51. Patient Reported Outcomes Collection: A Mixed Methods Study at an urban HIV Clinic associated with a Historically Black Medical College in the Southern United States

Abstract Background Black Americans, particularly in the South, are disproportionately affected by the US HIV epidemic. We piloted the use of an electronic tablet to collect patient reported outcomes (PRO) data on social and behavioral determinants of health among people with HIV (PWH) at the Meharry Community Wellness Center (MCWC), an HIV clinic affiliated with a Historically Black Medical College in Nashville, Tennessee. Studies have shown PRO collection can improve patient outcomes and provide oft-overlooked data on mental health, substance use, and patient adherence to ART. Methods We enrolled 100 PWH in care at the MCWC consecutively to complete validated PRO tools (Table 1) using the Research Electronic Data Capture (REDCap) platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the Cognitive Behavioral Model in which thoughts, feelings, and behaviors are inter-related. IDIs were audio recorded, transcribed, de-identified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach. Results Among 100 PWH enrolled, median age was 50 years, 89% were Black, 60% were male, and 82% were living below 100% of the Federal Poverty Level. IDI participants felt the tablet was easy to use and the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful and most would complete these surveys without compensation at future visits if offered. Conclusion The use of an electronic tablet to complete PRO data collection was feasible and well received by this cohort of vulnerable persons in HIV care in the US South. Despite some discomfort, our cohort overwhelmingly believed this was a valuable part of their medical experience. Real-time PRO data collection allows providers to screen for and act on social and behavioral determinants of health. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner. Disclosures Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel)


Pilot Study on Offering HIV Pre-Exposure Prophylaxis (PrEP) to People Who Inject Drugs (PWID) in the Inpatient Setting
Background. Due to the ongoing opioid epidemic, PWID represent an increasingly high-risk population for HIV infections in the United States, accounting for 10% of all new HIV diagnoses in 2018 and 12.5% of all deaths among people living with HIV. PrEP is an effective means of preventing HIV, though uptake has been low among PWID, possibly due to low access to care. Inpatient admissions may represent missed opportunities for provision of PrEP to PWID.
Methods. Inpatient prescriptions for tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) from 10/2019 to 8/2020 were analyzed to assess baseline provision of PrEP to PWID. Physicians on the Infectious Diseases ward service were anonymously queried on perceived barriers and their practices regarding provision of PrEP to PWID. PWID admitted from 9/2020 to 5/2021 were approached at bedside, provided counseling on PrEP and offered initiation prior to discharge. We analyzed patient perceptions and acceptance of PrEP.
Results. 16 total prescriptions for TDF-FTC were provided at discharge from 10/2019 to 8/2020, with 0 being for PrEP in PWID. The 8 physicians surveyed estimated caring for an average 4 PWID per week of service. 5/8 physicians reported that at least one PWID was offered PrEP during their most recent week of service. The most commonly reported physician barrier to prescribing PrEP was uncertainty regarding adherence and follow up (5/8). 30 patients were approached, with 14 reporting prior knowledge of PrEP. 18 were willing to engage in further education. Only 4 were accepting of PrEP, with 2 provided prescriptions. Of those declining, 13 denied equipment sharing, 4 denied active drug use, 7 stated a commitment to future abstinence, 3 were unwilling to adhere to a daily medication, 2 declined due to concerns of adverse effects and 1 due to concerns regarding stigma. Conclusion. In this pilot study, few admitted PWID were accepting of PrEP. Attempts to initiate PrEP in PWID in the inpatient setting may not be effective at our institution. The most common reason for declining was low self-perceived risk of HIV acquisition; however, a significant proportion of patients showed interest in further education. Therefore, the inpatient setting may be a valuable site of initial counseling and referral for future potential provision of PrEP in the outpatient setting.
Disclosures. platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the Cognitive Behavioral Model in which thoughts, feelings, and behaviors are inter-related. IDIs were audio recorded, transcribed, de-identified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach.
Results. Among 100 PWH enrolled, median age was 50 years, 89% were Black, 60% were male, and 82% were living below 100% of the Federal Poverty Level. IDI participants felt the tablet was easy to use and the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful and most would complete these surveys without compensation at future visits if offered.

Conclusion.
The use of an electronic tablet to complete PRO data collection was feasible and well received by this cohort of vulnerable persons in HIV care in the US South. Despite some discomfort, our cohort overwhelmingly believed this was a valuable part of their medical experience. Real-time PRO data collection allows providers to screen for and act on social and behavioral determinants of health. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner.
Disclosures. Peter F. Rebeiro, PhD, MHS, Gilead (Other Financial or Material Support, Single Honorarium for an Expert Panel) Background. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical strategy to decrease Human Immunodeficiency Virus (HIV) acquisition. Effectiveness of oral PrEP is linked to medication adherence. In 2018, Grady Health System (GHS) launched a PrEP program to increase PrEP access among un-and underinsured individuals living in metro Atlanta, Georgia. The purpose of this study is to determine PrEP medication adherence, PrEP discontinuation rates, and associated individual factors of patients enrolled during the first 18 months of the program's implementation.

PrEP Adherence and Discontinuation at a Pharmacy-Supported PrEP
Methods. A single-center, retrospective chart review was conducted on patients enrolled in the GHS PrEP program between June 1, 2018 and February 29, 2020 who received more than one monthly PrEP prescription. Adherence was estimated using the medication possession ratio (MPR). The primary outcome was mean adherence to PrEP. Secondary outcomes include rate of high percent adherence (MPR > 80%), median time of engagement in care, PrEP discontinuation rates, rates of PrEP re-engagement, and individual factors associated with PrEP discontinuation and low adherence.
Results. This study included 154 patients, 70.8% of them were Black, 62.3% were cisgender men, 59.1% were uninsured, and the mean age was 34. The majority of patients identified as men who have sex with men (51.9%). Mean PrEP adherence was 89.2%; 77.3% of patients demonstrated a high rate of adherence. No individual or social factors were associated with low adherence, but younger age was associated with higher rates of PrEP discontinuation (p< 0.0061). At the end of the follow up period on October 30, 2020, 53.8% of patients were active in the program and 12.7% of those who discontinued had re-engaged with the program. The average length of program engagement was 9.8 months.