Prior Counseling Research Articles

Improving Grief Counseling: Enhancing the Education and Confidence of Psychology Graduate Students

Most therapists do not receive formal graduate training in grief counseling and may rely on outdated knowledge and questionable skills when working with grieving clients (Dodd et al., 2022; Jankauskaite et al., 2021). This study aimed to develop a virtual intervention to educate psychology graduate students about grief counseling and evaluate whether this training can increase knowledge in grief and grief counseling and self-efficacy in working with grieving individuals. This mixed-methods study compared participants in three conditions (full video intervention, partial video intervention, and control). When controlling for prior grief counseling training and experience, those randomized to the full video intervention had higher grief and grief counseling knowledge and self-efficacy in working with bereaved individuals than those in the partial intervention and control groups. Further, qualitative results highlighted the assessment and treatment approaches that therapists-in-training would use with a bereaved client across conditions. Overall, the full intervention is a feasible and efficacious way to teach psychology doctoral students about grief counseling and increase their confidence in working with bereaved clients. Future research considerations and recommendations are discussed.

Uptake of Cancer Genetic Services for Chatbot vs Standard-of-Care Delivery Models: The BRIDGE Randomized Clinical Trial.

Increasing numbers of unaffected individuals could benefit from genetic evaluation for inherited cancer susceptibility. Automated conversational agents (ie, chatbots) are being developed for cancer genetics contexts; however, randomized comparisons with standard of care (SOC) are needed. To examine whether chatbot and SOC approaches are equivalent in completion of pretest cancer genetic services and genetic testing. This equivalence trial (Broadening the Reach, Impact, and Delivery of Genetic Services [BRIDGE] randomized clinical trial) was conducted between August 15, 2020, and August 31, 2023, at 2 US health care systems (University of Utah Health and NYU Langone Health). Participants were aged 25 to 60 years, had had a primary care visit in the previous 3 years, were eligible for cancer genetic evaluation, were English or Spanish speaking, had no prior cancer diagnosis other than nonmelanoma skin cancer, had no prior cancer genetic counseling or testing, and had an electronic patient portal account. Participants were randomized 1:1 at the patient level to the study groups at each site. In the chatbot intervention group, patients were invited in a patient portal outreach message to complete a pretest genetics education chat. In the enhanced SOC control group, patients were invited to complete an SOC pretest appointment with a certified genetic counselor. Primary outcomes were completion of pretest cancer genetic services (ie, pretest genetics education chat or pretest genetic counseling appointment) and completion of genetic testing. Equivalence hypothesis testing was used to compare the study groups. This study included 3073 patients (1554 in the chatbot group and 1519 in the enhanced SOC control group). Their mean (SD) age at outreach was 43.8 (9.9) years, and most (2233 of 3063 [72.9%]) were women. A total of 204 patients (7.3%) were Black, 317 (11.4%) were Latinx, and 2094 (75.0%) were White. The estimated percentage point difference for completion of pretest cancer genetic services between groups was 2.0 (95% CI, -1.1 to 5.0). The estimated percentage point difference for completion of genetic testing was -1.3 (95% CI, -3.7 to 1.1). Analyses suggested equivalence in the primary outcomes. The findings of the BRIDGE equivalence trial support the use of chatbot approaches to offer cancer genetic services. Chatbot tools can be a key component of sustainable and scalable population health management strategies to enhance access to cancer genetic services. ClinicalTrials.gov Identifier: NCT03985852.

북유럽 출소자의 갱생보호 프로그램 동향

The aim of the study is to make policy suggestions that are suitable for the situation of the Korea Rehabilitation Agency. Therefore, we compared and analyzed the domestic Rehabilitation Policy with advanced North European countries, and derived shortcomings and improvements of the Korea Rehabilitation Agency. As a result, regarding the improvements for the domestic Rehabilitation Policy, first, it is necessary to actively utilize Nordic Rehabilitation policies to solve problems related to addiction and mental illness. Second, actively implementing empathy-building programs such as prison experience programs or camps with peers is needed. Third, we suggest strengthening the willingness for social adaptation by incorporating a motivation reinforcement program (MI) into prior counseling. Fourth, through the procedure of the program certification system, we propose to benchmark advanced programs that have been proven effective in reducing recidivism. Fifth, it is crucial to strengthen the expertise of employees and volunteers who are performing rehabilitation protection tasks by providing systematic and specialized education. Sixth, in order to effectively help released prisoners return to society and manage them professionally and systematically, the scope of social welfare services should be expanded to released prisoners and their families.

