks vs other) and type of insurance (public/private) did not correlate with engagement. Conclusion We noted high rates of loss of engagement and retention in SCCA screening even in PWH highly engaged in HIV care. Older MSM PWH, who are at higher risk of SCCA, were less likely to be engaged in screening. Disclosures Michael D. Virata, MD, FACP, Gilead Sciences: Advisor/Consultant|Janssen: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant

Implementation of free-draft text messaging to enhance care retention and satisfaction for persons living with HIV infection

ABSTRACT Eligible persons with HIV infection can receive client-centered case management to coordinate medical and social services. Novel mobile health interventions could improve effective case management and retention in care, an important goal to help end the HIV epidemic. Using a hybrid type I effectiveness-implementation design, we assessed whether access to bidirectional, free-draft secure text messaging with a case manager and clinic pharmacist could improve client satisfaction and care retention in a Southern academic HIV clinic. Sixty-four clients enrolled between November 2019 and March 2020, had a median age of 39 years, and were mostly male, single, and African-American. Heavy app users texted over 100 times (n = 6) over the course of the 12-month intervention while others never texted (n = 12). App usage peaked during months of clinic closure due to COVID-19. Most participants reported high satisfaction with the app and planned continued usage after study completion. Changes in clinic retention and virologic suppression rates were not observed, a result confounded by practice changes due to COVID-19. High usage and satisfaction of free-draft text messaging in case-managed HIV clients supports inclusion of this communication option in routine HIV clinical care.

Lung Cancer Screening in People With HIV: A Mixed-Methods Study of Patient and Provider Perspectives

People with HIV are at higher risk of lung cancer; however, there is limited research on attitudes, barriers, and facilitators to lung cancer screening in people with HIV. The objective of this study was to understand the perspectives on lung cancer screening among people with HIV and their providers. Surveys of people with HIV and HIV-care providers were complemented by qualitative focus groups and interviews designed to understand the determinants of lung cancer screening in people with HIV. Participants were recruited through an academic HIV clinic in Seattle, WA. Qualitative guides were developed by integrating the Consolidated Framework for Implementation Research and the Tailored Implementation of Chronic Diseases checklist. Themes that emerged from thematic analyses of qualitative data were compared with surveys in joint displays. All study components were conducted between 2021 and 2022. Sixty-four people with HIV completed surveys, and 43 participated in focus groups. Eleven providers completed surveys, and 10 were interviewed for the study. Themes from joint displays show overall enthusiasm for lung cancer screening among people with HIV and their providers, particularly with a tailored and evidence-based approach. Facilitators in this population may include longstanding engagement with providers and health systems and an emphasis on survivorship through preventive healthcare interventions. People with HIV may also face barriers acknowledged by providers, including a high level of medical comorbidities and competing issues such as substance abuse, mental health concerns, and economic instability. This study reveals that people with HIV and their providers have overall enthusiasm toward screening. However, tailored interventions may be needed to overcome specific barriers, including complex decision making in the setting of medical comorbidity and patient competing issues.

Effects of drug and hazardous alcohol use on having a detectable HIV viral load: An adherence mediation analysis

ObjectivesPeople living with HIV (PWH) with substance or alcohol use often have unsuppressed plasma HIV viral loads (pVL). The degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication nonadherence is incompletely understood. MethodsWe included PWH prescribed antiretroviral therapy and receiving care at an academic HIV clinic between 2014 and 2018 who completed both patient-reported outcomes (PRO) questionnaires and had subsequent pVL measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (NIDA-ASSIST), and self-reported adherence measured using four different methods. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE), and percentage mediated. ResultsAmong 3125 PWH who met eligibility criteria, 25.8% reported hazardous alcohol use, 27.1% cannabis, 13.1% amphetamines, 1.9% inhalants, 5.3% cocaine, 4.5% sedative-hypnotics, 2.9% opioids, and 2.3% hallucinogens. Excellent adherence was reported by 58% of PWH, and 10% had detectable pVL. Except for sedatives, using other substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR (95% CI)]: amphetamine use 2.4 (1.8–3.2) and opioid use 2.3 (1.3–4.0). The percent of marginal total effect mediated by nonadherence varied by substance: 36% for amphetamine use, 27% for opioid use, and 39% for polysubstance use. ConclusionUse of amphetamines, opioids, and multiple substances predicted detectable pVL. Up to 40% of their effects were mediated by self-reported nonadherence. Confirmation using longitudinal measurement models will strengthen causal inference from this cross-sectional analysis.

Trends in diabetes incidence and associated risk factors among people with HIV in the current treatment era.

