Hospitalization represents a unique opportunity to re-engage out-of-care individuals, improve HIV outcomes and reduce health disparities. Electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013-December 2015 were reviewed. In October 2014, a multidisciplinary HIV consult team (HIV specialist, case manager, and transitional care nurse (TCN)) was implemented. Engagement in care, retention in care and virologic suppression before and after hospitalization were compared between the pre-and postintervention periods and by treatment received. Of 1056 inpatient admissions (pre-intervention=571, post-intervention=485), the majority were among males (69%) and racial/ethnic minorities (55% Black, 23% Hispanic). Each step of the HIV care cascade increased after hospitalization for both time periods (p<0.01 for each comparison). Those who received the HIV consult (N=131) or consult +TCN (N=128) had greater increases in engagement in care (23.7% and 30.5% v. 11.1%, p=0.04 and <0.01 respectively) and virologic suppression (28.3% and 29.7% v.7.1%, p <0.01 for both) than the no intervention (N=225) subgroup. Hospitalized patients with HIV have low rates of engagement in care, retention in care and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention.

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BackgroundKaposi’s sarcoma (KS) is an AIDS-related condition that is mediated by HHV-8. Although incidence and mortality of KS in the United States have decreased over time since the advent of HAART, there may be disparities in mortality based on geographic location and race/ethnicity, particularly African-American men in the South.MethodsA retrospective electronic medical record review was conducted using integrated inpatient and outpatient data in EPIC from PHHS. We included all individuals with a diagnosis of HIV and Kaposi’s sarcoma between January 1, 2009 and December 31, 2018 based on ICD-9/10 codes. We collected demographic information, HIV history, variables related to HIV and KS diagnosis, treatment and outcomes data for each patient. We calculated hazard ratios using Cox proportional hazards modeling.ResultsWe identified 252 patients with KS. 95% of patients were male, and the majority were MSM (men who have sex with men; 77% of all patients). 35% of patients were Hispanic, 34% were African-American and 31% were Caucasian. Over half (56%) of patients were funded through Ryan White or were uninsured. The median CD4 count and viral load at the time of cancer diagnosis were 44 and 73,450, respectively. 24% of patients were confirmed to have died by the end of the study time frame. However, due to loss to follow-up, 35% of the cohort had an unknown vital status at the time of the final chart review. Variables most strongly associated with mortality were >2 hospitalizations in the first 6 months of cancer diagnosis (aHR=4.93, P = 0.0003), IV drug use (aHR=3.61, P = 0.0009), and T1 stage of KS (aHR= 2.13, P = 0.0264). African American patients had lower survival than Caucasian or Hispanic patients, with a 5-year survival of 69%, 81% and 80% respectively, although this did not reach statistical significance (aHR 1.77, P = 0.1396).ConclusionWe describe a large cohort of patients with HIV and HHV-8-related disease, who are predominantly of minority race/ethnicity, uninsured, and have advanced HIV disease. Factors associated with mortality include Black/African-American ethnicity, number of hospitalizations, IV drug use and T1 stage of KS. Our mortality analysis is limited due to high lost to follow-up rates, so we suspect overall mortality in our cohort is higher than currently reported. DisclosuresAnk E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant.

Background: Chronic lower extremity wounds have become a major challenge to healthcare systems and are a significant source of morbidity and mortality. Assessment of lower extremity perfusion is strongly recommended for non-healing lower extremity wounds. However, there is wide variation in treatment practices and the frequency of vascular assessment in an outpatient setting remains unknown. Methods: Our retrospective cohort included all adult patients seen in Parkland Hospital’s outpatient foot wound clinic over a six month time period (2/2014-6/2014). Charts were reviewed to collect demographic characteristics, wound characteristics, common vascular risk factors, vascular assessment and subsequent interventions. Peripheral arterial disease was defined as an ankle-brachial index (ABI<0.9) or non-compressible (ABI>1.4). Wounds were characterized as non-healing if there was no evidence of improvement after 3 months of follow up. Statistical analysis was then performed on patients with non-healing wounds and no previous history of peripheral vascular disease. Results: Our retrospective cohort included a total of 438 patients that were followed for a median of 2.1 years. The population was 70% male with a median age of 56 and a median BMI of 30. The majority of patients were Hispanic (45%) and there was high prevalence of hypertension (82%), hyperlipidemia (59%), diabetes (87%), tobacco use (51%), peripheral vascular disease (36%) and coronary artery disease (19%). Follow up data was missing in 39 patients. Among all patients seen in the foot wound clinic, an ABI was performed in 185 (42%) patients. At 3 months, 170 patients (38%) had evidence of a non-healing wound. After excluding patients with a known history of PVD, an ABI was performed in 27% patients (27 of 99) with non-healing wounds. Those patients undergoing ABIs were older (56 vs 50, p=0.006), had lower BMI (30 vs 34, p=0.04) and higher prevalence of CKD (40% vs 15%, p=0.007). After adjusting for common risk factors both age and CKD were remained statistically significant (p=0.004 and p=0.001, respectively). Among the ABIs performed, 15% (4 of 27) were found to have PAD, 48% (13 of 27) were normal and 37% (10 of 27) had non-compressible disease. Patients with PAD were also more likely to undergo peripheral angiography with intervention compared to patients with (50% vs 7%, p=0.02) and remained statistically significant after adjusting for traditional risk factors (p=0.001) Discussion: Although the foot wound population has a high rate of vascular risk factors, a vascular assessment was performed in the minority of patients. Patients who underwent vascular assessment and were found to have evidence of ischemia were more likely to undergo subsequent revascularization.