Background: In 2024, national guidance was issued for doxycycline post-exposure prophylaxis (doxy-PEP) to prevent bacterial sexually transmitted infections (STIs). The study purpose was to evaluate doxy-PEP use in patients with increased risk of STI exposure at a large, urban health system. Methods: IRB-exempt study of adult patients with clinic encounters for increased risk of STI exposure and testing for N. gonorrhoeae, C. trachomatis, and T. pallidum from 01/01/2023-31/10/2024. Patients were identified using ICD-10 code Z20.XX and STI testing. Doxy-PEP prescription utilization was evaluated after a dedicated doxy-PEP order was implemented with appropriate patient counseling instructions. The primary outcome was the proportion of doxy-PEP prescriptions utilized in at-risk patients; secondary outcomes were utilization of the dedicated doxy-PEP order and abnormal STI testing within 3-months of the doxy-PEP prescription. Results: 4234 high-risk sexual patient encounters were documented; 7.37% of patients received a doxy-PEP prescription. Of these, 29.5% were ordered utilizing a dedicated doxy-PEP order. Most patients who received a doxy-PEP prescription were Black (96.6%), men (92.6%), with a median (IQR) age of 29 (24-37) years, and had private/commercial insurance (42%). One patient had abnormal syphilis testing within 3-months of doxy-PEP prescription. Conclusions: These findings highlight doxy-PEP underutilization and the need for broader provider engagement and advanced antimicrobial stewardship interventions.

Diagnostics for particular populations outside of traditional health care settings have driven development of point-of-care testing (POCT). POCT is particularly suitable for patients with infections conditions to mitigate infection spread via its provision in venues with less concern for stigma. Patients in rural or resource-limited settings can benefit from POCT through more timely diagnosis and linkage-to-care. However, gaps in POCT availability compared with better-resourced, urban counterparts persist. Leveraging communication technologies, using mobile clinics, changing national health care policy, and implementing novel geospatial science concepts can address limitations of POCT use and reduce POCT access gaps in these settings.

Abstract Background Social media is increasingly being used among Infectious Disease (ID) programs. It can be a valuable recruitment tool in addition to providing education, self-promotion, and increasing collaborations across the ID community. We sought to analyze factors associated with increased engagement for our ID fellowship program’s Twitter account. Methods We analyzed various metrics from consecutive Twitter posts and utilized the Twitter Analytics Dashboard to extract data from time of account inception. Impressions were defined as the number of times a tweet was seen by users, and engagements as a composite of interactions with a tweet. Tweet content was organized into educational, social, promotional, and other categories. Educational content was subcategorized into tweetorial, microbiology, question & answer (Q&A), and journal articles. A subset of tweets were analyzed for engagement from April 2022 to March 2023 for trends according to content and date the tweet was posted. Standard univariate descriptive statistical analyses, moods median test, and one-way analysis of variance was performed. Data analysis was performed using R version 3.4.0. Results 460 tweets were posted from October 2020 to March 2023 (Figure 1). Educational subcategories showed a large amount of engagement related to microbiology, with specifically more retweets, likes, and profile clicks (Table 1). There was no difference in engagement based on time of day of tweet (Table 2), although profile clicks were significantly more likely if tweets occurred on a weekend (p=0.04). A subset of 284 tweets from April 2022 to March 2023 revealed that months where multiple content categories were tweeted resulted in the most engagement (Figure 2). Generally, more twitter posts correlated with more engagement with a Pearson correlation coefficient of 0.7.Figure 1.Tweet content by (a) overall categories and (b) educational categories. Conclusion To increase engagement with social media, there should be frequent tweets with varied content categories. Subcategories of content such as microbiology tweets draw further interest and showcase a program's educational and clinical innovation.Figure 2.Composite categorical engagement from April 2022 – March 2023. Disclosures Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria

