991. Psychosocial Factors and HIV Risk among Transgender Women Living in Miami

Abstract Background Transgender (TG) women are disproportionately affected by HIV infection and have poor health outcomes when compared to cisgender women. This study evaluates psychosocial factors, and HIV risk among transgender women with and without HIV infection living in Miami, the city with the highest incidence of HIV in the US. Methods Adults who identified themselves as TG living in Miami were recruited from the community and local clinics. Self-reported HIV status, sociodemographic, behavioral data (HIV risk behaviors, sexual partners, illicit substance and alcohol use), and psychosocial factors (depression, violence or abuse events, and HIV stigma) were collected with questionnaires into RedCap. Results A total of 22 participants completed assessments. Ten (45.5%) indicated being HIV uninfected (HIV-) and 12 (54.5%) had been diagnosed with HIV (HIV+). A total of 15 (68%) participants reported use of feminizing hormones and 11 (50%) had undergone feminizing surgeries. Median age was 55 (20, 69); 15 (69%) were white and 5 (23%) Black; 15 (69%) were of Hispanic ethnicity; Level of education 11 (12; 1.8) 12(55%) had completed at least high school; 2 (9%) were employed. 16 (73%) reported being sexually active in the previous month; median number of partners in the last month was 1.5 (1; 2.13); only 13 (60%) reported consistent condom use in the last sexual encounter; 14 (64%) engaged in receptive anal sex; 9 (41%) reported ever engaging in sex for money. Violence or abuse events were common, and participants had experienced an average of 3.9 lifetime events (Median = 3; SD = 3.45). Depression measured by the BSI-18 scale revealed low depression scores (Mean = 1.77; SD = 0.82). HIV infected participants were more likely to be black (p=0.05) and unemployed. We did not find significant differences by HIV status in other variables, including depression and violence or abuse. Among HIV+ participants, HIV stigma measured by the ‘Stigma Scale’ was low (Mean = 1.71; SD = 0.41). Conclusion We identified high rates of events of violence or abuse, that did not differ by HIV status. HIV infection was more common among black TG women.Further research is necessary to identify potential targets for HIV prevention and care in the vulnerable population of TG women. Study funded by the Miami CFAR (P30AI073961) Disclosures All Authors: No reported disclosure

953. Frailty Among People Living with HIV In Miami, A Cross Sectional Pilot Study

Abstract Background Frailty, a status of high vulnerability, is a clinical syndrome associated with adverse health outcomes and characterized by a constellation of various health deficits. Although age is a major contributor of being frail, HIV infection is associated with accelerated aging, and likely contributes to frailty. This association has seldom been evaluated. This study evaluated factors associated with frailty among PWH in Miami. Methods Cross-sectional study. Adults (> 18 years), HIV infected (HIV+) and uninfected (HIV-), virologically suppressed for at least 1 year (< 50 copies/ml). Sociodemographic factors and the self reported FRAIL scale was administered (Fatigue, Resistance or ability to climb a single flight of stairs, Ambulation or ability to walk one block, Illnesses or non-HIV associated comorbidities, and more than 5% weight Loss in the previous year). Groups were categorized base on the FRAIL scale scoring as Non-Frail (0), Pre-Frail (1-2), and Frail (3 or more). The association by Frail categories were analyze using descriptive statistics and ordinal logistical regression. Results N (40), median age was 43 years (SD 20.6); 35% White; 20% Hispanic; 52% females; 25 (62.5%) HIV +/ 15 (37.5%) HIV -. A small number of participants reported use of tobacco 2 (5%) and alcohol 7 (18%). More than half of the participants were frail or pre- frail (18 or 45% Non-Frail, 18 or 45% Pre-Frail, and 4 or 10% Frail, and HIV+ were more likely to be pre-frail or frail than HIV-, 72% vs 26%, p = 0.019). Frail scale symptoms were common among all participants but HIV+ reported higher fatigue than HIV- (85% vs 14%, p= 0.01). On Regression analysis, both HIV status and age were significant predictors of frailty status (HIV χ2 (1) = 4.36, p = .037 and age χ2 (1) = 13.48, p < .001). When controlling for age, being HIV - on average reduced frailty by an odds of 2.16 (b = -2.164, SE = 1.04, p = .037, 95% CI [-4.2 -0.13]). When controlling for HIV status, for every one year of increase in age, the ordered log odds of being frail increased by 0.07 (b = 0.07, SE = 0.02, p < .001, 95% CI [0.03 0.1]). Conclusion Using the FRAIL scale, a simple tool to screen for frailty, we identified high prevalence of frailty among PWH. Further studies are needed to identify the best tools to assess frailty and prevent poor health outcomes among this vulnerable population. Disclosures All Authors: No reported disclosure

Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US.

