BackgroundBehavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child’s condition and (2) subjective strain, that arises from the caregiver’s feelings regarding these events. ObjectiveThis study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers’ strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning. MethodsWe examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child’s web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering. ResultsThe majority of children were White 60.8% (1002/1647), female 53.6% (882/1647), and aged between 5 and 9 years (33.7%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child’s future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child’s disease severity (P<.001), decreased significantly in all therapeutic groups. ConclusionsWeb-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7.

There is no standardized way to determine if telehealth is an appropriate level of care for youth with nonsuicidal self-injury (NSSI). To address this practice gap, we developed a level-of-care decision-making tool for youth who reported NSSI when presenting to a national pediatric telepsychiatry service. This research investigates the rate that youth who presented to telehealth services required a subsequent referral to in-person care and the clinical outcomes in those youth and their caregivers who completed a course of care.

Background The burden of pediatric mental illness in the United States has steadily worsened over the past decade. A recent increase in employer-sponsored behavioral health programs has focused on the needs of the general population. However, these programs do not provide the specialty mental health care required for children, adolescents, and their families. Objective This study aimed to evaluate the effects of a technology-enabled pediatric and family behavioral health service on clinical outcomes among children and caregiver strain. The service is available to commercially insured populations and provides educational content; tele-behavioral health care, including coaching, therapy, and psychiatry; and care escalation and coordination. Methods A retrospective cohort analysis of members using the service between February and September 2022 was conducted. Clinical outcomes for children and their caregivers were collected using the Pediatric Symptom Checklist-17 (PSC-17), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire 8-item (PHQ-8), and Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Rates of reliable improvement were determined by calculating the reliable change index for each outcome. Paired, 2-tailed t tests were used to evaluate significant changes in assessment scores at follow-up compared to baseline. Results Of the 4139 participants who enrolled with the service, 48 (1.2%) were referred out for more intensive care, 2393 (57.8%) were referred to coaching, and 1698 (41%) were referred to therapy and psychiatry. Among the 703 members who completed the intervention and provided pre- and postintervention outcomes data, 386 (54.9%) used psychoeducational content, 345 (49.1%) received coaching, and 358 (50.9%) received therapy and psychiatry. In coaching, 75% (183/244) of participants showed reliable improvement on the PSC-17 total score, 72.5% (177/244) on the PSC-17 internalizing score, and 31.5% (105/333) on the CGSQ-SF7 total score (average improvement: PSC-17 total score, 3.37 points; P<.001; PSC-17 internalizing score, 1.58 points; P<.001; and CGSQ-SF7 total score, 1.02 points; P<.001). In therapy and psychiatry, 68.8% (232/337) of participants showed reliable improvement on the PSC-17 total score, 70.6% (238/337) on the PSC-17 internalizing score, 65.2% (219/336) on the CGSQ-SF7 total score, 70.7% (82/116) on the GAD-7 score, and 67.5% (77/114) on the PHQ-8 score (average improvement: PSC-17 total score, 3.16 points; P<.001; PSC-17 internalizing score, 1.66 points; P<.001; CGSQ-SF7 total score, 1.06 points; P<.001; GAD-7 score, 3.00 points; P<.001; and PHQ-8 score, 2.91 points; P<.001). Conclusions Tele-behavioral health offerings can be effective in improving caregiver strain and psychosocial functioning and depression and anxiety symptoms in a pediatric population. Moreover, these digital mental health offerings may provide a scalable solution to children and their families who lack access to essential pediatric mental health services.

Culturally responsive care is one approach that can address pervasive disparities in the delivery of pediatric mental health care. Tailored care can be optimized by leveraging assessments of patient identity and context into targeted interventions led by providers trained in delivering culturally responsive care. This study evaluates the effectiveness of culturally responsive provider care delivered through virtual mental health coaching and therapy programs on measures of pediatric clinical outcomes and caregiver strain across race/ethnicity and gender identities.

