Prevalence of Prenatal HIV Screening in Massachusetts: Examining Patterns in Prenatal HIV Screening Using the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2016

Prenatal HIV screening is critical to eliminate mother-to-child (MTC) HIV transmission. Although Massachusetts (MA) has near-zero MTC transmission rates, recent trends in statewide prenatal HIV testing are unknown. This study examined variations in prenatal HIV screening across race/ethnicity, socioeconomic status, and prenatal care settings in MA, in the period following national and state-level changes in guidance encouraging routine prenatal HIV testing. According to the MA Pregnancy Risk Assessment Monitoring System (PRAMS) data, 68.3% of pregnant women in MA were screened for HIV between 2007 and 2016. There were significant differences in prenatal screening rates across race/ethnicity, with 83.38% of Black non-Hispanic (NH), 85.5% of Hispanic women, and 62.4% of White NH women reporting being tested for HIV at some point during their pregnancy ( P <.0001). Multivariate regression found that differences in screening were explained by race/ethnicity, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) status, prenatal care site, type of insurance, nativity, and marital status. Annual rates of prenatal HIV screening did not change significantly in MA from 2007 to 2016 ( P = .27). The results of the analysis revealed that prenatal HIV screening rates differ based on race/ethnicity, with higher rates in Black NH and Hispanic women when compared to White NH women. The racial disparities in prenatal HIV screening and lack of universal screening in MA raises questions about the effectiveness of the state's approach.

Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis

Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.

Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review

HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people’s acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13–17, 18–24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.

Description of The Chemiluminescence Immunoassay (ChLIA) Method of HIV Screening Test on The Donor's Blood

Human Immunodeficiency Virus (HIV) is one of the transmitted infection through blood transfusion. Chemiluminescence immunoassay for HIV testing is performed to ensure the safety and quality of blood product that released. Purpose of the study to identify the result of Chemiluminescence Immunoassay methode for HIV testing to blood donor’s characteristic based on gender, age, blood group, HIV titer, and donation location. The design of this research is descriptive retrospective. There is 11 (0,8%) reactive blood bag and 1.289 (99,2%) blood bag non reactive to HIV, reactive blood bag based of gender is 8 (72,7%) blood bag from male donors and 3 (27,3%) blood bag from female donors. Based on donors age, mostly reactive result are from 41-70 years old is 4 (36,4%) donors, and the fewest is from (under) 19 years old is 1 (9,1%) donors. The majority based on blood group is B Rh+ is 4 (36,4%) donors. The majority based on HIV titer is low titer, 1,0-2,0 is 7 (63,6%) donors. Based on donation location, mostly from mobile unit (MU) is 8 (72,7%) donors over 11 donors with HIV reactive. Conclusion of this study is donors gender, donors age, and donation location had a significant influence on reactive result of HIV testing.

845. Impact of the COVID-19 Pandemic on Routine HIV Screening in an Emergency Department

Background The Emergency Department (ED) at Memorial Hermann Hospital (MHH) - Texas Medical Center (TMC), Houston, Texas has a long established screening program targeted at detection of HIV infections. The impact of the COVID-19 pandemic on this screening program is unknown. Methods The Routine HIV screening program includes opt-out testing of all adults 18 years and older with Glasgow score &gt; 9. HIV 4th generation Ag/Ab screening, with reflex to Gennius confirmatory tests are used. Pre-pandemic (March 2019 to February 2020) to Pandemic period (March 2020 to February 2021) intervals were compared. Results 72,929 patients visited MHH_ED during the pre-pandemic period and 57,128 in the pandemic period, a 22% decline. The number of patients tested for HIV pre-pandemic was 9433 and 6718 pandemic, a 29% decline. When the pandemic year was parsed into first and last 6 months interval and compared to similar intervals in the year pre pandemic, 39% followed by 16% declines in HIV testing were found. In total, 354 patients were HIV positives, 209, (59%) in the pre-pandemic and 145 (41%) in the pandemic period.The reduction in new HIV infections found was directly proportional to the decline in patients visiting the MHH-ED where the percent of patients HIV positive was constant across intervals (2.21% vs 2.26%). Demographic and outcome characteristics were constant across the compared intervals. Conclusion The COVID -19 pandemic reduced detection of new HIV infections by screening in direct proportion to the reduction in MHH-ED patient visits. The impact of COVID-19 pandemic decreased with duration of the pandemic. Disclosures All Authors: No reported disclosures

901. Integrated Community Health Screening for COVID-19 and HIV Promotes HIV Diagnoses and Linkage to Care

Background New Jersey experienced a 64% decrease in HIV screening during the COVID-19 pandemic, hampering the Federal “End the Epidemic Initiative”. From March 2020- May 2021, North Jersey Community Research Initiative, a community-based organization in Newark, NJ, noted a HIV seropositivity of 3.1% despite a decrease of 25% in testing. Qualitative interviews conducted virtually with community individuals and focus groups during that time period indicated that COVID-19 suggested clients were taking more risks due to feelings of isolation, depression and anxiety. NJCRI in collaboration with Robert Wood Johnson Medical School in Somerset, NJ and five other community-based partners in NJ wanted to assess if offering community combination COVID-19 screening and HIV screenings during the pandemic would increase community screening for HIV. Methods CLIA Waived Screening for COVID-19 from two antigen assays, LumiraDx and BD Veritor was combined with a referenced laboratory based molecular screening from saliva Infinity Biologix under FDA emergency use authorization within CDC guidance with HIV Alere/Determine and INSTI in those individuals that identified as asymptomatic for COVID-19 but with high risk for HIV Results NJCRI began the COVID-19 and HIV rapid screening to clients on January 4, 2021.Clients tested for COVID-19 (N=274), 3% tested positive for HIV and &lt; 3% are self-reported HIV+ (94% of the sample tested negative for HIV). Overall, 92% of clients tested negative for COVID-19. Clients testing positive for COVID-19 (N=19), there was a 6% positivity rate utilizing COVID-19 Antigen by nasal swab. Those positive via COVID-19 Molecular (N=19) method, results indicate clients also tested positive 6% of the time using a saliva indicator. Approximately, 5% of the study sample are confirmed COVID-19 positives via both testing methods (separately 1% Antigen and &lt; 2% Molecular). 19% of the sample (N=3) tested positive for both HIV and COVID-19. Figure 2. Demographics Figure 3. Social and Economic Risk Factors Conclusion Newly diagnosed patients were treated the same day with antiretroviral therapy; linked to medical care, behavioral health and risk reduction services. Combining COVID-19 and HIV screening in a trusted community-based setting improved delivery of HIV care and linkage to care for newly diagnosed individuals in Newark, NJ. Figure 4. Behavioral Risk Factors Figure 3. Social and Behavioral Risk Factors Disclosures All Authors: No reported disclosures