The Information–Motivation–Behavioral Skills (IMB) model of antiretroviral therapy (ART) adherence describes self-reported ART adherence determinants among people living with HIV (PLWH) who struggle to achieve optimal adherence, but less is known about young Black gay, bisexual, and other men who have sex with men (MSM), a group reported to have less than optimal ART adherence levels, partially affected by depression. Using the IMB model, we analyzed baseline data from 315 Black MSM living with HIV aged 18–34 years struggling with ART adherence enrolled in a multi-state mobile health (mHealth) randomized controlled trial. Generalized structural equation modeling was used to estimate the direct and indirect effects of (1) ART-related information, (2) motivation and (3) behavioral skills, or treatment self-efficacy, on non-optimal self-reported ART adherence (< 80

Purpose In response to disparities in COVID-19 vaccine uptake in urban environments, we ascertained whether a community-engaged evaluation could rapidly determine why unvaccinated Chicago residents were hesitant to receive the COVID-19 vaccine.Approach The assessment used a mixed-methods approach, grounded in community-based participatory research (CBPR) principles.Setting Interviews were conducted by community partners between April and May 2022 in Chicago, in-person and via phone.Participants A purposive sample of Chicagoans (n = 456), who were: (1) adults (>= 18 years); (2) living in priority areas in Chicago heavily impacted by COVID-19; (3) who spoke English or Spanish; and (4) had not received the COVID-19 vaccine.Method A transdisciplinary academic-community team co-developed an assessment tool. Members of Chicago's Community Health Response Corps (CHRC) (N = 115) interviewed participants, using a 46-item survey in Qualtrics. Interviews were analyzed using qualitative and quantitative software, including Dedoose for coding and SAS for descriptive statistics.Results Over half of all respondents were not concerned about getting COVID-19. Respondents voiced concerns about side effects (36%), vaccine safety (27%), and trust in governmental institutions, given historical events involving unethical research. Participants also reported other social needs (e.g., food or housing insecurity) that made COVID-19 a lower priority.Conclusion The collaborative research approach highlighted issues of trust, concerns about side effects and vaccine safety, issues that have informed vaccine messaging.

Emergency events such as natural disasters, pandemics, and other health disasters have a predictably disproportionate impact on vulnerable populations and the COVID-19 pandemic was not an exception. To respond to potentially catastrophic consequences of COVID-19 and to build an infrastructure for a more inclusive recovery, in June 2020, the Chicago Department of Public Health partnered with a state university school of public health, a community college that prepares students for healthcare occupations, a research institute at a private university, a public health institute affiliated with a hospital system, and a workforce development organisation. The team formed the Chicago COVID-19 Contact Tracing Corps (ChiTracing). Centring the expertise of grassroots community-based organisations (CBOs), ChiTracing partnered with 31 CBOs operating in the highest hardship community areas. These CBOs hired and trained over 500 community members, who had a history of unemployment, as neighbourhood-level public health ambassadors and contact tracers, known as the ChiTracing Corps members. Informed by a shared theory of change, we brought three strategies to this work: investing in a new public health infrastructure by centring trusted CBOs and people with lived experience of systems of oppression as part of the public health system, increasing awareness and knowledge of public health and available resources for the most vulnerable, and fostering relationships and power building among diverse collaborators. In this paper, we highlight lessons learnt and share insights on how future efforts can bring collaborative, inclusive approaches to public health workforce development.

