{'fraction_non_alphanumeric': 0.035140735624244517, 'fraction_numerical': 0.02037644620963564, 'mean_word_length': 5.157894736842105, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
1902. A Survey of Pediatric Bone Marrow Transplant Centers Regarding Local Cytomegalovirus Prophylaxis Management Practices and Interest in a Future Randomized Trial

Abstract Background Cytomegalovirus (CMV) is a major source of morbidity and mortality after hematopoietic cell transplantation (HCT). A recent adult trial comparing letermovir to placebo, found this agent to be efficacious in preventing CMV reactivation with limited toxicity. Additional investigation of letermovir in pediatric HCT recipients is needed. To inform the feasibility of a pediatric trial, we surveyed bone marrow transplant (BMT) centers registered with the Children’s Oncology Group (COG) regarding their CMV management practices and interest in a pediatric trial for CMV prevention. Methods A brief 6-item questionnaire was created using REDCap™ and distributed by email to all COG-approved BMT Centers. The initial email request was sent on March 26, 2018 to the BMT physician representative listed in the COG member roster. A follow-up request was sent on April 2, 2018. The questionnaire requested information about CMV prophylaxis strategies, including antiviral agent(s) employed, and interest in a pediatric trial of CMV prophylaxis. Results The questionnaire was emailed to 89 BMT centers and was completed at 57 (64%). Of these, 23 (40%) reported giving prophylaxis to all or a subset of allogeneic/haploidentical HCT recipients. The most common indication for CMV prophylaxis (21/23) was a CMV recipient-positive, donor-negative allogeneic/haploidentical HCT recipient. Two centers provided prophylaxis to all cord blood recipients regardless of CMV status. Among these 23 prophylaxis centers, there were 10 different reported prophylaxis regimens. Fifty-one (89%) respondents confirmed an interest in a randomized trial to assess the efficacy of letermovir prophylaxis against CMV reactivation. The preferred comparator for such a trial was placebo/nothing (55%) followed by high dose acyclovir (24%). Conclusion A significant proportion (40%) of pediatric BMT centers in the United States administer CMV prophylaxis to at least a subset of their HCT recipients. The variation in prophylaxis regimens highlights the lack of comparative effectiveness data to guide clinical decisions. Nearly all centers, regardless of whether they currently provide prophylaxis, reported an interest in a trial assessing the utility of letermovir prophylaxis in children. Disclosures B. T. Fisher, Merck: Grant Investigator, Grant recipient and Research grant. C. L. K. Boge, Merck: Grant Investigator, Research grant.

at the discretion of treating providers with data gathered retrospectively. The primary outcome was summative limb strength score (SLSS; sum of Medical Research Council strength in all four limbs).
Conclusion. Fluoxetine was safely administered and relatively well-tolerated. Patients with AFM treated with fluoxetine were more likely to have EV-D68-associated disease and had more severe paralysis at nadir and poorer long-term outcomes. These data do not suggest a positive efficacy signal for fluoxetine as a potential antiviral therapy for AFM.

Disclosures. All authors:
No reported disclosures. Background. Cytomegalovirus (CMV) is a major source of morbidity and mortality after hematopoietic cell transplantation (HCT). A recent adult trial comparing letermovir to placebo, found this agent to be efficacious in preventing CMV reactivation with limited toxicity. Additional investigation of letermovir in pediatric HCT recipients is needed. To inform the feasibility of a pediatric trial, we surveyed bone marrow transplant (BMT) centers registered with the Children's Oncology Group (COG) regarding their CMV management practices and interest in a pediatric trial for CMV prevention.

A Survey of Pediatric Bone Marrow Transplant Centers Regarding Local Cytomegalovirus Prophylaxis Management Practices and Interest in a Future
Methods. A brief 6-item questionnaire was created using REDCap™ and distributed by email to all COG-approved BMT Centers. The initial email request was sent on March 26, 2018 to the BMT physician representative listed in the COG member roster. A follow-up request was sent on April 2, 2018. The questionnaire requested information about CMV prophylaxis strategies, including antiviral agent(s) employed, and interest in a pediatric trial of CMV prophylaxis.
Results. The questionnaire was emailed to 89 BMT centers and was completed at 57 (64%). Of these, 23 (40%) reported giving prophylaxis to all or a subset of allogeneic/haploidentical HCT recipients. The most common indication for CMV prophylaxis (21/23) was a CMV recipient-positive, donor-negative allogeneic/haploidentical HCT recipient. Two centers provided prophylaxis to all cord blood recipients regardless of CMV status. Among these 23 prophylaxis centers, there were 10 different reported prophylaxis regimens. Fifty-one (89%) respondents confirmed an interest in a randomized trial to assess the efficacy of letermovir prophylaxis against CMV reactivation. The preferred comparator for such a trial was placebo/nothing (55%) followed by high dose acyclovir (24%).
Conclusion. A significant proportion (40%) of pediatric BMT centers in the United States administer CMV prophylaxis to at least a subset of their HCT recipients. The variation in prophylaxis regimens highlights the lack of comparative effectiveness data to guide clinical decisions. Nearly all centers, regardless of whether they currently provide prophylaxis, reported an interest in a trial assessing the utility of letermovir prophylaxis in children.
Disclosures  HIV care is expensive. The modelled lifetime cost of treating one HIV-positive patient in the UK is estimated at £360,800, with ARVs accounting for 68% of the cost. This audit aims to assess potential savings in ARV spend if a cost-based prescribing approach was adopted for suitable treatment-naïve patients of the clinic.

