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We conducted a systematic review of safer conception strategies (SCS) for HIV-affected couples in sub-Saharan Africa to inform evidence-based safer conception interventions. Following PRISMA guidelines, we searched fifteen electronic databases using the following inclusion criteria: SCS research in HIV-affected couples; published after 2007; in sub-Saharan Africa; primary research; peer-reviewed; and addressed a primary topic of interest (SCS availability, feasibility, and acceptability, and/or education and promotion). Researchers independently reviewed each study for eligibility using a standardized tool. We categorize studies by their topic area. We identified 41 studies (26 qualitative and 15 quantitative) that met inclusion criteria. Reviewed SCSs included: antiretroviral therapy (ART), pre-exposure prophylaxis, timed unprotected intercourse, manual/self-insemination, sperm washing, and voluntary male medical circumcision (VMMC). SCS were largely unavailable outside of research settings, except for general availability (i.e., not specifically for safer conception) of ART and VMMC. SCS acceptability was impacted by low client and provider knowledge about safer conception services, stigma around HIV-affected couples wanting children, and difficulty with HIV disclosure in HIV-affected couples. Couples expressed desire to learn more about SCS; however, provider training, patient education, SCS promotions, and integration of reproductive health and HIV services remain limited. Studies of provider training and couple-based education showed improvements in communication around fertility intentions and SCS knowledge. SCS are not yet widely available to HIV-affected African couples. Successful implementation of SCS requires that providers receive training on effective SCS and provide couple-based safer conception counseling to improve disclosure and communication around fertility intentions and reproductive health.

Objective: To investigate the role of insurance carriers and changes in insurance on rates of cancelation and rescheduling of tympanostomy tube surgery. Methods: Retrospective cohort study between January 1, 2013 and December 31, 2018 at a single tertiary care academic pediatric otolaryngology practice of pediatric patients (≤18 years) who underwent tympanostomy tube placement for any indication. Patients had to have insurance providers recorded both at clinic visit and at the time of surgery. Rates of cancelation and postponement of tympanostomy tube placement were assessed. Logistic regression was performed to determine factors associated with cancelation or postponement of surgery. Results: Of the 5080 patients, 2961 patients had Medicaid and 2012 patients had private insurance at the time of surgery. A total of 197 (3.96%) patients switched insurance between clinic appointment and date of surgery. Time to surgery was nearly 2 weeks more for those who had a change in insurance vs. those who did not (33 vs. 20 days, P < .001). Those who switched insurance were nearly twice as likely to have to reschedule surgery than those who did not (OR 1.95, CI 1.42-2.67). Patients who had Medicaid as the primary payer also had increased odds of needing to reschedule and postpone surgery (OR 1.39, 95% CI 1.17-1.63). Conclusion: Difference in insurance carrier and loss/change of insurance appear to be associated with delays in tympanostomy tube placement. Standardization of re-enrollment schedules across insurance providers or a single payer model may be useful in addressing these delays in care.

Background. The use of molecular testing in oncology is rapidly expanding. The aim of this study is to determine how oncologists describe molecular testing and whether patients understand the terminology being used. Materials and Methods. Sixty conversations between oncologists and patients about molecular testing were observed and technical terms used were noted by the researcher. Patients were interviewed post-conversation to assess their understanding of the noted technical terms. A patient understanding score was calculated for each participant. Comparisons of the terms were conducted using chisquare tests, Fisher's exact tests, or ANOVA where appropriate.Results. Sixty-one unique technical terms were used by oncologists, to describe 7 topics. 'Mutation' was a challenging term for patients to understand with 48.8% (21/43 mentions) of participants correctly defining the term. 'Genetic testing' was understood a little over half the time (53.3%; 8/15). 'Gene' was well understood (66.7%; 26/39) as was 'DNA' (80%; 12/15). There was no correlation between the terms being defined by the oncologist in the conversation, and the likelihood of the patient providing a correct definition. White participants were significantly more likely to understand both 'mutation' and 'genetic testing' than nonwhite participants. 42%(n=25) of participants had an understanding score below 50%, and a higher family income was significantly correlated with a higher score. Conclusion.Our results show that oncologists use variable terminology to describe molecular testing, which is often not understood. Since oncologists' defining the terms did not correlate with understanding, it is imperative to develop new, improved methods to explain molecular testing. The Oncologist 2021;9999:• • Implications for Practice: The use of molecular testing is expanding in oncology, yet little is known about how effectively clinicians are communicating information about molecular testing and whether patients understand the terminology used. Our results indicate that patients do not understand some of the terminology used by their clinicians, and that clinicians tend to use highly variable terminology to describe molecular testing. These results highlight the need to develop and implement effective methods to explain molecular testing terminology to patients to ensure that patients have the tools to make autonomous and informed decisions about their treatment.

Background: There is a critical need for comprehensive and effective healthcare- associated infection and antibiotic resistance (HAI/AR) programs in the United States. Since 2009, the CDC has funded and engaged public health, healthcare, academic, community, corporate, federal, and other stakeholders to develop effective HAI programs that rely upon such these stakeholders for success. State and local public health programs play a central role in these programs because they bridge healthcare and the community. They may regulate and assess facilities, collect and validate data on infections, and implement prevention programs. Myriad other state, federal, and privately supported stakeholders play essential roles. CDC is developing a framework for highly effective state HAI/AR programs that describes core program elements and can be used as a strategic tool, both in day to day processes and in a public health crisis, such the COVID-19 response. Program elements may include engaged leaders and champions, reliable data for action, effective policies, evaluation, program innovation, communications, and partner networks. This presentation describes a success framework for developing and leveraging HAI/AR partner networks to achieve and sustain their capacities and impact.Methods: CDC collected qualitative data in select states and combined with expert opinion to draft core elements for success among a network of partners working to achieve HAI/AR and COVID-19 response and prevention in states. The core elements serve as a foundation for the framework. Ongoing analyses will inform refinement of the core elements and framework. The CDC is gathering stakeholders’ input on the framework for applicability and usability in states, with the goal of national implementation. Results: Currently, data indicate the following core elements for partner networks: leadership, strategy and structure; policies; innovation and adaptability; implementation; expertise and resources; communications; and monitoring and evaluation. The framework includes a process for partner network development and sustenance, maturity levels, and supporting tools. States have reported support for core elements and agreed that a success framework is beneficial to achieving core elements. Multiple states have reported support for a process that includes building partner networks and clearly defining roles, as a critical step toward full implementation of Program core elements. Conclusions: A framework for building high-level strategy and competency in partner networks has never been developed for HAI/AR programs. Effective partner networks represent an essential core element of a comprehensive state HAI/AR program. This framework could be applied to a variety of programs and public health contexts, increasing the effectiveness of partner networks.Funding: NoneDisclosures: None