Knowledge Gaps Identified in a Survey of Maine Physicians' Firearm Safety Counseling Practices.

Numerous medical associations have identified firearm injuries as a public health issue, calling on physicians to provide firearm safety counseling. Data suggest that while many physicians agree with this, few routinely screen and provide counseling. We aimed to survey Maine physicians to assess their current firearm safety counseling practices and knowledge of a new state child access prevention (CAP) law. We conducted an anonymous cross-sectional survey of Maine primary care and psychiatry physicians. We recruited multiple statewide medical organizations, residency programs, and two major health systems to distribute the survey to their membership. Group differences were compared by physician rurality and years in practice using Fisher's Exact and Chi Squared tests. Ninety-five surveys were completed. Though most participants agreed that firearm injury is an important public health issue that physicians can positively affect (92%), few had received prior firearm safety counseling education (27%). There were significant differences in firearm screening frequency, with rural physicians screening more often. More rural physicians and physicians with > 10 years of clinical practice felt they had adequate knowledge to provide meaningful counseling, compared with non-rural and early career physicians, respectively. Overall, 62% of participants were unaware of the 2021 Maine CAP law. This study highlights significant differences in firearm safety counseling practices among Maine physicians based on rurality and years of experience. Participants also reported a significant gap in knowledge of a recent state child access prevention law. Next steps include development of firearm safety counseling education tailored to Maine physicians.

Stigma and discrimination faced by adolescents living with HIV and experiencing depression in Malawi

BackgroundIn Malawi, approximately 25% of adolescents living with HIV (ALWH) also suffer from depression. Not only is HIV stigma a major contributor to depression but it also adversely impacts HIV care engagement. ALWH can experience HIV stigma as stereotyping, social exclusion, low social support, and abuse, and these experiences are associated with poor mental health. Despite recognition of the deleterious effects of HIV stigma, we have limited knowledge of how stigma is experienced by ALWH with comorbid depression. Guided by the Health Stigma and Discrimination Framework, we describe stigma faced by ALWH and comorbid depression in Malawi and its implications for future interventions.MethodsAs part of a larger formative study to adapt a mental health counseling intervention, we conducted in-depth interviews, social support mapping sessions, and focus-group discussions with 25 ALWH, 4 caregivers of ALWH, 3 HIV providers, and 5 participants and 5 staff of a prior mental health counseling intervention. After analyzing the stigma codes, we used the Health Stigma and Discrimination Framework to organize the data into four key domains: drivers, manifestations, outcomes, and health and social impacts.ResultsMajor drivers of HIV stigma included fear of HIV transmission, negative effects of antiretroviral therapy (ART), association with death, inaccurate knowledge, and negative attitudes towards ALWH. The most common manifestations of HIV stigma were gossip, insults and mocking, and physical and social distancing. Decreased ART adherence and missed HIV appointments were commonly cited outcomes of HIV stigma. Broader health impacts of HIV stigma were notable for mental health comorbidities including depression, anxiety, substance use, and suicidality. Identified resilience strategies included support for HIV care engagement and psychosocial support from family and friends.ConclusionsThis study systematically describes the stigmatization process faced by ALWH and experiencing depressive symptoms in Malawi. Notably, HIV stigma continues to disrupt HIV care and detrimentally impacts mental health during adolescent development. Further studies focused specifically on stigma are needed to better characterize this process and identify additional resilience factors. Investment in stigma-reduction interventions for ALWH is needed to avert poor mental health and HIV outcomes.

Efficacy of medication abortion with concurrent initiation of progestin contraceptives: A retrospective cohort study