OBJECTIVES/GOALS: In 2022, Chicago created the COVID-19 Response Corps, a cohort of community health workers (CHWs), trained to conduct contact tracing and vaccine outreach. Through an Earn and Learn program, corps members studied community-engaged participatory research, and co-led a rapid assessment with researchers to assess vaccine hesitancy in communities. METHODS/STUDY POPULATION: The Chicago COVID-19 Community Response corps worked to mitigate COVID-19 transmission in disadvantaged neighborhoods by activating CHWs, a diverse public health workforce from communities most affected by health and economic inequities. The Earn and Learn Program allotted 600 corps members up to 7.5 hrs/week of paid capacity building opportunities to learn new skills, pursue training programs, or college courses. Embodying a praxis of participatory action research and intergenerational organizing, corps members co-designed research questions and survey instruments, pilot tested the tools, trained other corps members on how to recruit and collect data, and contributed to the analysis and interpretation of the results. They generated evidenced-informed solutions to address future real-world problems. RESULTS/ANTICIPATED RESULTS: Corps members brought insight, cultural literacy, and lived experience that was invaluable in reaching the priority population of unvaccinated Chicagoans. They enhanced all aspects of the rapid assessment while conducting their work safely and comfortably in neighborhoods that outsiders consider challenging. Community member responses as to why they had not yet received a COVID-19 vaccine included being unable to risk putting what they saw as a rushed or improperly tested product into their bodies, to not being able to risk becoming ill even temporarily due to the potential for lost wages, as well as having other priorities in their lives which took precedence over concern about COVID-19, such as paying bills and feeding their families. DISCUSSION/SIGNIFICANCE: Research and evaluation benefits from the inclusion of CHWs. They are agile agents of change with the potential to replenish and repair trust in a fractured public health system. Engaging CHWs in evaluation work can strengthen community-academic partnerships and enhance the understanding of challenges and solutions to improving community health.

BACKGROUND:Outside of randomized controlled trials, there are limited data regarding the acceptability of injectable long-acting cabotegravir + rilpivirine (LA-CAB+RPV) among persons living with HIV. To evaluate acceptability, we described participant-reported outcomes of LA-CAB+RPV among a population underrepresented in randomized controlled trials. SETTING:Ruth M. Rothstein Core Center (CORE), large urban HIV clinic in Chicago, IL, USA. METHODS:We interviewed persons living with HIV prescribed LA-CAB+RPV who receive primary care at CORE. Participant-reported outcome endpoints included treatment satisfaction, reasons for switching to LA-CAB+RPV, tolerability of injections, and unexpected effects of LA-CAB+RPV. Mean and standard deviations (mean ± SD) and proportions (%) are reported. RESULTS:Among respondents (N = 150), 67% identified as non-Hispanic Black, 24% Hispanic, 56% male; the average age was 43 years (SD: 13.2), and 37% were ≥50 years old. Most respondents (93%) completed ≥3 injection appointments at the time of interview. The most common reasons for switching to LA-CAB+RPV were no longer wanting to take pills (89%) and trouble taking their pills daily (58%). Treatment satisfaction was high (6.7 ± 0.5 out of 7). Two-thirds (61%) reported an unexpected aspect of their life improved. Pain from injections was common (89%), with a mean pain score of 4.3 out of 10. Among those reporting pain, half (47%) reported that pain decreased after initial injection. Among participants reporting pain score >6 (n = 36), most (78%) reported no improvement since initial injection. CONCLUSIONS:We found high treatment satisfaction with LA-CAB+RPV in a diverse population. Participants reported moderate injection pain, which improved with time. Results suggest injectable LA-CAB+RPV will be met with acceptability across diverse participant populations.

We determined factors associated with non-adherence (consuming <90% of monthly antiretroviral therapy) among female sex workers (FSWs). An interviewer-administered questionnaire was used in a sample of 100 South Indian FSWs living with HIV. We examined demographics, food insecurity, side effects, stigma, alcohol/substance use and self-efficacy. Non-adherence was assessed by self-report, pill-count and combined measures. Prevalence ratios and 95% confidence intervals (CIs) were calculated at p-value <0.1. Thirty-seven percent (33/90) of FSWs were non-adherent by pill-count, 29% (28/95) by self-report and 52% (51/99) by the combined measure. Seventy-six percent (76/100) of FSWs reported experience of at least one form of food insecurity in the past six months. In the regression analysis, arrest in the past year was independently associated with the combined measure of non-adherence (crude prevalence ratios 1.7, 95% CI 1.0–2.8). A successful combination adherence intervention should consider several of the socio-behavioral factors identified in this study including arrest and food insecurity.