To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH). A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018. PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: hemoglobin A1C ≥6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart), diagnosis of diabetes in the EMR, or exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes. Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 person years (PY) in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (hazard ratio [HR] 10.5 (6.2, 17.7)), liver disease (HR 1.9 (1.2, 3.1)), steroid exposure (HR 1.5 (1.1, 1.9)), and use of integrase inhibitors (HR 1.5 (1.1, 2.0)) were associated with incident diabetes. Additional associated factors included lower CD4 + cell counts, duration of HIV infection, exposure to nonstatin lipid-lowering therapy, and dyslipidemia. Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.

Hepatitis C Knowledge and Recent Diagnosis Affect Hepatitis C Treatment Willingness in Persons Living With HIV.

We assessed the impact of health literacy and hepatitis C (HCV) knowledge on HCV treatment willingness among people living with HIV (PLWH) at an academic HIV clinic. Cross-sectional analysis of PLWH coinfected with HCV who completed health literacy, HIV literacy, and HCV knowledge inventories. We estimated the prevalence of low health literacy, HIV knowledge, and HCV knowledge sampled from 3-comparison groups: PLWH not referred for HCV, referred but who "not showed" to the HCV clinic, and referred and attended the HCV clinic. We used mixed-model linear and logistic regression to ascertain predictors of low health literacy, HIV knowledge, HCV knowledge, and predictors of willingness to start HCV treatment. We enrolled 151 PLWH; 17% were female, 38% non-White, and 60% without a high-school education. Approximately, 68% were men who have sex with men, of whom 62% used intravenous drugs. The prevalence of low health, HIV knowledge, and HCV knowledge was 10%, 32%, and 29%, respectively. Predictors of low health literacy were being Hispanic, cirrhotic, and not completing high-school education. Low HCV knowledge was observed in female, non-White, and those diagnosed with HCV for a decade. In adjusted analyses, PLWH living with HCV for a decade (OR: 0.23) were less likely to be very willing to be treated for HCV. By contrast, those with high HCV knowledge were more likely to be very willing to receive treatment (OR: 1.27). Low HCV knowledge and living with HCV for at least a decade are under-recognized negative predictors for PLWH's willingness to receive HCV treatment. ClinicaTrials.gov identifier: NCT20170991.

Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond.

In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH). The purpose of this study was to examine the clinical significance of renal, liver, and lipid testing. We reviewed the charts of 261 PWH who initiated care at an academic HIV clinic between January 1, 2016 and December 21, 2018. Analysis included one-sided binomial exact tests and multiple linear, Poisson, and Beta regression models. The most common abnormality was a glomerular filtration rate (GFR) <60 mL/min (10%). Age <40 years [estimated relative rate (rr) 0.017, 95% confidence interval (CI) 0.207 to 0.494], cobicistat (rr 0.284, 95% CI 0.128 to 0.63), and tenofovir alafenamide (rr 0.295 95% CI 0.151 to 0.573) were associated with a decreased risk of GFR <60 mL/min. An increased AST and ALT ≥2 × upper limit of normal (ULN) was found in 5% and 3%, respectively. Hepatitis C and use of darunavir and lopinavir were associated with increased AST or ALT. When a GFR was <60 mL/min or an AST or ALT was ≥2 × ULN, no action was taken in 53% of cases. In 18% of cases the only intervention was repeat testing. The most common interventions after lipid results were calculation of a 10-year cardiovascular risk score (31%) and addition of a statin (18%). Taking action after lipid results was strongly associated with age ≥40 (rr 7.37, 95% CI 3.0 to 18.3). Young PWH without hepatitis C rarely have renal, liver, or lipid test results that alter clinical care. Decreased testing should be considered.

A Midwestern Academic HIV Clinic Operation during the COVID-19 Pandemic: Implementation Strategy and Preliminary Outcomes.

During the COVID-19 pandemic, HIV clinics had to transform care delivery for people with HIV (PWH). We developed a multifaceted telehealth implementation strategy and monitored number of out of care patients (OOC), medical visit frequency (MVF), gap in care (GiC) and viral suppression (VS), and compared measures to baseline data. Between April and October 2020, 1559 visits were scheduled; 328 (21%) were missed, and 63 (4%) were new to care. Of the remaining 1168 follow-up visits, 412 (35%) were telehealth visits. As of October 2020, there were 53 patients OOC, MVF was 55% and GiC was 24% compared to 34, 69% and 14% at baseline, respectively. Overall VS rate remained high at 93% (97% for telehealth and 91% for in-person visits, p = 0.0001). Our implementation strategy facilitated quick provision of telehealth to a third of PWH receiving care in our clinic. While MVF decreased and GiC increased, VS rates remained high.