ObjectivesTo evaluate medication abortion (MAB) outcomes for participants receiving intramuscular depot medroxyprogesterone acetate (DMPA) injections or subdermal etonogestrel implants concurrently with mifepristone compared to those who did not in a real-world setting. Study designThis retrospective cohort study included MAB patients from one Planned Parenthood health center in St. Paul, MN, between 2017 and 2019. We abstracted electronic health records and compared sociodemographic variables, clinical information, and treatment failure rates (primary outcome) between study groups with logistic regression (generating odds ratios [OR] and 95% confidence intervals [CI]). ResultsAmong 7296 MAB participants, 224 (3.1%) received DMPA injections and 309 (4.2%) received etonogestrel implants concurrently with mifepristone; 141 (62.9%) and 200 (64.7%) completed follow-up respectively. From a random sample of 1000, 990 comparison participants met inclusion criteria; 704 (71.1%) completed follow-up. Fourteen (9.9%) DMPA participants (aOR 4.26, 95% CI 1.87–9.68, p < 0.001) and 6 (3.0%) etonogestrel implant participants (aOR 1.38, 95% CI 0.48–3.55, p = 0.522) required additional treatment to empty the uterus and/or had an ongoing pregnancy, each contrasted with 15 (2.1%) comparison patients (models adjusted for gestational duration, patient age, parity, and race). ConclusionAlthough our study is limited by high rates of loss to follow-up, our analysis suggests that concurrent administration of DMPA with mifepristone may decrease MAB efficacy, while etonogestrel implant placement does not appear to alter MAB outcomes. These findings are overall consistent with prior literature and inform post-MAB contraception counseling. ImplicationsThis retrospective cohort study reinforces prior randomized controlled trial findings that concurrent depot medroxyprogesterone acetate injection with mifepristone administration may decrease medication abortion efficacy. Conversely, concurrent etonogestrel contraceptive implant placement with mifepristone administration does not appear to decrease medication abortion efficacy. These findings inform post-abortion contraception counseling.

Dietary macro and micronutrients associated with MASLD: Analysis of a national US cohort database

Introduction and ObjectivesOur objective was to measure and compare the intake of macro and micronutrients in a cohort of individuals with Metabolic Syndrome Associated Steatotic Liver Disease (MASLD) compared with matched controls to identify areas of further research in this area; we identified nutrition-associated associations with MASLD in the United States general population. Materials and MethodsWe used the 2017 – 2018 NHANES dataset. Elastography Controlled Attenuation Parameter (CAP score>280) in the absence of other liver disease was defined as MASLD in adults (>18). Advanced fibrosis was defined by transient elastography >10 kPa. Controls were adults without liver disease. Results1648 MASLD cases (11.4 % advanced fibrosis) and 2527 controls were identified. MASLD cases were older (P<0.001), more likely males (P = 0.01), less likely to have a college education (P = 0.04) and more likely married (P = 0.002). MASLD cases were more likely to be of Mexican American or Hispanic ethnicity (P = 0.002), have higher BMI, and have higher prevalence of diabetes, hyperlipidemia and hypertension (P<0.001 for all). MASLD cases had higher hs-CRP (P = 0.02) and ferritin (P = 0.02). MASLD cases had lower total (P = 0.004) and added vitamin E in their diet (P = 0.002), lower vitamin K intake (P = 0.005), and higher selenium intake (P = 0.03). Caloric intake (P = 0.04), carbohydrate intake (P = 0.02), cholesterol intake (P = 0.03) and saturated fatty acid intake (P = 0.05) were higher in MASLD. Individuals with MASLD were more likely to be on a diet (P<0.001), sedentary (P = 0.008) and less likely to participate in moderate or vigorous recreational activities (P<0.001). ConclusionsThe deficiencies of micronutrients and excess of macronutrients point to oxidative stress, pro-inflammatory state, and lipotoxicity as pathways linking the US diet to MASLD. MASLD patients are more often on special diets, which may reflect prior provider counseling on diet changes to improve health.

Enhancing Contraceptive Utilization among Females of Reproductive Age: Factors, Challenges, and Strategies at Jinja Regional Referral Hospital

The research aimed to assess the factors influencing the utilization of contraceptives among females of reproductive age seeking health services at Jinja Regional Referral Hospital. Specifically, it sought to establish socio-demographic characteristics, examine health service factors affecting contraceptive utilization, and determine its prevalence. A cross-sectional and descriptive research design employing both quantitative and qualitative methodologies was utilized to ensure the gathered information was representative of the population and captured at a single point in time. The study discovered a prevalence of contraceptive use among females of 55.7%, with short-term hormonal methods being the most common at 57.1%. Key findings revealed that females aged 18 to 30 years (57.1%) were significantly more likely to use contraception (p-value = 0.036), and multiparous individuals (98.2%) were more inclined to utilize contraception compared to para-one individuals (50.6%) (p-value = 0.024). Moreover, prior counseling (73.2%) significantly promoted contraceptive usage (p-value = 0.015). In conclusion, despite the observed prevalence, contraceptive utilization remained relatively low. Recommendations include increasing the availability of contraceptive services at lower-level health care centers to enhance accessibility, educating mothers visiting health facilities about contraceptive services, and addressing contraception-related phobias through counseling to encourage uptake among females. Keywords: Contraceptives, Females, Reproductive age, Health services, Health facility.