BACKGROUND:Pediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families' behavioral health needs.OBJECTIVE:The aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents' reports of workplace productivity.METHODS:A clinical research team at Brightline-a virtual, pediatric behavioral health solution-drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents' reports of workplace productivity.RESULTS:Participants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children's behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents' workplace productivity.CONCLUSIONS:This survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child's behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers.

ObjectivesThere is no easy way for parents to obtain evidence-based mental health care for their children; a primary barrier is the lack of trained pediatric mental health providers. Task shifting the delivery of evidence-based treatment to trained behavioral health coaches can reduce the care gap. This study evaluates the effectiveness, in the context of real-world telepsychiatry services, of an online cognitive behavioral coaching program on caregiver strain and goal attainment.MethodsRetrospective data were collected from 20 parents and their children who enrolled in a child and adolescent telepsychiatry benefit offered through their employer. Changes in caregiver stress were measured using the Caregiver Strain Questionnaire–Short Form 7 (CGSQ). A paired t test was used to evaluate CGSQ scores preprogram and postprogram. Additionally, achievement of individualized family-centered goals were assessed using Goal Attainment Scaling (GAS) throughout coaching.ResultsCGSQ scores improved from baseline (M = 6.35, SD = 1.66) to follow-up (M = 4.80, SD = 1.64; t[df] = 4.23[19]; p < .001). Cohen's d suggests a large treatment effect size on the CGSQ (d = 0.94). Of those who had individualized behavioral goals, 100% (5/5) children attained their goals with a median of 2 sessions.ConclusionsThis preliminary study demonstrates that online transdiagnostic cognitive behavioral coaching for children can be effective in reducing caregiver strain and achieving individualized family-centered goals. Behavioral health coaching, delivered via a scalable telepsychiatry platform, has the potential to address the child and adolescent mental health crisis by allowing for efficient redistribution of care tasks from therapists to coaches.TVM, PAT, PRE ObjectivesThere is no easy way for parents to obtain evidence-based mental health care for their children; a primary barrier is the lack of trained pediatric mental health providers. Task shifting the delivery of evidence-based treatment to trained behavioral health coaches can reduce the care gap. This study evaluates the effectiveness, in the context of real-world telepsychiatry services, of an online cognitive behavioral coaching program on caregiver strain and goal attainment. There is no easy way for parents to obtain evidence-based mental health care for their children; a primary barrier is the lack of trained pediatric mental health providers. Task shifting the delivery of evidence-based treatment to trained behavioral health coaches can reduce the care gap. This study evaluates the effectiveness, in the context of real-world telepsychiatry services, of an online cognitive behavioral coaching program on caregiver strain and goal attainment. MethodsRetrospective data were collected from 20 parents and their children who enrolled in a child and adolescent telepsychiatry benefit offered through their employer. Changes in caregiver stress were measured using the Caregiver Strain Questionnaire–Short Form 7 (CGSQ). A paired t test was used to evaluate CGSQ scores preprogram and postprogram. Additionally, achievement of individualized family-centered goals were assessed using Goal Attainment Scaling (GAS) throughout coaching. Retrospective data were collected from 20 parents and their children who enrolled in a child and adolescent telepsychiatry benefit offered through their employer. Changes in caregiver stress were measured using the Caregiver Strain Questionnaire–Short Form 7 (CGSQ). A paired t test was used to evaluate CGSQ scores preprogram and postprogram. Additionally, achievement of individualized family-centered goals were assessed using Goal Attainment Scaling (GAS) throughout coaching. ResultsCGSQ scores improved from baseline (M = 6.35, SD = 1.66) to follow-up (M = 4.80, SD = 1.64; t[df] = 4.23[19]; p < .001). Cohen's d suggests a large treatment effect size on the CGSQ (d = 0.94). Of those who had individualized behavioral goals, 100% (5/5) children attained their goals with a median of 2 sessions. CGSQ scores improved from baseline (M = 6.35, SD = 1.66) to follow-up (M = 4.80, SD = 1.64; t[df] = 4.23[19]; p < .001). Cohen's d suggests a large treatment effect size on the CGSQ (d = 0.94). Of those who had individualized behavioral goals, 100% (5/5) children attained their goals with a median of 2 sessions. ConclusionsThis preliminary study demonstrates that online transdiagnostic cognitive behavioral coaching for children can be effective in reducing caregiver strain and achieving individualized family-centered goals. Behavioral health coaching, delivered via a scalable telepsychiatry platform, has the potential to address the child and adolescent mental health crisis by allowing for efficient redistribution of care tasks from therapists to coaches.TVM, PAT, PRE This preliminary study demonstrates that online transdiagnostic cognitive behavioral coaching for children can be effective in reducing caregiver strain and achieving individualized family-centered goals. Behavioral health coaching, delivered via a scalable telepsychiatry platform, has the potential to address the child and adolescent mental health crisis by allowing for efficient redistribution of care tasks from therapists to coaches.