Abstract Background Cabotegravir (CAB) + rilpivirine (RPV) is the first recommended complete long-acting (LA) regimen for maintenance of HIV-1 virologic suppression. The efficacy and safety of switching to CAB + RPV LA (CAR) has been shown in clinical trials. CAR injections offer less frequent dosing and address issues of adherence and disclosure related to daily oral cART. We describe the clinical characteristics and outcomes of switching a diverse group of people with HIV (PWH) to CAR in a real-world setting. Methods A retrospective cohort study was performed to assess virologic efficacy of intramuscular CAR given every 4 or 8 weeks among adult PWH receiving care at Henry Ford Health ID Clinic by an interdisciplinary team of physicians, nurses, social workers, and a pharmacist. Efficacy was defined as HIV-1 RNA < 20 copies/mL at 3 months. Demographics, clinical characteristics, and outcomes were extracted from the electronic medical record. Results We included the first 51 patients to receive CAR. Median age was 46 years (IQR 34 -59). Black individuals were 75%, cisgender males 84%, and transgender females 3.9% of participants. PWH were diagnosed a median of 12 years ago (IQR 11-17). At time of switch, 90% had HIV viral load (VL) < 20 copies/ml, and 9.8% of patients were viremic with < 75 copies/ml. Mean Cd4+ cell count was 871 cells/µL (IQR 632-1603). Prior to switch, 80% had received ≥ 2 cART regimens, 75% had INSTI exposure, and 45% had NNRTI exposure. Among 38 patients with HIV-1 genotypes available prior to switch, 4 had either baseline NNRTI or INSTI mutations (Table 2). For patients with VL data at 3 months, 37 of 38 (98%) had an undetectable VL. Virologic failure occurred in 1 PWH with BMI 35 who had a Y188L RT mutation in a 2009 genotype which did not include RPV (2011 approval), with subsequent emergence of pan-NNRTI and INSTI resistance. Conclusion A high degree of virologic suppression at 3 months was achieved among an older, diverse cohort of PWH cared for by an interdisciplinary team. Unrecognized baseline HIV resistance to NNRTI contributed to one virologic failure. It is important to assure that genotypic susceptibility interpretations are current and to carefully assess for eligibility before switching to CAR. Disclosures John Di Lodivico, PharmD, Midwest AIDS Training & Education Center: Honoraria|ViiV Healthcare: Advisor/Consultant|Wayne State University: Honoraria Indira Brar, MD, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Janssen: Grant/Research Support|Janssen: Honoraria|ViiV: Advisor/Consultant|ViiV: Grant/Research Support|ViiV: Honoraria

Herpes Simplex Virus esophagitis typically manifests as mucocutaneous lesions in immunocompromised patients, most frequently in organ and bone marrow transplant recipients. However, it has not been appropriately reported as a cause of febrile neutropenia despite being a relatively common opportunistic infection in this patient population. A 58-year-old man recently diagnosed with Ewing Sarcoma for which he was receiving chemotherapy presented with febrile neutropenia. Following a prolonged hospital course characterized by persistent fevers, an endoscopic evaluation was performed and diagnosis of Herpes Simplex Virus esophagitis was confirmed via histopathology. Prompt administration of acyclovir resulted in the complete resolution of the patient's symptoms. Recognition of Herpes Simplex Virus esophagitis as an etiology of febrile neutropenia can ensure more prompt diagnosis and allow for appropriate management of these patients. In addition, this case report emphasizes a need for further research into additional diagnostic markers in the workup of these patients and the incorporation of antiviral therapy in febrile neutropenia algorithms.

Background COVID-19, a novel respiratory illness caused by SARS-CoV-2, has become a global pandemic. As of December 2020, 4.8% of the 941 people living with HIV in our Ryan White clinic have tested polymerase chain reaction positive for SARS-CoV-2. The aim of our study was to estimate the seroprevalence of COVID-19 in our Ryan White people living with HIV, irrespective of known past infection. Methods We conducted a cross-sectional study that recruited people living with HIV in the Ryan White program at Henry Ford Hospital in Detroit, Michigan, from September 2020 through May 2021. All Ryan White patients were offered participation during clinic visits. After informed consent, patients completed a survey, and had blood sampled for SARS-CoV-2 antibody testing. Results Of the 529 individuals who completed the written survey, 504 participants were tested for SARS-CoV-2 antibody and 52 people living with HIV were COVID-19 immunoglobulin (Ig) G positive resulting in a seroprevalence of 10.3%. Among 36 persons with PCR-confirmed COVID-19, 52.8% were IgG negative. Inclusion of PCR positive but IgG-negative people living with HIV yields a COVID-19 infection prevalence of 14.1%. Conclusions These findings suggest that passive public health-based antibody surveillance in people living with HIV significantly underestimates past infection.