We performed a pilot study among young African-American men who have sex with men (AAMSM) of real-time electronic adherence monitoring (EAM) in Chicago to explore acceptability and feasibility of EAM and to inform intervention development. We recruited 40 young AAMSM living with HIV on ART to participate in up to 3 months of monitoring with the Wisepill device. Participants were interviewed at baseline, in response to the first true adjudicated 1-dose, 3-day, and 7-day misses, and at the end of monitoring. Reasons for missing doses and the acceptability and feasibility of electronic monitoring were assessed using mixed methods. The median participant observation time was 90 days (N = 40). For 21 participants with 90 days of follow-up, <90% and <80% adherence occurred in 82% and 79%, respectively in at least one of their monitored months (n = 63 monitored months). The participants generally found the proposed intervention acceptable and useful. Although seven participants said the device attracted attention, none said it led to disclosure of their HIV status. This study found real-time EAM to be generally acceptable and feasible among YAAMSM living with HIV in Chicago. Future work will develop a triaged real-time EAM intervention including text alerts following detection of nonadherence.

We conducted a systematic review and meta-analysis to estimate the prevalence of adherence to antiretroviral therapy (ART) in India, the third largest HIV epidemic in the world. We identified peer reviewed literature published between 2007 and 2017 to extract data on ART adherence. We estimated pooled prevalence of adherence to ART using a random-effects model. Thirty-two eligible studies (n = 11,543) were included in the meta-analysis. Studies were mostly clustered in the southern and western Indian states. Overall, 77% (95% Confidence Interval 73-82; I-2 = 96.80%) of patients had optimum adherence to ART. Women had higher prevalence of optimum adherence compared to men. Depression or anxiety were significant risk factors in seven of the fifteen studies reporting determinants of nonadherence. Studies should be performed to explore the reasons for gender gap in ART adherence and HIV program in India should prioritize mental health issues among HIV patients to improve ART adherence.

We conducted a systematic review and meta-analysis to estimate the prevalence of adherence to antiretroviral therapy (ART) in India, the third largest HIV epidemic in the world. We identified peer reviewed literature published between 2007 and 2017 to extract data on ART adherence. We estimated pooled prevalence of adherence to ART using a random-effects model. Thirty-two eligible studies (n = 11,543) were included in the meta-analysis. Studies were mostly clustered in the southern and western Indian states. Overall, 77% (95% Confidence Interval 73–82; I2 = 96.80%) of patients had optimum adherence to ART. Women had higher prevalence of optimum adherence compared to men. Depression or anxiety were significant risk factors in seven of the fifteen studies reporting determinants of nonadherence. Studies should be performed to explore the reasons for gender gap in ART adherence and HIV program in India should prioritize mental health issues among HIV patients to improve ART adherence.

Abstract Background Antiretroviral therapy adherence remains a challenge, particularly for young African American men who have sex with men (YAAMSM). We enrolled 40 YAAMSM for 3 months of electronic adherence monitoring (EAM). These data may be useful in developing an antiretroviral EAM intervention that responds to missed doses with real-time text messages. Methods YAAMSM (age 18–34 years) living with HIV and taking ART participated in a quantitative and qualitative study that included ART adherence monitoring with a Wisepill electronic monitoring device for up to 3 months. Interviews were performed during April 2017–April 2019 at baseline and follow-up. Monitoring data were reviewed to determine timing and patterns of missing their first true adjudicated miss for durations of 1 dose, 3 consecutive days, and 7 consecutive days. Follow-up qualitative interviews included exploring acceptability of monitoring. Results The median age was 28 years and median participant observation time was 90 days (interquartile range 88–90 days) (n = 40 participants). Among those with at least 2 weeks follow-up and adjudication (n = 32), 100% missed at least 1 day. Most (82%) of these participants were <80% adherent in at least one of their monitored months. One dose and 3-day misses did not cluster (e.g., no disproportion on weekends). Most (88%) first missed doses occurred during the first 9 days monitored and most (69%) of the 13 who missed 3 consecutive days missed within the first monitored month. Four participants missed 7 consecutive days. Among 31 with a follow-up interview, 28 (90%) felt receiving a text because of device monitoring would affect their medication taking in the future. Illustrative quotes included, “It made me more responsible” and “…it makes you want to do it right.” Conclusion Most YAAMSM living with HIV in this study had adherence below the target threshold of >80%. These data support development of a text message responsive real-time electronic adherence monitoring intervention approach. Disclosures All authors: No reported disclosures.