Resilience, a measure of stress coping ability, may be important in helping older people (age 50+) living with HIV (PLWH) age successfully, but limited data exist regarding factors that contribute to resilience for this group. This study uses the Connor–Davidson Resilience Scale 2 (CD-RISC2) to assess resilience, based on a cross-sectional analysis of 1047 older PLWH. Bivariate linear regression models were used to identify predictor variables that had a relationship with resilience. Those variables were then included in a multivariable linear regression model, which was pared using backward selection. In the multivariable model, higher income and greater interpersonal support were associated with greater resilience, whereas depression and anxiety were associated with lower resilience. Relevant interventions that address these issues, such as increasing opportunities for social support and increasing screening for and treatment of depression and anxiety, are identified as potential pathways to increase resilience among older PLWH.

Pediatric behavioral health needs have skyrocketed during the COVID-19-pandemic. Currently, parents do not have well-established tools to identify risk and protective factors for pediatric behavioral health needs resulting during the pandemic. The objective of this study was to investigate the use of a patient-reported outcomes measure to help parents understand critical risk and protective factors for their children’s behavioral health and the associations that may exist between these factors and parents’ COVID-19 exposure and workplace productivity We designed a 30-item COVID-19 Behavioral Health Instrument (COBI) using items from three existing, validated clinical instruments augmented by a set of questions about the COVID-19 pandemic and workplace productivity. Multivariable linear regression was used to characterize the relationship between these variables and workplace productivity. Participants (n=361) completed the COBI online between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children’s behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents’ workplace productivity. The novel COBI captured child stress and family resilience and connection during the COVID-19 pandemic. Feedback provided by COBI can empower parents by providing them with insights into managing their child’s behavioral health concerns and directing them to resources to address their needs. Furthermore, insights from COBI can help both parents and their employers understand the impact childrens’ behavioral health needs can have on workplace productivity.