Common Mental Disorders in Brazilian Graduate Students

This study is aimed at ascertaining the prevalence and predictors of common mental disorders (CMD) among Brazilian graduate students (N = 5266) during the COVID‐19 pandemic. Employing the Self‐Reporting Questionnaire (SRQ‐20), the study found that CMD prevalence was 63.5%. Variables such as not feeling well psychologically in the past year, the necessity to take leave of absence from activities, residence in different regions, female gender, studying for a master’s degree, extension of deadlines, experience of setbacks in education, COVID‐19 risk group membership, self‐medication practices, seeking medical assistance, and prior psychological counseling emerged as predictors of CMD. The findings reveal the vulnerability of graduate students to CMDs and risk factors amenable to institutional intervention. To this end, the study provides support for strategies promoting mental health in this population.

DO RELIGION, CULTURE, RACE, OR ETHNICITY PLAY A ROLE IN CHOOSING PEG TUBE AT THE END OF LIFE?

Abstract Although there is substantial evidence that Percutaneous Endoscopic Gastrostomy (PEG) causes significant morbidity and does not change mortality for patients with advanced dementia it continues to be used. We describe a quality initiative of Palliative Care Consultation (PCC) in conjunction with any new PEG evaluation. EMR review and interview with patient (and/or proxy) being evaluated for first-time PEG in two community hospitals within large health system in demographically diverse major metropolitan area. PCC teams provided consistent, culturally/religiously, language-sensitive education regarding PEG, conducted interviews about subsequent decision. Post-initiative PEG placement dropped from &amp;gt;75% to 17.6%, 76 patients received PCC with PEG evaluation. Average age 83.5 (range: 56-108), 55% female. Religion: 54% Christian, 7% Muslim, 10% Jewish, 11% non-religious, 18% other; 46% White, 37% Black, 8% Asian, 8% Hispanic. Common evaluation reasons: difficulty swallowing (30%), low PO intake (30%). Majority of patients had dementia (71%), stroke (18%), Parkinson’s (8%). Most decision-makers (66%) hadn’t received prior counseling regarding alternate nutrition options. After PCC, 17.6% chose PEG, 79.7% careful hand feeding, 2.7% remained unsure. Those choosing PEG mostly desired “guaranteed” nutrition despite risks (10/13), and/or a trial seeking patient recovery (5/13). There were no apparent differences in race/ethnicity, age, sex, or religion that distinguished those electing PEG. PCC initiative to support patients and families “choosing wisely” around PEG placement for those with advanced illness has resulted in significant reduction. Decision-makers mostly cited wish to guarantee nutrition while some hoped for patient recovery. Religious affiliation and sex were not cited as reasons in this group.

The crucial role of the nephrologist in the management of pregnancy in women with adult autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disease characterized by gradual kidney enlargement and progressive renal function loss. Pregnancy is a significant risk factor for adverse maternal and fetal outcomes in chronic kidney disease (CKD), regardless of the nephropathy. Women with ADPKD often face concerns about worsening their renal condition and passing the disease on to their offspring. Recent studies show better outcomes due to improved pregnancy surveillance and prior counseling. Risk factors for poor fetal and maternal outcomes include advanced maternal age, pre-existing hypertension, urinary infections, proteinuria, and renal failure. Collaboration between nephrologists and gynecologists is essential for addressing clinically significant concerns in pregnant women with ADPKD. Nephrologists should play an active role in assisting and supporting pregnant ADPKD patients as part of a multidisciplinary team.