An embodied conversational agent can serve as a relational agent and provide information, motivation, and behavioral skills. To evaluate the feasibility, acceptability, and preliminary efficacy of My Personal Health Guide, a theory-based mobile-delivered embodied conversational agent intervention to improve adherence to antiretroviral therapy in young African American men who have sex with men, we conducted this prospective pilot study using a 3-month pre-post design. Outcome measures included adherence, acceptability, feasibility, pre versus post health literacy, and pre versus post self-efficacy. There were 43 participants. Pill count adherence > 80% improved from 62% at baseline to 88% at follow-up (p = .05). The acceptability of the app was high. Feasibility issues identified included loss of usage data from unplanned participant app deletion. Health literacy improved whereas self-efficacy was high at baseline and follow-up. This pilot study of My Personal Health Guide demonstrated acceptability and preliminary efficacy in improving adherence in this important population.

Background: Among persons living with HIV, poorer antiretroviral therapy adherence has been reported in African Americans and disproportionate mortality reported in young African American men who have sex with men (AAMSM) compared to whites. We report the results of focus groups with young AAMSM living with HIV that explore their opinions about the acceptability and feasibility of a triaged real-time missed dose alert intervention to improve treatment adherence. The purpose of this study is to develop a theory-driven triaged real-time adherence monitoring intervention to promote HIV medication adherence in young AAMSM. Methods: We performed five focus groups and two individual interviews among young HIV-positive AAMSM (n=25) in Chicago guided by the Technology Acceptance Model and explored perceptions regarding the monitoring concept including device issues and concerns about inclusion of support persons whose involvement is triggered by sustained missed doses. The purpose was to inform the development of this intervention in this population. Results: Generally, the participants found the proposed intervention acceptable and useful. Privacy was a major concern for participants especially with attention to possible disclosure of their HIV status by receiving a medication-related text that someone else might view and could lead to unwanted attention. There was concern that the device could be confused with a taser. Approximately half of the men already had a close personal contact that helped them with medication taking. Some participants acknowledged that the notification might lead to friction. Conclusions: A triaged real-time alert intervention to improve treatment adherence is acceptable and feasible among young AAMSM living with HIV.

Objective: To determine the incidence of antiretroviral therapy (ART) adherence among treatment-naive HIV-infected patients and to evaluate the impact of single-tablet regimen (STR) on ART adherence among this population. Design: Retrospective cohort study. Methods: We used a nationally representative sample of IQVIA LRx Lifelink individual level pharmacy claims database during 2011-2016, and defined adult patients with index date (first complete ART regimen prescription fill date) after 30 June 2011 as treatment naive. We estimated ART adherence, measured as the proportion of days covered during 1 year following the index date. We conducted multivariable analysis to identify the factors associated with optimum adherence (>= 90% proportion of days covered). We also compared adherence between patients prescribed STR and multiple-tablet regimens among those prescribed integrase strand transfer inhibitor-based or nonnucleoside reverse transcriptase inhibitor-based regimens. Results: Overall 42.9% of the patients were optimally adherent. Adherence was significantly lower among blacks, Hispanics and patients in low-income communities. Adjusting for the covariates, patients on STR had higher incidence of optimum adherence compared with those on multiple-tablet regimens among patients on integrase strand transfer inhibitor-based regimens [49 vs. 24%, relative risk, 2.16 (95% confidence interval: 1.96-2.26)], but no significant difference was observed among those on nonnucleoside reverse transcriptase inhibitor-based regimen [45 vs. 45%, relative risk, 1.12 (95% confidence interval: 0.99-1.26)]. Conclusion: Low ART adherence observed among treatment-naive patients in this nationally representative study suggests the need for public health interventions to improve adherence among this population.