Abstract Background Many older (age 50+) adults living with HIV (OALWH) are sexually active. However, little is known about the relationship between number of sexual partners and mental health outcomes among OALWH. Methods Data were utilized from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of OALWH from ten US clinics. To measure sexual activity, participants were asked “How many sexual partners have you had in the last year?” with response options ranging from zero to “greater than five.” Loneliness was measured using the Three-item Loneliness Scale, and depression was measured using the Patient Health Questionnaire-2. Significance was determined by Kruskal-Wallis tests followed by unadjusted pairwise comparisons. Results Of 1,027 participants, the mean (SD) age was 58.9 (6.1) and 876 (85%) were male. 312 (30%) had zero sexual partners in the past year, 308 (30%) had one partner, 197 (19%) had 2-5 partners, and 210 (20%) had >5 partners. Of the participants with one partner, 230 (75%) were married, coupled or partnered, and 78 (25%) were single, widowed, separated, or divorced (Single). Figure 1 shows that people with one partner were significantly less lonely than any other group (p< 0.01 for pairwise comparisons), and all other groups were statistically similar to each other. This pattern was also seen with depression (p< 0.01 for pairwise comparisons, Figure 2). Among subgroup of people with one sexual partner, those who were married, coupled or partnered were less lonely (4.41 vs. 5.67, p< 0.01) and less depressed (0.95 vs 1.38, p=0.02) than those who were single, widowed, separated, or divorced. Conclusion Among OALWH, people with one sexual partner were less lonely and depressed than people with zero or with ≥2 partners. Furthermore, people with one sexual partner who were married or in a committed relationship were less lonely and depressed than people with one sexual partner who were not. Disclosures Peter Mazonson, MD, MBA, ViiV Healthcare (Grant/Research Support) Jeff Berko, MPH, BS, ViiV Healthcare (Scientific Research Study Investigator) Theoren Loo, MPH, ViiV Healthcare (Grant/Research Support) Giselle D. Coelho, MD. MPHTM, Lilly (Research Grant or Support)Medscape, Clinical Care Options (Independent Contractor)Viiv, Gilead, Janssen (Advisor or Review Panel member, Research Grant or Support) Erik Lowman, MD, Gilead (Grant/Research Support)Janssen (Grant/Research Support)ViiV (Grant/Research Support) Peter Shalit, MD, PhD, Abbvie (Grant/Research Support)Gilead Sciences (Consultant, Grant/Research Support, Speaker’s Bureau)Glaxo Smithkline (Consultant, Grant/Research Support)Janssen (Consultant, Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau)Thera (Speaker’s Bureau)ViiV Healthcare (Speaker’s Bureau) Frank Spinelli, MD, ViiV Healthcare (Employee)

Background: Older adults (≥50 y) living with HIV (OALWH) may experience elevated levels of depression, anxiety, and loneliness. Online mindfulness lessons have the potential to ameliorate these problems and enhance access, especially during the COVID-19 pandemic. The objective of this randomized controlled trial was to determine the effectiveness of online mindfulness lessons in reducing feelings of depression, anxiety, and loneliness among OALWH. Methods: The study was conducted between May and August 2020. Individuals with any degree of self-reported loneliness at baseline were eligible to participate. Outcomes of interest included depression, measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10), anxiety measured using the Generalized Anxiety Disorder (GAD-7), and loneliness measured using both the Three-item Loneliness Scale (3IL) and a Daily Diary that asked “How lonely do you feel today?” Two sample t-tests were used to compare group scores at follow-up. Results: Of 214 participants who were randomized, the mean (SD) age was 60.4 (5.9) years, 89% were male, 69% were white, and 74% were gay or lesbian. At the end of the 25-day intervention, the intervention group demonstrated reduced levels of depression (2.6 point improvement;p<0.01), and reduced levels of anxiety (1.5 point improvement;p=0.03) compared to the control group (Table 1). Among the subset of participants with elevated baseline depression scores (defined as CES-D-10 ≥ 8), the between-group improvement in depression scores was greater (4.2 point improvement;p<0.01). Similarly, among the subset of participants with elevated baseline anxiety scores (defined as GAD-7 ≥ 5), the between-group improvement in anxiety scores was greater (2.4 point improvement;p<0.01). Loneliness improved significantly, as indicated by the Daily Diary, for those with at least moderate loneliness at baseline (0.7 point improvement;p<0.01). Conclusion: This randomized controlled trial is the first to show that a series of brief, online mindfulness audio lessons improves mental health outcomes among OALWH who report some degree of loneliness. For many patients, this intervention may offer emotional relief, particularly with regard to depression and anxiety, even in the face of the COVID-19 pandemic.