BackgroundHuman papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women's HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage.MethodsFrom April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18-45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher's exact test, studentized t-test, and multivariate logistic regression (MLR).ResultsA total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators.ConclusionFindings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake

Rapid Point-of-Care Test Kit for Bacterial Vaginosis: Detection of Vaginolysin and Clue Cells Using Paper Strips and a Smartphone

There is an unmet need for a point-of-care test that is accurate, affordable, and simple to diagnose bacterial vaginosis, the most common cause of vaginal symptoms among women. Bacterial vaginosis leaves patients with undesirable vaginal discharge, malodor, and discomfort. Currently, the diagnosis of bacterial vaginosis is inaccurate and complex, leading to high rates of misdiagnosis. Inaccurate diagnoses are unsafe as bacterial vaginosis increases the risks of acquiring sexually transmitted infections as well as the likelihood of miscarriages. To date, the most commonly identified bacteria associated with bacterial vaginosis is Gardnerella vaginalis. We developed a method for the expression, purification, and detection of vaginolysin, the most well-characterized virulence factor of G. vaginalis. Elevated levels of G. vaginalis have been shown to lead to a toxic vaginal environment, facilitating bacterial vaginosis. We have developed an enzyme-linked immunosorbent assay for the detection of vaginolysin, which was translated to a lateral flow assay for use in a rapid, straightforward, cost-effective paper-based diagnostic test for vaginolysin that does not require the use of instrumentation. In conjunction, we have employed a commercially available smartphone microscopy kit to visualize clue cells without the need for equipment or electricity. The combination of these methodologies allows for an accurate and easy approach to diagnose bacterial vaginosis with minimal resources for use in any setting

Knowledge, attitudes, and practices towards HPV vaccination among reproductive age women in a HIV hotspot in the US

Background Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, responsible for cervical cancer and increased risk of Human Immunodeficiency Virus (HIV) acquisition. Despite an effective HPV vaccine, women’s HPV vaccination coverage and rates remain far below desired levels. This study aimed to evaluate HPV knowledge, attitudes, and vaccination practices as well as factors associated with HPV vaccination among women of reproductive age living in Miami, Florida, a Southern US city with a high incidence of STIs and low HPV vaccination coverage. Methods From April to June 2022, 100 HIV-negative, cisgender, sexually active women aged 18–45 years were recruited from the Miami community. Participants completed validated questionnaires using REDCap© electronic surveys, assessing socio-demographics and sexual behaviors; HPV knowledge, screening, vaccination practices; barriers and motivators to HPV vaccination. A cumulative HPV knowledge score (HPV score) was generated. Factors associated with HPV vaccination were analyzed by Chi-square, Fisher’s exact test, studentized t-test, and multivariate logistic regression (MLR). Results A total of 100 participants were enrolled, and 84 who knew their vaccination status were included in the analysis. Of these, 43 reported receiving at least 1 HPV vaccine dose (vaccinated group) and 41 reported never being vaccinated (unvaccinated group). Mean age was 24.7 (SD 4.03) years for the vaccinated group and 31.4 (SD 8.33) for the unvaccinated group. Mean HPV score was 18.9/29 (SD 6.05) for the vaccinated group and 9.1/29 (SD 8.82) for the unvaccinated group. Amongst vaccinated participants, 76.74% reported a history of HPV/Pap smear screening vs 87.80% in the unvaccinated group. Barriers to HPV vaccination included: 14.6% low-risk perception, 29.3% healthcare barriers, and 46.3% vaccine hesitancy and personal beliefs. Motivators t HPV vaccination included: risk perception and vaccine beliefs (71.42%), healthcare-related (60.71%) and social motivators (55.95%). In the first MLR, one-point increases in HPV score were significantly associated with higher odds of HPV vaccination until an HPV score of 16, and a one-year increase in age was associated with a 16% lower odds of HPV vaccination (aOR = 0.84, 95% CI [0.72, 0.99]; p = 0.035). Contraception use was also associated with HPV vaccination (aOR 8.36 (95% CI [1.41, 49.62]; p = 0.020). Race, ethnicity, college education status, and number of sexual partners were not significant predictors of HPV vaccination. In the second MLR evaluating vaccination motivators as predictors of HPV vaccination, we found that individuals who were motivated by healthcare had 3.03 (95% CI [1.02, 9.00]; p = 0.046) times the odds of HPV vaccination compared to individuals without healthcare-related motivators. Conclusion Findings suggest suboptimal HPV knowledge and low vaccination rates among women of reproductive age. Public health efforts should focus on increasing basic HPV knowledge among women with little-to-no HPV knowledge to increase vaccine uptake