Cost Minimization Analysis of a Preferred ARV Prescribing Pathway for Treatment-Naïve HIV-Positive Patients
Methods. A retrospective analysis of newly attending HIV-positive patients attending the HIV Clinic in 2016 was undertaken. Treatment-naïve patients were identified. 2016 ARV drug acquisition costs were obtained from the St. James' Hospital Finance department. The cost of first-line ARV regimens were calculated. Patients were evaluated for their suitability for the lowest-cost, first-line ARV regimen by analysing baseline viral loads, CD4 counts, resistance patterns, renal function, bone health and HLA B5701 status. The price difference between their prescribed regimens and the most cost-effective first-line regimen was calculated.
Results. From January to December 2016, there were 266 new attendances. One hundered fifty-four of these patients (58%) were treatment naïve. The treatment regimens were ascertained for 145/154 (94%). A cost difference of approx. €390 per month existed between the most expensive and least expensive first-line ARV regimens. The monthly cost of ARV regimens prescribed came to €152,949.09, equating to an annual spend of €1,835,389.08. The predicted monthly ARV cost of the cost-based prescribing approach has been calculated at €139,186.27 with an annual cost of €1,670,235.24. This would lead to an annual saving of €165.153.84, equating to 9% of the 2016 ARV spend for this population.
Conclusion. This audit outlines the potential cost-effectiveness of a cost-based prescribing approach for suitable treatment-naïve patients that also adheres to best clinical practice guidelines. It demonstrates that significant cost savings (9%) can be made by simple analysis of ARV costs. These data can be used to support future options in ARV procurement and tender-processing for the department and nationally. It can also serve as a template in the construction of a pathway for the safe and cost-effective switching of ARV regimens of patients already on established regimens when generic ARV medications become available in Ireland.
Disclosures. All authors: No reported disclosures.

Impact of Mail Order Pharmacy Use on Viral Suppression Among HIV-Infected Patients
Justine Choe, PharmD 1 ; Cynthia Nguyen, PharmD 2 ; Natasha N Pettit, PharmD 3 and Jessica P. Background. There are many barriers to adherence to antiretroviral medications, including pharmacy accessibility. Few studies have evaluated the impact of pharmacy distance or use of mail order pharmacy services on HIV viral load suppression relative to use of an "in-person" pharmacy. The purpose of our study was to determine whether there is a difference in viral suppression rates among patients who utilize mail order pharmacy services vs. an in-person pharmacy for filling antiretroviral prescriptions. Our study also looked at the effect of distance and travel time to viral suppression for patients who use in-person pharmacy services.
Methods. This was a single-center, retrospective cohort study of adult HIV-positive patients who received care between 2006 and 2015 at an urban HIV care clinic. We collected patient demographic information, ART regimen, home address, pharmacy address, and laboratory values. For patients who utilized retail pharmacies, patients' home addresses and the location of the pharmacy were geocoded using ESRI's StreetMap Premium geocoding service. We calculated patients' travel distance to pharmacy and travel time to pharmacy along a street network in a private vehicle. Chi-squared tests and logistic regression were used to determine the association between in-person or mail order pharmacy services and distance to pharmacy and viral suppression (viral load ≤200 copies/mL).

Results.
There were 214 patients in the mail order group and 214 patients included the in-person pharmacy group. Baseline characteristics were similar between the groups, with the exception of more people who inject drugs in the mail order group (6.1% vs. 1.8%, P = 0.05). No difference in viral load suppression was observed between groups (21.7% vs. 20.2%, P = 0.679). There was no difference in viral suppression depending on the distance (1.46 miles away in viral suppressed patients vs. 1.36 miles, P = 0.75) or travel time to pharmacy (7 minutes vs. 6.6 minutes, P = 0.75) for the in-person pharmacy group. Factors found to be significantly associated with suppressed viral loads were older age, white race, and higher CD4 counts.
Conclusion. Viral suppression was not associated with pharmacy type, distance to pharmacy, or travel time to pharmacy.
Disclosures. All authors: No reported disclosures. Methods. Participants were randomly selected from 11 Ryan White-funded HIV clinics in community (n = 7), hospital (n = 3), and academic (n = 1) settings. At baseline, 200 consecutive charts (~20 per clinic) were reviewed for documentation of guideline-directed practices. Clinic teams participated in audit-feedback interventions to develop improvement plans. Three months later, consecutive charts were reviewed according to baseline methods. Chi-square tests were conducted to analyze pre-and post-intervention differences.

Real-World Insights into Quality Improvement across 11 HIV Clinics in the
Results. Significant improvements were seen in sexually transmitted infection (STI) screening, and patient counseling on sexual risk, pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). Documentation of several health maintenance measures improved significantly.
Conclusion. Audit-feedback of QI measures improved performance. This approach can inform future QI initiatives.