Background Loneliness is a concern among older people living with HIV (PLWH), especially given the ongoing COVID-19 pandemic. Currently, there is little research characterizing loneliness and race. To investigate how HIV impacts older (age 50+) PLWH in the US, a study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This study uses ADHOC data to compare loneliness between older Black and White PLWH. Methods A cross-sectional analysis was performed to compare loneliness between older Black and White PLWH. Loneliness was assessed using the Three-item Loneliness Scale, a validated patient-reported outcome measure (range 3–9), with higher scores indicating greater loneliness. Student’s t-test was used to compare loneliness between White and Black people. Control variables for loneliness were identified a priori and included in a multivariable linear regression model. Results Of 868 participants, the average age was 60 (SD 6.2) years, 77% (N=671) were White and 23% (N=197) were Black, 85% were male, and 82% were gay or lesbian. In bivariate analyses, Black participants were less lonely than White participants (5.2 vs 5.6, P=.02). In the multivariable linear regression analysis, Black participants were again less lonely than Whites (coef. -0.45, P=0.01) while controlling for age, education, depression, anxiety, number of co-morbid conditions, being single, income, gender, sexual orientation, and spirituality (Adjusted R2=0.38; P<.01). Conclusion Among PLWH over age 50 in ADHOC, Black participants experienced less loneliness than White participants, even after controlling for a variety of factors. Additional research is needed to better understand the causes of these racial differences, so that programs designed to decrease loneliness among PLWH can consider the unique characteristics of each group.

Abstract Background Improving quality of life (QoL) is an important goal of care for people living with HIV (PLWH). This analysis uses data from the Aging with Dignity, Health, Optimism and Community (ADHOC) online registry to identify the different challenges faced by older white/Caucasian (“white”) and black/African American (“black”) gay or bisexual men living with HIV, and to assess differences in total QoL between the two groups. Methods QoL was measured using the PozQoL, a validated instrument for PLWH. The PozQoL assesses QoL across four domains: health concerns, psychological, social, and functional wellbeing. Total QoL was determined by combining domain scores for a total score. Student’s t-tests and chi-squared tests were used to identify disparities between black and white men. Factors with p< 0.05 were used as control variables in a multivariable linear regression model where PozQoL total score was the dependent variable. Results In the ADHOC database, 91% (n=612) of respondents were white men (WM) and 9% (n=59) were black men (BM). Both BM and WM had a median age of 59 years, and had a similar number of comorbidities (7.9 vs 9.2 respectively, p=0.12). Compared to WM, BM were more likely to be single (74% vs 51%, p< 0.001), less likely to have an income greater than $50,000 (25% vs 56%, p< 0.001), less likely to have a college degree or more (42% vs 69%, p=0.034), and less likely to be virally suppressed (87% vs 96%, p=0.001). Even after controlling for these differences in the multivariable model, BM had significantly higher total QoL than WM (Table 1). Conclusion In this analysis, there were substantial differences between older BM and WM living with HIV. After controlling for sociodemographic and clinical challenges, BM still reported higher QoL than WM. Programs designed to improve QoL for older gay and bisexual BM and WM living with HIV should take into consideration the unique strengths and challenges faced by each group. Disclosures Peter Mazonson, MD, MBA, ViiV Healthcare (Grant/Research Support) Theoren Loo, MS, BS, ViiV Healthcare (Grant/Research Support) Jeff Berko, MPH, BS, ViiV Healthcare (Grant/Research Support) Oluwatoyin Adeyemi, MD, ViiV Healthcare (Grant/Research Support) Alan Oglesby, MPH, ViiV Healthcare (Employee) Frank Spinelli, MD, ViiV Healthcare (Employee) Andrew Zolopa, MD, ViiV Healthcare (Employee)

ABSTRACT Loneliness is common among older (age 50+) people living with HIV (PLWH). However, little is known about the prevalence of loneliness across subgroups of older PLWH, and the factors that impact loneliness. An online questionnaire was used to collect data from 998 older PLWH. Of those, 61% were 50–59 years old and 39% were 60 or older. The majority were male (89%), gay (77%), and white (69%). Fifty-one percent of participants were classified as lonely. The prevalence of loneliness was lower in the older age group, 46.2% vs. 53.8% (Χ 2 = 5.53, p = 0.02). Covariates associated with loneliness included being younger, being single, having at least a four-year college degree, living alone, screening positive for depression, using recreational drugs, smoking tobacco, having a lower quality of life, and not feeling close to friends. Logistic regression analysis showed that the “younger old” were at 26% greater risk of loneliness, after controlling for the effects of these covariates (RR 1.26, 95% CI: 1.06–1.45). Reasons why the “older old” were less lonely may include lower rates of depression and lower likelihood of feeling distant from friends. Understanding factors that protect the “older old” against loneliness may provide guidance for future interventions.