Successful cessation of smoking among GAD patients during COVID-19 pandemic: A retrospective study in Eastern India

Tobacco use is one of the most significant causes of morbidity and mortality among patients suffering from psychiatric disorders. Even though the COVID-19 pandemic has been going on for two years, numerous researches have questioned the link between smoking and severe COVID-19.This paper aims to find out the outcomes of the pandemic fear intervention method in generalized anxiety disorder (GAD) patients with tobacco use.Only 48 patients were divided into two groups out of the total of 102 individuals. The only distinction between the two groups is the "pandemic fear intervention". These people were identified as heavy smokers seeking mental health treatment at the institution’s mental health + de-addition clinic.In comparison to the prior situation, counselling and cognitive behavioural therapy (CBT) resulted in significant improvements during the COVID-19 epidemic. All of the forty-eight patients were heavy smokers; the combination of COVID-19 anxiety and the lack of tobacco availability enhanced the ability of all forty-eight patients to stop smoking when rigorous psychotherapy health education and cognitive behavioural therapy (HE and CBT) was present. The COVID-19 fear factor's connection to the pandemic situation led to successful tobacco use cessation in 48 patients with chronic anxiety disorders, according to this study.Several tobacco use cessation sessions, as well as diverse technologies like CBT and health education counselling, are required for heavy smokers with general anxiety disorders. According to these models, the COVID-19 pandemic could be an important and counterintuitive motivator for quitting smoking. This study gives a fascinating fact and some data regarding COVID-19's impact on heavy smokers, in addition to the horrific misery it causes. We give an example of this by telling medical practitioners that they must use the "COVID-19 pandemic anxiety model" to extend patient lives, maintain environmental quality, and quit smoking.

The genetic counselor workforce in inherited retinal disease clinics: a descriptive assessment

ABSTRACT Background Genetic counselors (GCs) have practiced in Inherited Retinal Disease (IRD) clinics for several decades. In this small subspecialty of genetic counseling, GCs are critical for patient understanding of genetic information, which can have prognostic, systemic, family planning and therapeutic implications. Recently, both access to genetic testing for IRDs and the number of genes associated with IRDs (>350) has increased dramatically. However, the practice models and roles of IRD GCs have not been previously described. Materials and Methods GCs working in academic IRD clinics were surveyed to assess their experience, clinical practices, and roles performed. The collected data was compared to the broader genetic counseling profession and to other specialties using publicly available data on GC professional practices. Results While roles of IRD GCs were overlapping with those of the overall genetic counseling profession, all survey respondents reported diverse roles that included both clinical and non-clinical duties, spending up to half their time on research and educational responsibilities. Most respondents (89%) felt that their clinic’s MD to GC ratio was too high, while clinical load varied. IRD GCs report varying degrees of prior genetic counseling and ophthalmology-specific experience but unanimously desire additional subspecialty-specific training. Conclusions This descriptive assessment of a small subspecialty suggests a need for growth in the number of GCs practicing in IRD clinics and could help to inform development of new GC positions in IRD centers. It also highlights the desire for additional GC-specific education and may be relevant to curriculum development within GC programs.

Patient Perspectives on Contraceptive use in North India: A Case for Increased Contraceptive Counseling by Providers.

Given the underutilization of contraception in India, this study was undertaken to gauge cisgender female clients' knowledge of, attitudes toward, and barriers to contraceptive usage in North India. The present study was done at a tertiary care Institute in North India, where 209 structured interviews were conducted with cisgender female patients attending the outpatient department. One-way chi-square tests for independence, Kruskal-Wallis test, and Wilcoxon test were applied to quantitative data. Themes from qualitative questions were coded and analyzed. Differences in awareness among contraceptives were found to be highly statistically significant (H (9) = 1022.3, p < 2.2 e-16). Friends or colleagues comprised the predominant information source for most contraceptive methods. Participants' contraceptive usage was low, with 27.27% stating no prior use and 47.47% indicating occasional use (X2 (3, N = 198) = 66.121, p < 2.89 e-14). Lack of perceived need, concern for side effects, fear and desire for children were top reasons for non-use of contraceptive methods. Majority of the participants (79.45%) expressed comfort speaking with their spouse about contraception, 47.18% with a medical provider, 32.82% with friends, 15.38% with family, 2.05% with a health educator, and 3.59% with no one. Participants indicated little prior contraceptive counseling experience. Our study shows differential levels of awareness, usage, and barriers on contraceptive methods among participants. Results also suggest the importance of spouses and friends in clients' contraceptive decision-making process and their limited counseling experience with health care providers.