112. A Quality Management Project of a Midwestern Academic HIV Clinic Operation During COVID-19: Implementation Strategy and Preliminary Outcomes

BackgroundDuring the COVID-19 pandemic, HIV clinics had to transform care delivery in order to ensure retention in care (RIC) for people with HIV (PWH). The objective of this quality management project is to maintain high rates of RIC and viral load suppression (VLS) during the pandemic for PWH receiving services at an academic HIV clinic in the Midwest.MethodsWe developed a multifaceted implementation strategy for clinic operation using a combination of telehealth and in-person visits. The strategy included: 1) assess for readiness and identify barriers and facilitators, 2) identify and prepare champions, 3) organize clinician implementation meetings, and 4) staff training. As a result, we developed an implementation blue print with criteria for telehealth vs. office visits, criteria for rescheduling patients, conducted staff training on telehealth and personal protective equipment, and changed the clinic structure to accommodate in-person visits for patients who did not meet telehealth criteria and walk-ins. We monitored VLS (defined as HIV RNA < 200 copies per mL) and RIC as measured by medical visit frequency (MVF, defined as percentage of patients who had one visit in each 6 months of the preceding 24 months with at least 60 days between visits); and gap in care (GiC, defined as no visit in the preceding 6 months).ResultsAs of June 14, 2020, there were 1140 active PWH receiving care at the clinic. By February 29, 2020 there were 34 patients lost to care as (defined as no visit within the preceding 12 months). Between March 1 and June 14, 2020 we conducted a total 943 visits, out of which 642 (68%) were in person and 301 (32%) were telephone visits. By end of May 2020, there were 47 patients lost to care. MVF decreased to 40% compared to 69% for FY2020, and GiC increased to 25% compared to 14% for FY2020. VLS rate remained unchanged at 91%.ConclusionThe COVID-19 pandemic resulted in a decrease in MVF and an increase in GiC for PWH. However, VLS remained high at 91%. Our implementation strategy facilitated quick adoption of telemedicine, which helped us provide clinical care to a third of PWH during the pandemic. Telemedicine provided a great tool for ensuring patients remain VLS. Evaluation of implementation outcomes including fidelity and reach remains ongoing.Disclosures All Authors: No reported disclosures

Surprisingly Low Levels of Measles Immunity in Persons With HIV: A Seroprevalence Survey in a United States HIV Clinic.

BackgroundMeasles outbreaks have become increasingly common due to deteriorating vaccination rates, fluctuating herd immunity, and varying antibody decline. Limited knowledge exists regarding prevalence and risk factors associated with measles seronegativity among persons with HIV (PWH).MethodsThis was a cross-sectional study conducted at an academic HIV clinic in Omaha, Nebraska. Participants were screened for the presence of measles IgG antibody. Demographic and clinical information was obtained through electronic medical record review. Simple and multivariable logistic regressions were performed to identify risk factors for measles seronegativity.ResultsThree hundred fifty-one participants were enrolled, with a measles seroprevalence rate of 70.3%. The mean age (range) was 48 (20–74) years, 77% were male, and 53% were Caucasian. The mean CD4 nadir (range) was 334 (1–1675) cells/mm3. At the time of testing, 86% and 87% of the seronegative and seropositive participants had an HIV RNA <50 copies/mL, respectively. Younger age was significantly associated with measles seronegativity (P = .003), as was birth year after 1957 (P = .021). Prior history of measles infection was associated with seropositivity (P = .011). All other risk factors evaluated, including written documentation of adequate vaccination, were not associated with seronegativity.ConclusionsOur study demonstrates a measles seroprevalence rate that is remarkably lower than previously reported in PWH (92%), and, more importantly, is considerably lower than the rate needed to maintain herd immunity (95%). With higher than expected seronegativity and absence of notable risk factors aside from age, our findings support expanded measles immunity screening for PWH who are at risk of measles exposure.

Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter?

BackgroundThe impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear.MethodsPWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non–high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance.ResultsOf 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75–0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88–1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68–1.15).ConclusionsClinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.

Development of a Novel Competency-Based Evaluation System for HIV Primary Care Training: the HIV Entrustable Professional Activities.