2660. Evaluating Risk for Bacterial Vaginosis Utilizing an Unsupervised Machine Learning Approach

Abstract Background Clustering methods using machine learning may be useful for identifying variables predicting clinical outcomes. Despite the need to better understand risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition, machine learning methods have not been used to better understand BV. This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of BV. Methods Participants were 402 cisgender women recruited in Miami, Florida, aged 18-45 (median age=31); over half of them were black (56%) and non-Hispanic (43.8%). Participants completed measures of demographics characteristics, sexual and medical history, and intravaginal practices (IVP), and underwent collection of vaginal samples. BV was diagnosed using Amsel or Nugent criteria; abnormal vaginal flora was defined as Nugent score of 4 or above. sidClustering and random forests were used to identify clusters and the most important variables in classifying clusters associated with BV; 135 behavioral variables (including substance use and number of partners) were subjected to analysis. Results We identified 4 clusters explained most of the variation in behaviors, and variables were ranked by importance in distinguishing these clusters. Results showed that clusters associated with BV were composed of women who 1) engaged in IVP primarily using water and fingers (Cluster 1: n = 108 (26.9%)], 2) engaged in IVP using multiple methods [water, rags, etc.; Cluster 2: n = 127 (31.6%)]; 3) engaged in a combination of IVP and other risk behaviors [Cluster 3: n = 119 (29.6%)]; and 4) those who did not engage in IVP but engaged in other high-risk behaviors [Cluster 4; n = 48 (11.9%)]. Clusters were related to abnormal vaginal flora (p < .001). Cluster 2, the cluster with most frequent IVP, had the highest prevalence of BV (64.9%, compared with Cluster 1 (38.0%), Cluster 3 (50.4%), and Cluster 4 (39.6%). Conclusion Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, and in developing interventions intended to reduce BV and IVP, and ultimately to reduce the risk of HIV infection among women. Disclosures Maria L L. Alcaide, MD, Discidium Biosciences: Board Member|Gilead: Honoraria|Merk & Co: Honoraria|Senhwa Biosciences: Honoraria|Virology Education: Honorari

Using unsupervised machine learning to classify behavioral risk markers of bacterial vaginosis

This study used an unsupervised machine learning algorithm, sidClustering and random forests, to identify clusters of risk behaviors of Bacterial Vaginosis (BV), the most common cause of abnormal vaginal discharge linked to STI and HIV acquisition.  METHODS: Participants were 391 cisgender women in Miami, Florida, with a mean of 30.8 (SD = 7.81) years of age; 41.7% identified as Hispanic; 41.7% as Black and 44.8% as White. Participants completed measures of demographics, risk behaviors [sexual, medical, and reproductive history, substance use, and intravaginal practices (IVP)], and underwent collection of vaginal samples; 135 behavioral variables were analyzed. BV was diagnosed using Nugent criteria. We identified four clusters, and variables were ranked by importance in distinguishing clusters: Cluster 1: nulliparous women who engaged in IVPs to clean themselves and please sexual partners, and used substances frequently [n = 118 (30.2%)]; Cluster 2: primiparous women who engaged in IVPs using vaginal douches to clean themselves (n = 112 (28.6%)]; Cluster 3: primiparous women who did not use IVPs or substances [n = 87 (22.3%)]; and Cluster 4: nulliparous women who did not use IVPs but used substances [n = 74 (18.9%)]. Clusters were related to BV (p < 0.001). Cluster 2, the cluster of women who used vaginal douches as IVPs, had the highest prevalence of BV (52.7%). Machine learning methods may be particularly useful in identifying specific clusters of high-risk behaviors, in developing interventions intended to reduce BV and IVP, and ultimately in reducing the risk of HIV infection among women

PrEP awareness and use among reproductive age women in Miami, Florida.