Psychological Help-Seeking Among Undergraduate Medical Students

Abstract. Background: Stress among medical students requires careful attention and support to help them overcome it and avoid untoward consequences. Identifying the students’ attitudes and limitations in approaching professional counseling services would help provide targeted solutions and formulate personalized counseling plans. Objective: To compare the perceived needs, benefits, and barriers experienced by medical undergraduate students for availing professional counseling services based on prior counseling exposure, year of medical education, and gender. Methodology: This cross-sectional research included 239 students, aged 17–23 years, studying in the first and final years of undergraduate medical training. Their attitudes, perceived benefits, and barriers to approaching counseling were assessed using the Counseling Need Assessment Questionnaire (CNAQ). Differences in these parameters were compared among the students based on their gender, prior counseling exposure, and year of medical education. Statistical analysis was done using χ2 test and Goodman–Kruskal analysis, and p value &lt; .05 indicated statistical significance. Results: Fifty-one percentage of the students accepted the need for counseling, but 44% expressed hesitation in approaching a professional counselor. No significant gender differences were noted in counseling-related attitudes, barriers, or perceived benefits ( p &gt; .05). However, students with prior exposure to counseling and those in their first year of study were significantly more oriented to seek counseling ( p &lt; .01), but more reluctant too in availing professional help ( p &lt; .05). Conclusion: Students with prior exposure and first-year students were more open to expressing the need for counseling; however, first-year students were more hesitant for availing the same.

How Should Surgeons Approach Gender-Affirming Surgery Revisions When Patients Were Not, Perhaps, Well Informed in Prior Counseling?

Surgeons often encounter patients with realistic goals yet who desire unrealistic means of achieving them. This tension is compounded when surgeons consult with patients eager to revise a prior gender-affirming procedure completed by another surgeon. Two key factors of ethical and clinical relevance are that (1) a consulting surgeon's job is complicated when a population-specific evidence base is lacking and (2) a patient's marginalization is exacerbated by their having suffered the downstream effects of compromised initial access to comprehensive, realistic surgical care. This case commentary about revision of gender-affirming phalloplasty canvasses the pitfalls of a limited evidence base and focuses on strategies surgeons can use to help guide consultation. In particular, informed consent discussion may need to reframe a patient's expectations about clinical accountability for irreversible interventions.

Prevalence and factors associated with HIV treatment non-adherence among people living with HIV in three regions of Cameroon: A cross-sectional study.

In Cameroon, HIV care decentralization is enforced as a national policy, but follow-up of people living with HIV (PLWH) is provider-driven, with little patient education and limited patient participation in clinical surveillance. These types of services can result in low antiretroviral therapy (ART) adherence. The objective of this study was to assess the prevalence and predictors of ART non-adherence among PLWH in Cameroon. A cross-sectional descriptive study of PLWH in HIV treatment centres in Cameroon was conducted. Only PLWH, receiving treatment in a treatment centre within the country, who had been on treatment for at least six months and who were at least 21 years old were included in the study. Individuals were interviewed about their demographics and ART experiences. Data were collected using a structured interviewer-administered questionnaire and analyzed using STATA version 14. A total of 451 participants participated in this study, 33.48% were from the country's Southwest region. Their mean age was 43.42 years (SD: 10.42), majority (68.89%) were females. Overall proportion of ART non-adherence among participants was 37.78%, 35.88% missed taking ART twice in the last month. Reasons for missing ART include forgetfulness, business and traveling without drugs. Over half of participants (54.67%) know ART is life-long, 53.88% have missed ART service appointments, 7.32% disbelieve in ART benefits, 28.60% think taking ART gives unwanted HIV Status reminder and 2.00% experienced discrimination seeking ART services. In the multivariate analysis, odds of ART non-adherence in participants aged 41 and above was 0.35 times (95%CI: 0.14, 0.85) that in participants aged 21-30 years, odds of ART non-adherence comparing participants who attained only primary education to those who attained higher than secondary education was 0.57 times (95%CI: 0.33, 0.97) and the odds of ART non-adherence in participants who are nonalcohol consumers was 0.62 times (95%CI: 0.39, 0.98) that in alcohol consumers. High proportion of participants are ART non-adherent, and the factors significantly associated with ART non-adherence include age, education and alcohol consumption. However, some reasons for missing ART are masked in participants' limited knowledge in taking ART, disbelief in ART benefits, feelings that ART gives unwanted HIV status reminder and experiencing discrimination when seeking ART services. These underscores need to improve staff (health personnel) attitudes, staff-patient-communication, and proper ART prior initiation counselling of patients. Future studies need to focus on assessing long-term ART non-adherence trends and predictors using larger samples in many treatment centres and regions.

Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: A cross-sectional survey.

