Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

Objectives: A standardized non-occupational post-exposure prophylaxis (nPEP) programme was implemented to improve guideline compliance for treatment of post-sexual assault patients within an emergency department (ED). Methods: A single-centre, retrospective, observational study of adult patients evaluated in the ED for sexual assault was performed following nPEP programme implementation. A comprehensive nPEP programme consisting of a standardized order set, real-time multidisciplinary consultation, on-site pharmacy and close post-discharge follow-up was implemented between July 2017 and June 2018. Laboratory, treatment, vaccination, prescription and follow-up data during the pre-(July 2016 to June 2017) and post-intervention (July 2018 to August 2019) periods were compared. Results: Of the 147 post-sexual assault patients included in this study (59 preintervention, 88 post-intervention), 133 (90.5%) were eligible for nPEP. Patient demographics and rate of those eligible for nPEP were similar in both cohorts.Antiretroviral therapy (ART) was offered (72.2% vs. 100%; p < 0.005) and ultimately prescribed (51.9% vs. 86.1%; p < 0.005) more frequently following nPEP programme implementation. Patients were more likely to have appropriate screening for renal function, liver function, pregnancy, syphilis, hepatitis B, hepatitis C and HIV in the post-intervention period (all p < 0.005). Hepatitis B vaccination was more commonly administered post-intervention (8.5% vs. 22.7%; p < 0.024). In-person 28-day follow-up was rare in both pre-(3.5%) and postintervention (11.3%) cohorts (p = 0.278).Conclusions: Implementation of a comprehensive nPEP programme resulted in improved guideline compliance with more frequent and appropriate ART administration. Recommended screening laboratories and hepatitis B vaccinations were more commonly performed, but in-person follow-up remained low. The nPEP programmes should be implemented to standardize efforts that decrease the risk of HIV transmission.

Background Antiretroviral therapy (ART) adherence decreases morbidity and mortality; however, this is often complicated by various external factors. Strategies implementing cellular technology have demonstrated improved medication adherence. The objective of this pilot study was to assess the effectiveness of utilizing weekly mobile phone calls or text messages to improve clinical outcomes among patients with HIV. Methods This study was conducted at an infectious disease clinic at an academic medical center 2019-21. Twenty-two patients were selected based on a history of poor ART adherence. For a period of 6 months, patients were contacted weekly by text message or phone call to determine medication adherence and to encourage continued adherence. Outcomes during the 12-month intervention period (6m intervention and subsequent 6m) were compared to the 12-month pre-intervention period and included viral load, CD4 count, clinic visits, emergency department (ED) visits, hospitalizations, and new-onset opportunistic infections (OI). Wilcoxon signed rank test and McNemar’s test were performed, though study is not powered for true analysis. Results Twenty-two patients were selected for inclusion and 13 (55%) maintained persistent communication throughout the intervention. For all 22 enrolled participants, this intervention resulted in increased mean yearly clinic visits (2.6 vs 3.8), decreased median viral load (32,979 vs 852 copies/mL, p=0.017), and increased median CD4 (142.5 vs 249 cells/uL). This also led to a decrease in patients with &gt; 1 ED visit (54.6% vs 36.4%), &gt; 1 inpatient hospitalization (36.4% vs 13.6%), and diagnosis of an OI (18.2% vs 13.6%). These outcomes were most remarkable in the 13 patients who maintained scheduled communication [mean yearly clinic visits (2.9 vs 5.2), median viral load (27,633 vs 118 copies/mL, p=0.0248), median CD4 cells/uL (76 vs 253), &gt; 1 ED visit (61.5% vs 30.8%), &gt; 1 inpatient hospitalization (38.5% vs 23.1%), and new OI (23.1% vs 7.7%)]. Impact of Intensifying Outpatient HIV Management Clinical outcomes for the pre-intervention year (routine communication) and the intervention year (enhanced communication) for all 22 patients initially selected for the study are compared to outcomes for the 13 patients who maintained persistent communication throughout the intervention period. Conclusion Enhanced communication through weekly mobile phone reminders may serve as a useful tool in the outpatient setting to improve ART adherence and reduce morbidity among adults with HIV. The findings of this small pilot study provide support for the need of a larger study to prove the benefit of this care model. Disclosures All Authors: No reported disclosures.