Objectives Human papillomavirus (HPV) vaccination coverage in the United States is far below coverage for other routine adolescent vaccines. We examined whether missed opportunities for HPV vaccination among adolescents differ by parental nativity (country of origin) in Minnesota. Methods We retrospectively analyzed birth record and immunization information data for adolescents in Minnesota born during 2004-2007 using data from January 1, 2015, through December 31, 2018. Using logistic regression, we assessed the association between parental nativity and missed opportunities for HPV vaccine initiation, or receipt of other vaccines without receipt of the HPV vaccine. We adjusted for parent/child demographic and vaccination characteristics. We defined nativity as the number of non–US-born parents and maternal region of birth. Results Adolescents with mothers born in Eastern Europe (adjusted odds ratio [aOR] = 2.33; 95% CI, 2.01-2.73) and Africa (aOR = 1.36; 95% CI, 1.28-1.43) had greater adjusted odds of missed opportunities for HPV vaccination than adolescents with US-born mothers. However, adolescents with mothers from Latin America and the Caribbean had lower odds of missed opportunities than adolescents with US-born mothers (aOR = 0.61; 95% CI, 0.58-0.65). Adolescents with 1 or 2 non–US-born parents had lower odds of missed opportunities for HPV vaccination than adolescents with 2 US-born parents (1 parent: aOR = 0.92; 95% CI, 0.88-0.96; 2 parents: aOR = 0.90; 95% CI, 0.87-0.94). Conclusions Future studies should evaluate outreach to groups with HPV vaccination disparities and identify other drivers of missed opportunities among adolescents with US-born parents, such as multiparity.

BACKGROUND:Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders.METHODS:We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews.RESULTS:14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient-clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake.CONCLUSION:Emphasizing the HPV vaccine's cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.

Background: COVID-19 first reported in the US on 1/2020 is a global pandemic. In PLWH, COVID-19 outcomes have been reported to be similar or worse compared to the general population;however, the seroprevalence in this group has not been identified. As of 6/2020, 2.7% of the 960 PLWH in our Ryan-White (RW) clinic have tested PCR+ for COVID-19. Yet, these likely represent only a fraction of COVID-19 infections, as an unknown proportion of cases are mild or asymptomatic and not diagnosed. Our goal was to estimate the seroprevalence in our RW patients (pts), irrespective of known past COVID-19 infection. The RW program funds HIV care for a diverse group impacted by a number of social determinants of health, including low socioeconomic status. Methods: We conducted a seroprevalence study, which recruited pts in the RW program at Henry Ford Hospital. All RW pts were offered participation during clinic visits. After informed consent, pts completed a survey and had blood sampled for COVID-19 antibody using the Beckman Coulter Access SARS-CoV-2 IgG assay. Pts' electronic medical records were reviewed for demographic clinical features, including previous COVID-19 testing. The study was IRB approved. Results: 187 PLWH were enrolled from 9/2020-11/2020 (Table 1). Median age: 46 (IQR: 34-57);153 males;152 black;24 reported a previous COVID-19 exposure;66 had a BMI of >/= 30. Mean CD4 count was 629.5 (IQR: 390-859), and 129 pts were HIV suppressed. 17 had PCR-confirmed COVID-19, and 16 reported symptoms consistent with COVID-19 but with unconfirmed diagnoses. Of 187 PLWH, 25 (13%) were COVID-19 IgG+ of whom 8 were previously PCR+. 9/17 PLWH who were PCR+ for COVID-19 were COVID-19 IgG negative at a mean of 7 months from the initial PCR test. Conclusion: The COVID-19 seroprevalence of 13% reported in this study of PLWH in our clinic was about 5-fold greater than the number of reported cases by PCR+ in the same population. This estimate of past infection is also an underestimate given the absence of antibody at the time of the serological testing in 53% of PLWH with documented PCR+ infection and the likelihood of infection in some of those never tested. Conversely, the impact of health disparities on the RW pts likely increases the chance of acquisition of COVID-19 compared to other populations. In order to better understand the penentration of COVID-19 into the PLWH community, a greater understanding of the dynamics of the antibody response to COVID-19 is needed.

