Background Central nervous system tuberculosis (CNS-TB) accounts for 5-10% of extrapulmonary TB cases. It takes 3 clinical forms: meningitis, tuberculoma, and arachnoiditis. Modern case descriptions of the presentation of CNS-TB are rare. The goal of this study is to examine the presentation, diagnostic studies, and associated comorbidities of CNS-TB. Methods In our academic healthcare system, cases of culture confirmed CNS-TB were identified in a database maintained by the infection control group. This is a retrospective case series of the 11 adults with confirmed CNS-TB. Results 273 patients were identified with TB infection from 2008 to 2022. 104 (38%) had extra pulmonary disease. 11 (4%) had CNS infection. Patient characteristics are described in Table 1. 5 (45%) of the patients with CNS disease also had pulmonary disease. Mean age of diagnosis was 42. 5 (45%) were male and 9 (82%) were African American. 5 (45%) had HIV; mean CD4 count was 100 (8-255). Diagnostics are shown in Table 2. CSF studies revealed a mean WBC of 295/mm3 (4-808), protein of 605 mg/dL (27-4476), and Glucose of 31 (12-64) mg/dL. 4 (36%) patients presented with British Research Medical Council (BMRC) clinical stage I disease and 7 (64%) with stage II disease. 8 (73%) patients had an abnormal CT or MRI scan of the head, with representative images seen in Figure 1. 5 patients (45%) had lesions consistent with tuberculomas. 1 (9%) had arachnoiditis identified on imaging. 1 (9%) patient died. Conclusion 38% of patients diagnosed with TB at our center had extrapulmonary disease compared to 17.5% reported in the literature. The 4% rate of CNS-TB was similar to previously reported. Our series describes abnormal imaging as well as CSF studies showing leukocytosis, pleocytosis, and hypoglycorrhachia consistent with previously described findings. Though numbers were small, no significant difference was found between HIV positive and negative patients. Although mortality was rare in our series, the patient who died had advanced AIDS and multidrug resistant meningitis. Given the significant global mortality of this disease, this series highlights the need for more current studies describing the presentation and diagnostic characteristics of modern CNS-TB so clinicians can better recognize and treat the condition without delay. Disclosures All Authors: No reported disclosures.

Background During the early stages of the COVID-19 pandemic, non-emergent services were limited or suspended in multiple ways. Restrictions in primary care may have limited STI testing, such as HIV, where timely access to testing and care is critical to mitigation efforts. Conversely, Emergency Departments (ED) operated with fewer restrictions and more in-person options. Even though patient census numbers decreased in some areas from those seen pre-covid lockdown, EDs and hospitals often became overwhelmed with patients seeking care for both severe acute illness but just importantly services that might normally have been received in outpatient settings. Methods Observational study of HIV screening year-over-year in four EDs that are part of a large healthcare system located in the Southeast. Screenings of individuals 18 and over seen in the EDs were normalized per 1000 patients. Rates were also compared to two primary care clinics, located in the same metropolitan area, serving mainly Medicaid and uninsured patients. Results From March 2019 through February 2020 there were 33.47 tests per 1000 patients at two community clinics and 7.79 tests per 1000 patient at four EDs located in the same region during that span. From March 2020 to February 2021, screening numbers in the primary care clinics dropped to an average of 22.7/1000; however, screenings in the ED remained stable and slightly increased to 10.7/1000. From March 2021 to February 2022, screenings in the primary care clinics returned to an average 36.9/1000 with screenings in the ED still above pre-covid levels at 9.48/1000. These trends in the ED screening remained consistent across gender, race, and ethnicity. Patient census at four ED sites located in the southwestern region of North Carolina dropped significantly during the first year of physical distancing covid-19 mitigation measures when compared to the two years prior. These census numbers increased during the second year of covid-19 but failed to return to previous levels. During the first year of physical distancing covid-19 mitigation measures HIV testing rates in the emergency department remained constant, and even increased in more urban areas, despite the significant decrease in overall patient census. Conclusion With the observation that HIV screening decreased in primary care settings during the beginning of the covid-19 pandemic, there exists the possibility that new HIV infections may yet remain undiagnosed. That HIV testing remained constant in the ED, however, reinforces the importance of having embedded procedures in place for screening and linking both newly positive and at-risk patients into care to help mitigate the HIV epidemic. Disclosures All Authors: No reported disclosures.

Background Evidence suggests linkage to care (LTC) should occur immediately after HIV diagnosis improves retention in care and viral suppression. Established protocol for newly diagnosed or out of care people living with HIV (PLwH) with hospital admission in our healthcare system is for an in person LTC encounter for outpatient care including clinic follow up. We compared whether an in-person versus phone encounter intervention, were equally effective LTC methods. Methods PLwH admitted to any of three hospitals in our vertically integrated healthcare system were identified through the electronic health record (EHR) daily by the LTC coordinator for further screening. Inclusion criteria included: inpatient status with ICD9/10 code in EHR for HIV, no self-reported combination anti-retroviral therapy (cART) in the 30 days prior to admission, and not engaged in HIV care in greater than 12 months. Patients were randomized to either an in-person visit or a phone-call LTC encounter. Primary outcomes included follow up with an HIV provider within 30 days of discharge, and cART prescription 90 days of being discharged. Viral load suppression, CD4 count and readmission rates were secondary outcomes. Results were analyzed using an intent to treat model. All tests were two-sided at the significance level of 0.05 Results 2750 patients were screened for eligibility, 260 randomized during an 18-month period to an in-person visit (n=131) or telephone visit (n=129). The median age was 45 years, 67% were male, and 78% Black/African American. 15% of patients were newly diagnosed during admission. (Table 1) No differences were observed between the two LTC groups in follow up within 30 days (41% total), cART prescription within 90 days (76%), viral load suppression at 6 months (45%), CD4 count (57%), and readmission within 30 days of discharge (34%). (Table 2). Conclusion Telephone and in-person encounters for LTC had similar outcomes regarding HIV follow up, ART prescribing, viral suppression, and hospital readmission at our institution. Improvements in the linkage process do need to be made in all outcome categories to further improve care with and ultimately viral suppression. Telephone visits provide opportunity to make LTC more efficient and with less human resource needs. Disclosures Christopher Polk, MD, Gilead: Advisor/Consultant.

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