Abstract Background Non-typhoidal salmonellosis is one of the most common causes of foodborne illness in the United States. The objective of this study was to update the epidemiology of salmonellosis-related mortality in the United States by examining multiple-cause-of-death data (MCOD). Methods MCOD data from the National Center for Health Statistics (NCHS) for the years 1990–2015 were analyzed. Mortality rates and 95% confidence intervals (CI) were calculated for age, sex, race/ethnicity, year, and state. Poisson regression models were used to examine temporal trends. Logistic regression was used to determine whether selected comorbid conditions were associated with salmonellosis-related deaths. Results Overall, 1,987 salmonellosis-related deaths (3.17%) were identified as an underlying and/or associated cause of death. The average annual age-adjusted mortality rate was 0.027 per 100,000 person-years. Salmonellosis mortality rates were higher among males with an age-adjusted rate ratio (RR) of 1.89 (95% CI, 1.79–2.01) compared with females. Mortality rates were higher among non-Hispanic Blacks and Asian/Pacific Islanders with an age-adjusted RR of 2.46 (95% CI, 2.19–2.77) and 2.06 (95% CI, 1.67–2.55) compared with Whites, respectively. The highest number of salmonellosis deaths were reported among the 75–84 year age group (n = 467; 24% of all cases). A significant decrease in trend was observed in age-adjusted salmonellosis mortality rates from 1990 to 2015. Since 2006, a significant increase of 66% in mortality rates was observed. Among selected comorbid conditions, HIV, acute renal failure, cancers affecting bone marrow, and diseases of the digestive system were associated with salmonellosis deaths with odds ratios of 11.51 (95% CI 8.78–15.10), 3.09 (95% CI, 2.01 = 4.75), 2.81 (95% CI, 1.67–4.74), and 2.82 (95% CI, 2.34–3.40), respectively. Conclusion Salmonellosis is an underlying and/or associated cause of death, especially among those with immune senescence and suppression. Despite a substantial decline in mortality rates, since 2006 rates have increased, a concerning trend. If rates continue to increase, an evaluation of Salmonella prevention efforts will be warranted. Disclosures All authors: No reported disclosures.

Determining the barriers and facilitators of antiretroviral adherence among former and current substance users may be useful in the creation of successful interventions that target this hard-to-reach population. We performed a cross-sectional study of HIV-infected patients (N = 123) prescribed antiretroviral therapy at four Chicago healthcare venues. Bivariate and multivariable analyses were performed to determine factors associated with non-adherence based on definitions of non-adherence (any missed doses) within the past 4-day, 14-day, and 1-month time periods. Factors consistently associated with non-adherence in bivariate and multivariate analyses, regardless of duration of non-adherence definition, were lower confidence in taking medication consistently and less self-reported ability to read. These data reveal the importance of self-efficacy and ability to read (rather than specific knowledge of CD4 and viral load definitions) in the design of interventions in a population of HIV-infected persons with significant substance use.

BACKGROUND:Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care.OBJECTIVE:This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM).METHODS:We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app's objectives.RESULTS:In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions.CONCLUSIONS:An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app's ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population.