The surge of coronavirus disease 2019 (COVID-19) hospitalizations at our 877-bed quaternary care hospital in Detroit led to an emergent demand for Infectious Diseases (ID) consultations. The traditional 1-on-1 consultation model was untenable. Therefore, we rapidly restructured our ID division to provide effective consultative services. We implemented a novel unit-based group rounds model that focused on delivering key updates to teams and providing unit-wide consultations simultaneously to all team members. Effectiveness of the program was studied using Likert-scale survey data. The survey captured data from the first month of the Detroit COVID-19 pandemic. During this period there were approximately 950 patients hospitalized for treatment of COVID-19. The survey of trainees and faculty reported an overall 95% positive response to delivery of information, new knowledge acquisition, and provider confidence in the care of COVID-19 patients. This showed that the unit-based consult model is a sustainable effort to provide care during epidemics.

Background: COVID-19 disease has spread globally and was declared a pandemic on March 11, 2020, by the World Health Organization. On March 10, the State of Michigan confirmed its first 2 cases of COVID-19, and the number of confirmed cases has reached 47,182 as of May 11, 2020, with 4555 deaths. Setting: Currently, little is known if patients living with HIV (PLWH) are at a higher risk of severe COVID-19 or if their antiretrovirals are protective. This study presents epidemiologic and clinical features of COVID-19 infected PLWH in Detroit, Michigan. Methods: This is a case series that included 14 PLWH with laboratory-confirmed COVID-19 infection who were evaluated at Henry Ford Hospital in Detroit, Michigan, between March 20, 2020, and April 30, 2020. Results: Fourteen PLWH were diagnosed with COVID-19. Twelve patients were men and 2 were women; 13 patients were virally suppressed. Eight patients were hospitalized, and 6 patients were told to self-quarantine at home after their diagnoses. Three patients who were admitted expired during their hospital stay. No patient required bilevel positive airway pressure or nebulizer use in the emergency department, and none developed acute respiratory distress syndrome, pulmonary embolism, deep venous thrombosis, or a cytokine storm while on therapy for COVID-19. Conclusion: Although the clinical spectrum of COVID-19 among PLWH cannot be fully ascertained by this report, it adds to the data that suggest that HIV-positive patients with SARS-CoV-2 infection are not at a greater risk of severe disease or death as compared to HIV-negative patients.

Abstract Background There is concern that patients with coronavirus disease 2019 (COVID-19) are at risk of developing secondary bacterial and fungal infections; however, data on the clinical characteristics and outcomes of COVID-19 patients with fungal infections are limited. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with fungal infections. Methods This was a retrospective chart review of 51 patients with fungal infections at an 877-bed teaching hospital in Detroit, Michigan from March through May 2020. Demographic data, comorbidities, complications, treatment, and outcomes, including relapse, readmission and mortality were collected. We performed a descriptive analysis. Results A total of 51 patients with fungal infections were included, in which 31 (60.8%) had confirmed or suspected COVID-19 infection. Of the COVID-19 patients, the average age was 66 years and the majority (54.9%) were female. The average length of stay (LOS) was 29.3 days. Aspergillus sp. (2 A. fumigatus, 1 A. niger) were isolated in 3 (10%) patients while 23 (74.2%) had candidemia diagnosed via blood culture or T2Candida® Panel. One had a positive serum galactomannan. The average time from admission to diagnosis was 13 days. Significant comorbidities included hypertension (74%), diabetes (51.6%), coronary artery disease (25.8%), congestive heart failure (32.2%), chronic kidney disease (22.6%), and malignancy (16.1%). Most patients received steroids (83.9%) and broad-spectrum antibiotics (80.6%), had a central line (80.6%), and required intensive care unit management (90%). Only 71% were treated with antifungals. One patient with candidemia relapsed due to poor source control; two were readmitted within 30 days. In-hospital mortality rate was 51.6% among COVID-19 patients. Conclusion COVID-19 patients with fungal infections had multiple comorbidities, prolonged hospitalization and predisposing risk factors for fungal infections with a high in-hospital mortality rate. Prevention of fungal infections in COVID-19 patients is paramount. Disclosures All Authors: No reported disclosures