There is an anticipated shortage of primary care providers trained to care for patients with HIV. The Yale School of Medicine developed and implemented a novel HIV training track within our Primary Care Internal Medicine Residency Program. A set of 12 Entrustable Professional Activities (EPAs) were developed to guide curriculum development and resident assessment. To describe the process of implementing a novel EPA-based curriculum for the HIV Primary Care Training Track including EPA-based trainee evaluation tools. Two to three residents were enrolled annually from 2012 to 2017 (total n = 11). Training sites included the outpatient academic center HIV clinic and inpatient HIV ward. An expert panel developed 12 HIV-specific EPAs. These were mapped to curricular and reporting internal medicine milestones. Curricular activities and evaluation tools were developed to guide EPA progress. Graduating residents were ready for unsupervised practice in 91% of EPAs at the end of the 3-year program. Development of HIV-specific training EPAs was effective for driving curricular development and resident evaluation, and served as an effective method to communicate expectations to resident participants. These HIV-specific EPAs could serve as a useful template to enhance HIV education in academic settings.

Acceptability of Cell and Gene Therapy for Curing HIV Infection Among People Living with HIV in the Northwestern United States: A Qualitative Study.

Multiple strategies to cure HIV infection are under investigation, including cell and gene therapy (C&GT) approaches. Research, and ultimately treatment, with these novel strategies will require patients' willingness to participate. To elicit the perspectives of people living with HIV specific to these novel approaches, we conducted 4 focus group discussions with a diverse group of 19 English-speaking men and women living with HIV in care at a large academic HIV clinic in the northwestern United States. Thematic analysis indicated participants expressed initial fear about C&GT research. They articulated specific concerns about risks, including analytical treatment interruptions, and thought only a person in desperate straits would participate. They voiced significant mistrust of research in general and believed there was already a cure from HIV that was being withheld from the poor. Overall, they were satisfied with their health and quality of life on antiretroviral therapy. These findings suggest the importance of community engagement and educational efforts about C&GT for HIV cure to ensure optimal collaborative partnerships.

A qualitative focus group study of perceived barriers and benefits to exercise by self-described exercise status among older adults living with HIV

ObjectivesAlthough exercise interventions have been shown to improve health outcomes among older people with HIV (PLWH), this population remains highly sedentary. The purpose of this study was to examine the...

577. Barriers to Transitions of Care in the Detroit Young HIV Population

BackgroundOne of the issues faced by clinics which care for young adults infected with HIV is a disruption to treatment during the transition from pediatric to adult care. Adherence to routine treatment is essential for this population to ensure decreased rates of transmission and favorable health outcomes for the patients. The purpose of this study was to characterize the out of care transitioning patient population from pediatric to adult HIV care in an academic HIV clinic in Detroit, Michigan.MethodsWe assessed barriers to transition for youth with HIV who had not met the requirements for successful transition to the adult HIV clinic (three appointments). Patient barriers were assessed through telephone calls with three questions assessing their reasons for not coming to the adult clinic conducted by adult medical staff and by a pediatric social worker.ResultsOne hundred and four youth were identified as transitioning youth. Of those, 13 were excluded due to relocation. Thirty-two (30.7%) patients did not successfully transition and 19 (18%) were accessible through telephone/text for interview. Demographic data for the 32 patients was collected and the predictors of disengagement were identified which included transportation (22.2, n = 10) and work (8.9%, n = 4). There were no statistically significant differences in the measured variables of race, HIV mode of acquisition, housing status, or employment status between those who did and did not successfully transition. In regards to reasons for missed appointments, there were eight reasons given to the adult medical staff, but the pediatric social worker was able to elicit, a much broader range of answers, 13.ConclusionWe found that lack of phone access, transportation and work play a key role in patients transitioning to the adult clinic; however, we initially expected more socioeconomic factors to impair the transition process. In looking at the mismatched reasons for missed appointments given to the adult clinic and the pediatric social worker, it appears that the pediatric social worker could elicit a greater the variety of reasons for missed appointments. Moving forward, more pediatric social work support for the transitioning process may be beneficial.Figure 1. Reasons for Missed Appointments Given to Pediatric Social Worker. Disclosures J. Veltman, Jansen: Speaker’s Bureau, Speaker Bureau payment.