To evaluate how technology access affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The Rural Opioid Initiative (January 2018-March 2020) was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. Using multivariable mixed-effect regression models, we examined associations between participant technology access and SUD treatment. Of 3,026 participants, 71% used heroin and 76% used methamphetamine. Thirty-five percent had no cell phone and 10% had no prior 30-day internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use (aIRR 1.29 [95% CI 1.11-1.52]) and a higher likelihood of SUD counseling in the prior 30 days (aOR 1.28 [95% CI 1.05-1.57]). Lack of cell phone was associated with decreased days of MOUD (aIRR 0.77 [95% CI 0.66-0.91]) and a lower likelihood of prior 30-day SUD counseling (aOR 0.77 [95% CI 0.62-0.94]). Expanding US rural SUD treatment engagement via telemedicine may require increased cell phone and mobile network access.

1019. The Future is Embedded in the Present - Characterizing Pharmacist Interventions in an Infectious Diseases Clinic

Abstract Background Incorporating clinical pharmacists into the outpatient care setting can improve patient outcomes; however, the focus has mostly been on primary care. In 2021, Ascension Specialty Pharmacy embedded clinical pharmacists into clinics prescribing specialty medications to increase prescription capture and improve patient care. The clinical pharmacist incorporated into the Ascension St. John Infectious Diseases clinic provides patient outreach, care coordination, financial and prior authorization assistance, medication reconciliation and counseling, and clinical interventions. This study characterizes the pharmacist interventions provided during a six month timeframe. Methods As of September 2021, the clinical pharmacist’s interventions were consistently captured in a documentation system. Each patient encounter that resulted in one or more interventions were entered as one documentation event, which captures type of problem, recommendation category, intervention acceptance, and estimated time spent. If more than one problem within the same type occurred on a patient, it could only be recorded as one problem. A report was pulled over a six month period of September 2021 through February 2022. Results During the timeframe reported, infectious disease specialty prescriptions filled at Ascension Specialty Pharmacy had nearly doubled from before embedding the pharmacist (monthly average, 115 vs. 66). During the study period, 316 patient encounters resulted in clinical pharmacist interventions, which included 594 problem types. The frequency of problem types included under-treatment (32%), medication monitoring needed (28%), suboptimal drug (18%), sub-optimal dosing/duration/frequency/administration (12.52%), nonadherence (5.92%), and adverse drug event (4.74%). Pharmacist interventions were accepted 90% by physicians and 81% by patients. The pharmacist time spent on interventions was estimated at 203 hours during the study period. Conclusion Despite limitations in how interventions are documented and reported, this study demonstrates the significant impact a clinical pharmacist embedded into an infectious diseases clinic can have on optimizing patient care. Disclosures Shawn Depcinski, PharmD, bioMérieux: Honoraria.

The effect of COVID-19 vaccination on the menstrual pattern and mental health of the medical students: A mixed-methods study from a low and middle-income country.

To assess the effect of COVID-19 vaccination on menstrual patterns and mental health of medical students and to explore the students' perspective regarding this effect. This mixed-method study was conducted on the medical and dental students of the private and public sector institutions of Peshawar from September 2021 to March 2022. A Menstrual symptom questionnaire (MSQ) and hospital anxiety and depression scale (HADS) were used. This was followed by qualitative interviews with the students who faced problems in their menstruation after the COVID-19 vaccination. A total of 953 students were included, with a mean age of 20.67±1. 56 years. More than half (n = 512, 53.7%) experienced menstrual cycle abnormalities post-vaccination. The majority having disturbances in their menstrual cycle had significantly higher levels of anxiety (p = 0.000). Results on the menstrual symptom questionnaire, anxiety, and depression subtype of HADS showed a negative and statistically significant relationship with changes after COVID-19 vaccination (p&lt;0.05). In the qualitative interviews, 10 (58.8%) students each had problems with frequency and flow, followed by 7 (41.2%) students, who had dysmenorrhea. Seven (41.2%) consulted a gynecologist for management. The majority (n = 14, 82.4%) stated that these issues had an adverse impact on their mental health and almost half (n = 8, 47.1%) suggested consulting a gynecologist while facing such situations. This study showed the impact of the COVID-19 vaccine on women`s menstrual patterns and subsequent mental health status. Although the majority of the students experienced menstrual cycle abnormalities and subsequent mental health adversities post COVID-19 vaccination but these were temporary and self-limiting and were attributed to the psychological impact of the vaccination. Therefore, it is imperative to alert health care professionals about possible side effects and prior counseling is expected to play an important role in this context.