Abstract Background In Michigan, 44,964 (68%) of the 66,269 COVID-19 patients have recovered. However, there is concern that COVID-19 infection may lead to long-term sequelae, including pulmonary defects, cardiac complications, blood clots, and neurocognitive impairment. This study describes the 30-day outcomes of patients who had recovered. Methods From 3/16/2020 to 5/19/2020, a follow-up was attempted for patients who were discharged alive from Henry Ford Hospital in Detroit and had recovered. Recovery was defined as being alive 30 days post symptom-onset. A telephone survey was conducted 30 days post-index admission and recorded in electronic medical records. Oxygen (O2) requirements, symptoms, readmissions and the need for antibiotics for secondary bacterial infections were evaluated. Results 585 patients met inclusion criteria and were contacted by phone; 303 answered their phone (Table 1), but only 266 (45%) completed a full telephone encounter and were included in the final analysis (Table 2). The majority were female (53%), black (80%), and discharged to home (84%). The clinical characteristics of those who completed the survey were as follows: 11% presented with O2 saturation < 90%, 16% had underlying lung pathology, and 57% had a BMI above 30. Patients’ average age was 61 ± 14.3 years. At 30 days post-index admission, 49% were still symptomatic. Of the symptomatic patients, 86% had dyspnea on exertion and 15% required O2 supplementation. 18% of patients were readmitted within 30 days, and 9% developed a secondary infection prior to the phone encounter. No statistically significant differences in demographics or comorbidities were found between symptomatic and asymptomatic cohorts (Tables 1, 2). Conclusion In our study, almost half of the discharged patients remained symptomatic after 30 days with a substantial proportion experiencing pulmonary symptoms. A better understanding of the long-term pulmonary sequelae following COVID-19 infection is needed to design interventions to reduce post-infectious morbidity. Disclosures Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)

Background. Although the human papillomavirus (HPV) vaccine has been approved for use in adolescents in the US for over a decade, vaccination uptake remains low. Of concern, HPV vaccine coverage is below the national average in Minnesota, USA. To understand the reach of current HPV programming and research, we use an online media scan; this method may be applied to other jurisdictions to gain insight about various public health issues. Design and Methods. This online media scan describes the nature and scope of ongoing activities to increase HPV vaccination in Minnesota. The media scan included: a) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and b) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018. Results. Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria. Results were categorized by activities focusing on race/ethnicity, sex, health providers, parents, lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) populations, geographic location, catchup vaccination, and insurance status. Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research) with only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural areas. Conclusions. A range of local and statewide HPV vaccine health education/promotion and research activities were identified in Minnesota. Several efforts partnered with American Indian and Somali/Somali-American communities, but fewer activities focused on HPV vaccination among LGBTQ youth and HPV vaccination in rural areas.

Background Sexually transmitted infection (STI) rates are increasing in the United States while funding for prevention and treatment programs has declined. Sample self-collection for STI testing in men may provide an acceptable, easy, rapid, and potentially cost-effective method for increasing diagnosis and treatment of STIs. Methods We conducted a systematic review of articles assessing self-collection of anal, oral, or genital swab samples among adult men for detection of STIs and/or human papillomavirus–related dysplasia. We searched for English-language articles in which men 18 years or older were recruited to participate. Results Our literature search resulted in 1053 citations, with 20 meeting inclusion criteria. Self-collection methods were highly sensitive and comparable with clinician collection for detection of multiple STI pathogens. However, self-collected samples were less likely to be of adequate quality for anorectal cytology and less sensitive for detection of anal intraepithelial neoplasia than clinician-collected samples. Self-collection was highly acceptable. Overall, studies were small and heterogeneous and used designs providing lower levels of evidence. Conclusions Self-collection methods are a viable option for collecting samples for STI testing in adult men based on their high feasibility, acceptability, and validity. Implementation of self-collection procedures in STI testing venues should be performed to expand opportunities for STI detection and treatment.