When taken consistently, pre-exposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) with once daily tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) has been shown to safely reduce the incidence of HIV infection in high-risk individuals by more than 90%. Yet, according to the Centers for Disease Control and Prevention, there were about 2.1 million new cases of HIV reported worldwide in 2015. Undoubtedly, there is significant room for improvement to prevent the transmission of HIV. Research to date has been heavily focused on the high-risk men who have sex with men (MSM) population, yet, many women worldwide remain at high risk of HIV transmission. PrEP offers women a protection method that is discrete, does not require partner consent, and may be compatible with both contraception or conception as desired. However, women often remain under-represented in HIV prevention literature and are reported to have lower real-world uptake in comparison to men. Furthermore, clinical trials that do focus on the female population demonstrate mixed efficacy results that highlight the adherence challenges in this population. It is essential to identify factors that contribute to PrEP non-adherence as well as barriers to preventative treatment. This review will discuss the clinical evidence behind PrEP in women, current barriers to use afflicting this population, pharmacotherapy considerations for the female patient, alternative and future agents, and the current real-world application of PrEP.

Objective: To identify the proportion of viral acute upper respiratory tract infections (AURTI) inappropriately treated with antibiotics before and after the implementation of a multimodal outpatient antibiotic stewardship initiative in a real-world setting.Design: Pre-post, quasi-experimental study. Patients: Adult patients with a diagnosis of either acute bronchitis, influenza, unspecified viral infection, or unspecified AURTI who visited internal medicine (IM) or family medicine (FM) ambulatory care clinics at an urban, academic health system in 2016 and 2017. Interventions: Provider education including the dissemination of an institutional guideline and algorithm for the treatment of AURTI occurred in FM and IM clinics. In the FM clinics, a roundtable discussion with clinicians promoting safe and appropriate antibiotic prescribing was conducted, and patient-facing educational posters were placed in exam rooms and clinic waiting areas describing the FM teams' commitment to using antibiotics only when necessary. Results: A total of 2817 patient encounters met study inclusion criteria. In total, inappropriate antibiotic prescribing had a relative decrease of 24% after implementation of the interventions (17.2% [235/1362] preintervention vs 13.1% [191/1455] postintervention; P = .02). During the preintervention period, 25.4% (143/563) of the encounters in the IM clinics were associated with inappropriate antibiotic prescribing compared with 19% (108/568) in the postintervention period (P < .01). Relative to the IM clinics, the FM clinics had a lower proportion of encounters associated withinappropriate antibiotic prescribing at baseline. In FM clinics, 11.5% (92/799) of encounters were associated with inappropriate antibiotic prescribing during the preintervention period compared with 9.4% (83/887) during the postintervention period (P = .15).

Baseline resistance testing was used for decisional support for 3 clinical scenarios in patients with HCV genotype 1 infection at the time of manuscript submission. Pending the approval of 2 new direct-acting antiviral regimens in the third quarter of 2017, the rapidly evolving HCV treatment guidelines will likely reflect a decreased clinical utility for resistance testing.

Background COVID-19 has become a worldwide pandemic that brought changes in sociological, economic and health perspectives. The impact of the pandemic on health maintenance is not yet understood, but aspects of the lockdown are being assessed for their impact on society. Diabetes and HIV are diseases that require frequent follow-up to achieve outcomes. Changes to routines during the lockdown, such as physical activity, eating habits, and psychological burden, may result in complications for this patient population. Methods This is a multi-center, retrospective cohort study performed between October 2019 to October 2020 at two medical centers in Brooklyn, NY. All adult patients with diagnoses of diabetes and HIV were screened for inclusion. Exclusion criteria included pregnancy and long-term steroid use. Electronic medical records were reviewed to obtain demographic, laboratory data, and appointment retention data. The primary endpoint was the mean change in HbA1c (A1c) values before and after the pandemic. Endpoints were evaluated using paired T-tests and Wilcoxon Sign-Rank tests, where appropriate, and a repeated measures logistic regression model was used to analyze appointment retention rates. Results Baseline characteristics are summarized in Table 1. No significance was observed between baseline A1c values and those taken either up to 3 months (p= 0.862) or up to 6 months (p= 0.977) after the start of the pandemic, as shown in Table 2. Similarly, no difference was observed in HIV surrogate markers. A1c significantly decreased from between the 3-month and 6-month study dates, after the start of the pandemic (p= 0.022). Table 3 shows patients were more likely to fulfill a scheduled appointment during the pandemic with an odds ratio of 1.455 (95% CI, 1.119-1.891). Conclusion No significance was found in surrogate markers for health maintenance before and after the pandemic. Patients were more likely to keep an appointment after the start of the pandemic and A1c values significantly declined from 3 months to 6 months into the pandemic. Although COVID-19 did not appear to change overall health maintenance of T2DM within our population, our results imply that pandemic measures, such as telehealth appointments, positively affected appointment adherence, which is key to success in this population. Disclosures Jessica E. Yager, MD MPH, Abbott Laboratories (Shareholder)Amgen Inc (Shareholder)Becton Dickenson & Co (Shareholder)Edwards Lifesciences Corp (Shareholder)Gilead Sciences, Inc. (Grant/Research Support, Recipient of FOCUS grant)

The treatment of hepatitis C virus (HCV) has evolved significantly, marked by the approval of combination, direct-acting antiviral medications, which have improved the tolerability and efficacy of therapy. As the number of patients engaged in HCV treatment increases, it is important that all members of the healthcare team remain current on treatment options and equipped with the knowledge to educate patients. Nursing staff play a critical role in understanding the role of new medications in treatment, significant drug interactions, and patient counseling points on administration, potential adverse reactions, and the importance of adherence.

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BackgroundAcute upper respiratory tract infections (URI) result in significant outpatient antimicrobial prescriptions and are targets for antimicrobial stewardship efforts given they are often of viral origin. Our objective was to evaluate the impact of educational antimicrobial stewardship initiatives on the proportion of URI treated with antibiotics in a large, ambulatory setting that included Internal Medicine and Family Medicine clinics.MethodsThis quasi-experimental pre–post intervention study evaluated antibiotic prescribing for URI from January 1, 2016 to December 31, 2017. The calendar year 2016 was considered the preintervention time period. The stewardship interventions were implemented in December 2016 and included practitioner education on URI treatment guidelines (education) and commitment to safe antibiotic use posters displayed in patient rooms and clinic waiting areas (poster). Education was provided in both clinics whereas posters were displayed only in the family medicine clinic. ICD-10 codes were used to identify cases, excluding patients with COPD. The primary endpoint was the proportion of patient visits for URI where antibiotics were prescribed for the treatment of acute bronchitis, influenza, and unspecified viral infection collectively.ResultsThere were 1,533 encounters preintervention and 1,479 postintervention. In the internal medicine clinic (education only), the rate of antibiotics prescribed for all URI diagnoses preintervention was 24.5% vs. 19.0% post (P = 0.022). In the family medicine clinic (education + poster), the antibiotic prescribing rate for all URI diagnoses preintervention was 11.0% vs. 9.4% post (P = 0.242). The overall rate of antibiotics prescribed for all clinics was 16.6% preintervention vs. 13.0% postintervention (P = 0.009).ConclusionThe educational and antimicrobial stewardship initiatives implemented in these outpatient clinics may have contributed to a significantly reduced rate of inappropriately prescribed antibiotics for URI in the internal medicine clinic and both clinics overall. The addition of the poster was not associated with a significant change in practice. However, these results demonstrate the potential utility of the educational initiative, and that stewardship strategies may have a different impact by clinic setting.Disclosures All authors: No reported disclosures.