BackgroundMiami, Florida is an epicenter of the HIV epidemic in the US, with 20% of new HIV infections occurring in women. Despite effectiveness of Pre-Exposure Prophylaxis (PrEP) in preventing HIV, only 10% of eligible women benefit from its use.SettingThis study evaluates PrEP awareness and use, and factors associated with PrEP awareness among sexually active women in Miami, Florida.MethodsResults reported in this study included cross-sectional data that were collected as part of a baseline visit from a parent study. Cis-gender, HIV-negative, 18-45-year-old, sexually active women were recruited as part of a study evaluating recurrent bacterial vaginosis and HIV risk. Participants completed questionnaires assessing socio-demographics, HIV risk factors, prior history of HIV testing and reproductive tract infections, PrEP awareness and use. Relationships between variables and PrEP awareness were analyzed and multivariable logistic regression identified variables strongly associated with PrEP awareness.ResultsAmong the 295 women enrolled, median age was 31 (24-38) years, 49% Black, 39% White, and 34% Hispanic. Of 63% who knew about PrEP, only 5% were on PrEP. Women with income below poverty line (OR = 2.00[1.04,3.87];p = 0.04), more male sexual partners in past month (OR = 1.30[1.01,1.68];p = 0.04), lifetime HIV testing (OR = 6.42[2.83,14.52];pConclusionPrEP awareness is low among reproductive age women in a high-risk setting. Culturally tailored interventions are needed to increase PrEP awareness and uptake, especially among Black and Hispanic women with inconsistent condom use during vaginal sex with male partners

2802. Occupational Exposure to the Ugandan Strain of Zika Virus in a Laboratory Worker in the United States: Clinical Presentation, Viral Persistence, and Antibody Response

Abstract Background A laboratory worker suffered an accidental needle stick resulting in infection with the Ugandan strain (MR766) of Zika virus (ZIKV), a strain that has rarely been studied in humans. We report the clinical presentation and outcomes, molecular and serological diagnostic results, and immunological response. A 34-year-old Brazilian-born female laboratory researcher, presented with malaise, skin rash, myalgia and joint pain 10 days after an accidental needle stick while inoculating a mouse with ZIKV-MR766. On physical examination she had bilateral maculopapular rash on the cheeks, and tender effusions at the metacarpal and proximal interphalangeal joints and ankles. Symptoms and signs resolved within 3 weeks. ZIKV infection was confirmed by Nucleic Acid Amplification Test (Lab Corp®) in urine. Serological testing using the ZIKV IgM ELISA test from Lab Corp®, and a confirmatory plaque reduction neutralization test (PRNT) in accordance with the Centers for Disease Control and Prevention (CDC), results were negative. Methods Whole blood, plasma, urine, saliva, and a vaginal swab were collected from day (D) 14 post exposure (PE) to D104 PE. A novel, antibody competition-based ZIKV diagnostic test (highly specific for ZIKV antibodies) was performed in serum, and detection of ZIKV-MR766 genomic RNA was performed in all body fluids longitudinally. Results Antibody response revealed broad IgM response to both ZIKV-Paraiba (strain from the 2015 outbreak) and ZIKV-MR766 during the acute phase of the infection, suggesting cross-reactivity. There was no cross-reactivity against dengue or yellow fever viruses. An IgG response was detected against both ZIKV strains and increased until D104 PE. ZIKV RNA was detected in whole blood, saliva, urine, and the vaginal swab at D14 PE. At D20 PE, virus was only detectable in whole blood at a value of less than 37 copies per mL. At D23 PE, there was no detectable virus. (figure). Conclusion This case highlights the potential for ZIKV occupational exposure. Findings may be useful for the development of diagnostic tests against ZIKV as we were able to accurately determine time of exposure, presence of virus in body fluids, development of symptoms, and antibody responses after a well-documented infection. Disclosures All authors: No reported disclosures

Adolescent girls' descriptions of dysmenorrhea and barriers to dysmenorrhea management in Moshi, Tanzania: A qualitative study.

Dysmenorrhea (menstrual pain) is common among adolescent girls globally, but many girls in Sub-Saharan Africa do not receive effective treatment. Qualitative interviews were used to describe adolescent girls' experiences of dysmenorrhea and identify sociocultural barriers to dysmenorrhea management in Moshi, Tanzania. From August to November 2018, in-depth interviews were conducted with 10 adolescent girls and 10 adult experts (e.g., teachers, medical providers) who have experience working with girls in Tanzania. Thematic content analysis identified themes related to dysmenorrhea, including descriptions of dysmenorrhea and the impact of dysmenorrhea on well-being, as well as factors influencing the use of pharmacological and behavioral pain management strategies. Potential barriers to dysmenorrhea management were identified. Dysmenorrhea negatively impacted the physical and psychological well-being of girls and hindered girls' ability to participate in school, work, and social events. The most common pain management strategies were resting, drinking hot water, engaging in physical activity, and taking paracetamol. Barriers to dysmenorrhea management included beliefs that medications are harmful to the body or can hinder fertility, limited knowledge about the benefits of hormonal contraceptives to manage menstruation, little continuing education for healthcare providers, and a lack of consistent access to effective medications, medical care, or other supplies necessary for pain management. Medication hesitancy and inconsistent access to effective medication and other menstrual supplies must be addressed to improve girls' ability to manage dysmenorrhea in Tanzania