A Social-Ecological Framework to Understand Barriers to HIV Clinic Attendance in Nakivale Refugee Settlement in Uganda: a Qualitative Study

The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.

927. Antiretroviral Laboratory Monitoring and Implications for HIV Clinical Care in the Era of COVID-19 and Beyond

Background In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing. Methods We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI). Results Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR < 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age < 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 –.43). When a GFR was < 60 ml/min or an AST or ALT was >2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia. Conclusion Individuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety. Disclosures All Authors: No reported disclosures

1326. Inter-Professional Education and Training to Build Capacity Among Healthcare Workers in Singapore

Background People Living with HIV (PLHIV) in Singapore continue to face stigma and confidentiality concerns in their interactions with Healthcare Workers (HCWs). There is a recognized gap in HIV-related knowledge and lack of training opportunities for HCWs in Singapore, particularly amongst nonphysicians and other HCWs who do not regularly care for PLHIV. The HCW HIV Education Series was conceptualized to address these issues and to improve the HIV-related knowledge, attitudes and practices of HCWs in Singapore. Methods The HCW HIV Education Series is organized by an interprofessional organizing committee. The series is made up of four half day modules which are conducted quarterly. The modules are designed and implemented to cater to as many HCWs as possible. The modules function as a series but can also be run as standalone education sessions. The modules are: HIV Basics, Working with PLHIV, Basic HIV Clinical Care and Advanced HIV Clinical Care. In its pilot year (2016–2017), 334 HCWs, predominantly nurses, pharmacists, and social workers attended the series. The HCWs attended from diverse healthcare settings, including public and private hospitals, nursing homes, faith based and community organizations. Pre- and post-module evaluations were completed by participants. Results Only 5% of Module 1 attendees had previously received training in HIV. Across all four modules, there was a marked improvement in knowledge and confidence pre- and post-training. 95% of attendees across all modules felt that they had gained new skills that would add value to their work. While 97% of attendees of Module 1 planned to attend future modules, the attrition rate between modules was high. Conclusion The HCW HIV Education Series is highly evaluated and well attended. Efforts to maintain and strengthen attendance across all modules is needed, the delivery of the modules over a 2-day period may be an effective way to achieve this. Research into the experiences of PLHIV in healthcare facilities should also be considered. Disclosures All authors: No reported disclosures.