People living with HIV (PLWH) experience chronic pain that may impact function. Gaps in knowledge exist for factors that impact pain and pain medication use in older (age 50+) PLWH. Data for this study were obtained from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of older PLWH from 10 clinics across the United States. Participants self-reported socioeconomic, psychosocial, and health factors via an online questionnaire. Of 1,051 participants, 66% reported pain. In a multivariable regression model, multimorbidity and tobacco use were associated with a greater likelihood of experiencing pain, whereas being male, black, and having higher cognitive function were associated with a lower likelihood of experiencing pain. Of the 696 participants who reported pain, 46% reported using pain medication. In a multivariable regression model, pain medication use was associated with multimorbidity and with lower income. Recognition of the factors associated with pain and pain medication use in this vulnerable population may lead to strategies that mitigate negative health outcomes.

Pain impacts up to 55% of people living with HIV (PLWH) and negatively impacts function. To date, limited data exist regarding factors that contribute to pain in older PLWH. Data were utilized from the Aging with Dignity, Health, Optimism and Community (ADHOC) cohort, an observational study of older PLWH from ten clinics across the U.S. that collects patient-reported outcomes (PROs) on socioeconomic, psychosocial, and health factors. To measure pain, ADHOC participants were asked whether they had been diagnosed with back pain, hip pain, joint pain, or muscle pain, and were also instructed to report chronic pain conditions that were not listed. Bivariate analyses were performed to determine the associations between pain and PROs. Of 1,051 participants, 66% reported at least one type of pain. Factors associated with pain included multimorbidity, low income, anxiety, loneliness, depression, tobacco use, and older age (Table 1). Factors negatively associated with pain included employment, higher cognitive function, higher quality of life, greater resilience, higher social well-being, and alcohol use. Table 1. Characteristics associated with pain among older people living with HIV. Pairwise correlations are reported above using correlation coefficient r. Improving pain management is currently a priority in the US healthcare system. Some factors identified in this study, including systemic issues such as socioeconomic status and employment, are not easily modifiable. Other factors, such as anxiety, depression, and smoking, are modifiable and therefore represent targets for interventions focused on improving pain and its sequelae in older PLWH. Maile Karris, MD, Gilead Sciences (Grant/Research Support)Viiv Healthcare (Grant/Research Support) Peter Mazonson, MD, MBA, ViiV Healthcare (Grant/Research Support) Theoren Loo, MS, BS, ViiV Healthcare (Grant/Research Support) Jeff Berko, MPH, BS, ViiV Healthcare (Grant/Research Support) Frank Spinelli, MD, ViiV Healthcare (Employee) Andrew Zolopa, MD, ViiV Healthcare (Employee)

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

The population of people living with HIV (PLWH) is aging. To investigate how HIV impacts older PLWH in the U.S., a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. A cross-sectional analysis of ADHOC was performed on 698 PLWH (age 50+) to determine associations between self-reported quality of life (QoL) and sociodemographic, health status, and clinical indicators. QoL was assessed using the PozQoL, a validated, HIV disease-specific instrument. The impact of various factors on QoL was analyzed using bivariate analyses. Factors associated with QoL at p < 0.2 were included in a backwards, stepwise, linear regression model. The average age of ADHOC participants was 59 years. 91% were male, 89% were gay or lesbian, 75% were white, 95% had an undetectable viral load, and 52% were employed. Clinical characteristics associated with lower QoL included having six or more comorbid conditions, taking a higher number of antiretroviral medications, and taking a higher number of non-HIV medications. Behavioral characteristics associated with lower QoL included having anxiety or depression. Social characteristics contributing to lower QoL included being single, HIV-related stigma, and an annual household income less than $50,000. Being 65 or older was associated with higher QoL (all p's < 0.05). Among PLWH over 50, some factors related to quality of life, like age, cannot be changed. Others may be modified through lifestyle choices (being single versus in a relationship) or through medical interventions (treating depression and anxiety, and minimizing the number of medicines prescribed). Given these findings, measuring QoL among older PLWH may surface unmet needs that allow for improvements in care beyond viral suppression. Observational studies of PLWH over age 50 are important to better understand the overall needs of this growing population.