2254. Adherence to Cardiovascular Disease Risk Management Guidelines Amongst HIV Providers at an Academic HIV Clinic

BackgroundCardiovascular disease (CVD) among HIV-infected individuals contributes significantly to morbidity and mortality, accounting for one third of non-AIDS defining illness and 11% of deaths. Compared with the general population, HIV-infected individuals are known to have elevated risk for CVD with chronic infection, regardless of HIV RNA levels and studies suggests that clinicians are not appropriately managing ASCVD risk in HIV-infected patients.MethodsThis retrospective cross-sectional study evaluated provider adherence to American College of Cardiology and American Heart Association guidelines for cardiovascular risk assessment and management, as well, as risk factors associated with inadequate management. Data were extracted from electronic medical records at a single institution in Detroit, Michigan. Criteria for inclusion were >39 years of age, HIV infected, and clinic visit during June 2017.ResultsOf 209 patients evaluated at the infectious disease clinic, 175 patients (84%) qualified per guidelines for statin therapy. Only 44% of these patients are taking a statin. Statin users were older and more likely to be nonsmokers than nonusers (P = 0.0022). Amongst patients on statin therapy, 77% receive appropriate intensity therapy. These patients tend to be older (P = 0.0212) and receive a high intensity regimen (P < 0.0001). CD4 count and viral loud were not associated with statin eligibility or appropriate intensity therapy.ConclusionDespite high rates of patients qualifying for statin therapy, a majority of patients do not receive statins to manage cardiovascular disease risk. Of note, patients at elevated risk for cardiovascular disease due to smoking are less likely to receive therapy. However, amongst patients receiving statin therapy, treatment tends to be appropriate, especially with older patients on high intensity therapy.Disclosures J. Veltman, Janssen: Speaker’s Bureau, Speaker honorarium.

596. Case Study of Motivational Interviewing Intervention in Patients Non-Adherent to Antiretroviral Therapy

BackgroundMotivational interviewing (MI) may have a positive impact on antiretroviral therapy (ART) adherence. However, few studies focus on non-adherent patients at high risk of viral transmission, as identified by unsuppressed viral load.MethodsPatients on ART with detectable viral load (VL) were identified from a major academic HIV clinic and referred to the study by physicians. Inclusion criteria were patients with over two clinic visits in the year prior, with most recent VL over 200 copies/mL. An MI trained social worker recruited participants, obtained written consent and provided a small financial incentive, and conducted MI sessions. After initial session, patients chose whether to continue further follow-up sessions. Patient VLs were compared between those measured before and after the intervention. Statistical analysis was limited by small sample size.ResultsOf 700 active patients in May 2014, 62 patients met enrollment criteria by chart review. Of those, 29 were referred by physicians for enrollment. Nine declined participation and four were lost to follow-up before the first session. Three participants were excluded in this analysis due to missing VL measurements. Average sessions per participant were 3 (range 1–8). Average VLs measured after intervention were 8 (range 1–19), spanning an average of 25 months (range 2–36).Of the 13 patients enrolled, 10 achieved VL suppression after the intervention. Six of these patients had a reemergence of VL >200 copies/mL, but five were able to lower their VL again below 200 copies/mL. Thus by the end of study dates, 9/13 (69%) had a viral load <200 copies/mL. Of the eight who had not had a recorded VL <200 copies/mL in the year prior to study dates, six achieved suppression at some point after the intervention. At the end of the study dates, of 13 initial participants, eight remain engaged with the social worker, two had discontinued sessions after agreeing their goals had been accomplished, and three were lost to follow-up. There was an average 52% decrease in the log 10 VL of patients after intervention as compared with before.ConclusionAlthough small and descriptive, this study shows potential impact of MI on a population of non-adherent patients at high risk of viral transmission.Disclosures All authors: No reported disclosures.

Willingness to Donate Organs Among People Living With HIV.

With passage of the HIV Organ Policy Equity (HOPE) Act, people living with HIV (PLWH) can donate organs to PLWH awaiting transplant. Understanding knowledge and attitudes regarding organ donation among PLWH in the United States is critical to implementing the HOPE Act. PLWH were surveyed regarding their knowledge, attitudes, and beliefs about organ donation and transplantation at an urban academic HIV clinic in Baltimore, MD, between August 2016 and October 2016. Responses were compared using Fisher exact and χ tests. Among 114 survey respondents, median age was 55 years, 47.8% were female, and 91.2% were African American. Most were willing to be deceased donors (79.8%) or living donors (62.3%). Most (80.7%) were aware of the US organ shortage; however, only 24.6% knew about the HOPE Act, and only 21.1% were registered donors. Respondents who trusted the medical system or thought their organs would function adequately in recipients were more likely to be willing to be deceased donors (P < 0.001). Respondents who were concerned about surgery, worse health postdonation, or need for changes in HIV treatment because of donation were less likely to be willing to be living donors (P < 0.05 for all). Most believed that PLWH should be permitted to donate (90.4%) and that using HIV+ donor organs for transplant would reduce discrimination against PLWH (72.8%). Many of the PLWH surveyed expressed willingness to be organ donors. However, knowledge about the HOPE Act and donor registration was low, highlighting a need to increase outreach.