A total of 817 human immunodeficiency virus-infected Ethiopians with CD4 <150 cells/mL underwent plasma cryptococcal antigen (CRAG) screening. CRAG prevalence was 6.2%. Of participants with plasma CRAG titers >1:640, 96% (27 of 28) had cryptococcal meningitis (cerebrospinal fluid CRAG-positive) whereas 50% (7 of 14) with 1:160-1:320 titers had meningitis. With fluconazole 1200 mg/d therapy, 68% of meningitis patients (23 of 34) died within 3 months. Plasma CRAG titers >1:160 predict meningitis, requiring more intensive antifungal therapy.

Hepatitis B virus (HBV) vaccination patterns and the understanding of its risks among healthcare workers (HCWs) is a critical step to decrease transmission. However, the depth of this understanding is understudied. We distributed surveys to HCWs in 12 countries in Africa. Surveys had nine multiple-choice questions that assessed HCWs' awareness and understanding of HBV. Participants included consultants, medical trainees, nurses, students, laboratory personnel, and other hospital workers. Surveys were completed anonymously. Fisher's exact test was used for analysis, with a P-value of < 0.05 considered significant; 1,044 surveys were collected from Kenya,

BackgroundAntimicrobial stewardship programs are nonexistent in most resource limited settings like Ethiopia. This has resulted in inappropriate use of antibiotics and widespread development of antibiotic resistance. Targeted initiatives surrounding antimicrobial use are needed to tackle this global health threat. Therefore, a program was established to generate data on antibiotic consumption, resistance, and facilitate appropriate use of antibiotics at an academic hospital in northwestern Ethiopia.MethodsA committee was developed with a multidisciplinary team of clinicians, microbiologist, pharmacists and nurses. A baseline assessment of antibiotic use in the hospital was conducted through review of patient prescriptions and antibiotic inventory changes over time. To understand patterns, listed indication for use was recorded. Clinical audits, provider feedback mechanisms, and a quarterly antibiogram were also developed.ResultsAmong 384 records of patients with infectious diseases, 250 adult and 134 pediatric cases were identified. Community acquired pneumonia (CAP) was the most common reason for use of antibiotics, accounting for 33.6% of adults and 22.2% of pediatric cases. Cephalosporins and penicillins were used in adults with CAP in 48.8% and 51.2% of cases, respectively, with or without macrolides or tetracycline. For severe CAP (30 cases), WHO or IDSA guideline concordance was identified as follows: appropriate antibiotic selection in 23 (76.6%), appropriate treatment duration in 15 (50.0%), and timely switch to oral therapy in 20 (66.7%) of the cases. The quarterly antibiogram included 516 bacterial isolates over one year. The most common organisms were Staphylococcus aureus and Escherichia coli, accounting for 34.7% and 16.8% isolates, respectively. The challenges faced in establishing the program were lack of electronic medical records for tracking antibiotic use and inconsistent supply of microbiologic reagents for microbial surveillance.ConclusionAn effective antimicrobial stewardship program can be established in a resource limited setting with a committed team. Data generated by the program will be used to guide appropriate use of antibiotics and design interventions.Disclosures All authors: No reported disclosures.

Background: Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis has been shown to improve valvular function among patients with clinically silent or mild disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, prospective studies are needed to evaluate their performance in these settings. Methods: We conducted a cross-sectional pilot study among 19 at-risk school-children participating in a rheumatic heart disease screening program in Ethiopia comparing a handheld ultrasound device (Phillips Lumify) to a fully-equipped portable ultrasound machine (Sonosite M-Turbo). Results: Agreement between devices was similar for expert and non-expert review (84%). However, when reviewed by a non-expert the Lumify identified fewer screen-positive cases (p-value 0.083). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p-value 0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions: Our study highlights that screening echocardiograms for RHD may yield different results when a handheld ultrasound device is used.