Abstract Background Socioeconomic factors have been identified as a root cause of a wide range of health outcomes. However, there are no studies that describe the impact of these factors on patient-reported outcomes (PROs) among older (age 50+) people living with HIV (PLWH). This study examines the relationship between annual household income, sociodemographic factors, and several PROs among older PLWH. Methods A cross-sectional analysis examined the relationships between self-reported annual household income, sociodemographic information, and validated PROs. Statistical differences within sociodemographic groups were determined using chi-squared tests, and within PROs using bivariate risk ratios. Results Of 922 participants, the median age was 58 years (range: 50–88). The majority of participants were male (89%), gay (79%), and white (70%). Fifty-five percent reported an annual household income of less than $50,000 per year and 45% reported a household income of $50,000 or greater. Among people in the lower-income group, 33% were working full or part time, 24% were retired, and 43% were disabled, whereas among people in the higher income group, 76% were working full or part time, 19% were retired, and 5% were disabled (Table 1). Bivariate analysis showed that while there was not a significant relationship between age and income, income was significantly associated with work status, race, gender, education, relationship status, sexual orientation, and having enough money to meet basic needs. People with lower household income were significantly more likely to be depressed, anxious, and lonely, and to have 4 or more comorbid conditions (Table 2). They were also less likely to have high resilience, high social well-being, and high quality of life. Conclusion To the best of our knowledge, this is the first examination of the relationship between self-reported annual household income and PROs among older PLWH. In these bivariate analyses, income was positively associated with desirable PROs, and negatively associated with undesirable PROs. To be successful, programs designed to improve health outcomes for older PLWH must take into account the economic challenges faced by many in this group. Disclosures All authors: No reported disclosures.

Ehrlichiosis and anaplasmosis are important emerging tickborne zoonoses that affect both humans and animals. Knowledge of the geographic distribution and prevalence of Ehrlichia spp. and Anaplasma phagocytophilum in Wisconsin is important information as a baseline for future comparisons. Reported human cases between 2009 and 2015 were identified using the Wisconsin Electronic Disease Surveillance System (WEDSS) and mapped by county of residence. Vector surveillance was established using ticks collected from animals by partners, including veterinary medical clinics, domestic animal shelters, and wildlife rehabilitation centers from 40 Wisconsin counties. A total of 1835 Ixodes scapularis tick specimens (larvae, nymphs, and adults) were collected from 18 different domestic and wildlife species from July 2011 to November 2015. An additional 1136 nymphs were collected by drag sampling at 23 locations in 19 counties in 2015. A real-time PCR assay that detects and distinguishes several Ehrlichia species, including a pathogenic Ehrlichia muris-like agent (EMLA), and A. phagocytophilum was performed on adult and nymphal ticks. A total of 757 I. scapularis ticks (predominately adults) were tested from animal collections, with 67 (8.9%) individuals positive for A. phagocytophilum and 22 (2.9%) positive for EMLA DNA. Of the 1150 questing nymphs, 62 (5.4%) were positive for A. phagocytophilum and 10 (0.9%) were positive for EMLA DNA. Specimens of I. scapularis that were positive for A. phagocytophilum were found in 27 of the 33 counties surveyed. Specimens that were positive for EMLA were less common and were found in nine counties. This study provides the first statewide survey of I. scapularis ticks for these pathogens and indicates that the risk of human exposure is widely distributed.