The purpose of this study was to identify predictors of increasing incidence of Spotted Fever Group rickettsioses (SFGR) in Illinois, with a specific focus on weather variables. We analysed cases of SFGR reported to the Illinois Department of Public Health from 2004 to 2013. Surveillance definitions changed in 2008 and 2010, but those changes alone did not account for observed spikes in incidence in 2008, 2012 and 2013. A total of 590 cases of SFGR occurred, with the majority in the southernmost portion of the state. Only 3·4% of the reported cases were considered confirmed under the case definition. Increased mean winter temperature (IRR 1·32, CI 1·25-1·40) and increased precipitation (IRR 1·08, CI 1·04-1·11) were each associated with increased incidence of SFGR. Our findings show that weather appears to play a significant role in explaining the increasing annual incidence of SFGR in Illinois.

OBJECTIVE:To explore knowledge on syphilis, sexual behaviors, and attitudes in men living with HIV in southwestern France. PATIENTS AND METHODS:In the ANRS CO3 Aquitaine Cohort of people living with HIV (PLHIV), a self-administered questionnaire was proposed to all male PLHIV attending one of the seven participating clinics between September 22 and October 24, 2014. The 15 questions explored patient knowledge about syphilis disease, attitudes, and behaviors during sexual intercourse. RESULTS:Among 302 patients surveyed, 101 reported at least one episode of syphilis. A history of syphilis was associated with awareness that syphilis was on the rise in men who have sex with men (MSM) in the Aquitaine region (46% vs. 22%, P<0.0001). Knowledge that syphilis could be transmitted by oral sex was low in both patients with (37%) and without (20%) a history of syphilis (P=0.0045). Patients with a history of syphilis more often used recreational drugs (RR 1.6; P=0.0028). Among 160 patients who had sexual intercourse with a man in the past 12 months, 23% reported using condoms for oral intercourse and 80% reported using condoms for anal intercourse. Sixty-two per cent of MSM declared being ready to change their practice if informed about the rise in syphilis. CONCLUSIONS:This survey revealed important information gaps in PLHIV about syphilis and related behavior. The reported receptiveness of this population to behavioral change may help inform educational interventions.

Abstract Background African American MSM (AAMSM) living with HIV are less likely to have viral suppression than other racial groups. Wisepill, a wireless pill bottle, transmits a cellular signal to a server when opened and is designed to measure antiretroviral therapy (ART) adherence. The objective of this study was to explore the acceptability of a proposed intervention in these young AAMSM using the Wisepill device opening data to trigger a real-time text alert that ART may not have been taken during a planned time to either the user, a trusted social contact, or a healthcare worker, depending on the duration of consecutively missed doses (1 dose, 3 doses, 7 doses, respectively). Methods From December 2016 – May 2017, AAMSM living with HIV age 18–34 years (N = 25) participated in a study that included five focus groups (n = 23) and one on one interviews (n = 2). We performed theory-based discussion grounded in the Technology Acceptance Model. Specifically, we explored usefulness, convenience, concerns, and intention to use. Results Fifty-two percent missed at least one dose in the 4 days prior to the focus group meeting. Almost all participants (94%) favored the idea of a wireless pill bottle monitor and linked text message notification that ART may have been missed. The device was considered convenient for use at home or in a backpack, but too large for a pocket. Stigma and privacy were common concerns. For example, participants did not want to carry the device with them if the pills would “sound like a walking pharmacy” and did not want a text message that said, “You missed your HIV meds.” They preferred text message notifications that ranged from emoji icons to cryptic short texts and wanted to receive an email as a backup plan. Most believed that the device appearance would not gain unwanted attention. Thirty percent of the participants identified a partner as a social contact to whom the 3-day missed dose reminders would be sent whereas others designated their mother, aunt, brother, friend, pastor, and case-manager. Conclusion An adherence intervention using a wireless pill bottle monitoring device linked to text notifications was acceptable to most of the young AAMSM in this study. Acceptability may be enhanced by personalization of the responsive text messages and a backup email option. Disclosures J. E. Haberer, Merck: Consultant, Consulting fee; Natera: Shareholder, Stock ownership