Background There are limited data reporting real-world incidence of integrase inhibitor resistance (INSTI-R) since the approval and first-line treatment recommendation of INSTIs in the US. A recent analysis of the national surveillance data estimated INSTI-R to be 6.3%. The purpose of this study was to describe real-world incidence of INSTI-R in patients who used an INSTI-based single tablet regimen (STR) in a major metropolitan area and identify risk factors for resistance. Methods This was a retrospective study of adult patients living with human immunodeficiency virus (HIV) who were prescribed an INSTI-STR between September 2017 and September 2020 and followed for > 12 months at the University of Illinois Chicago Community Clinic Network (UCCN). The primary endpoint was the difference in INSTI-R in UCCN patients compared to the national prevalence of 6.3%. Other outcomes included development of virologic failure (VF), defined as 2 consecutive HIV-1 viral loads (VL) > 200 copies/mL after week 24, and documented INSTI-R mutations. Patient specific factors associated with medication nonadherence were also collected. All endpoints were analyzed using chi-square and Fisher’s exact tests. Results Of 948 patients screened, 248 patients were included. Baseline characteristics are summarized in Table 1. VF occurred in 17 subjects (6.8%). Two of the 17 (11.8%) received subsequent INSTI-R testing and nine eventually virally suppressed without regimen changes (52.9%). Patients without VF were assumed to have no INSTI-R. No subjects developed INSTI-R, which was significantly less than the national prevalence of 6.3% (p=0.0029). Patients with a high VL at baseline were more likely to experience VF (p=0.001). The most common factors associated with nonadherence in patients with VF are summarized in Table 2. Conclusion The true rate of INSTI-R in UCCN patients is still unknown and factors associated with developing INSTI-R were unable to be assessed. Among patients at UCCN on INSTI-based STRs, INSTI-R rates were lower than the national average. Future analyses should also include patients on INSTI-based non-STR regimens as increased pill burden is a known risk factor for nonadherence leading to VF and drug resistance. Disclosures All Authors: No reported disclosures.

Simulation, an educational, assessment, and research technique used to mimic real‐world situations, is increasingly used in pharmacy education. The most‐used simulation methods include high‐fidelity simulation (HFS), low‐fidelity simulation (LFS), standardized patients, and game‐based simulation. A common element of simulation is its ability to offer learners the chance to practice a skill or acquire knowledge in a safe and accessible space. Simulation methods differ in key aspects, including cost and other resource investment as well as ideal venue for use in education. HFS provides a more realistic simulation environment than LFS but is typically more expensive. Standardized patients offer learners the opportunity to engage with a live person but may elicit greater variability in responses to learners' input than HFS. Computer‐based simulation uses technology to supply a wide variety of learning opportunities; however, it may require the use of proprietary software and devices. Despite widespread use, literature describing learning outcomes of simulation in pharmacy education is limited. Some existing reports with positive findings have focused on learner satisfaction with or perceived benefit of simulation activities. The few existing publications summarizing changes in skills or knowledge demonstrate a positive impact. Simulation is a promising modality for educating pharmacy students and residents; however, more data summarizing the benefit of learning outcomes are needed.

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