A student-led interprofessional virtual outreach program for people with HIV during the Covid-19 pandemic: a pilot program at an academic medical center in Boston

BACKGROUND

The Coronavirus disease 2019 (Covid-19) pandemic caused an abrupt disruption in clinical care and medical education, putting patients at increased risk for social stressors and displacing medical students from traditional clerkships. The pandemic also exposed the need for virtual tools to supplement clinical care and an opportunity to create meaningful roles for learners.

METHODS

An interdisciplinary group designed a student-led virtual outreach program for patients with HIV whose care was limited by the pandemic. Patients were identified by clinicians and social workers using a clinic-based registry. Students called patients to conduct needs assessments, provide Covid-19 education, and to facilitate connection to services. Students participated in case-based didactics and workshops on motivational interviewing and patient engagement using virtual tools. Facilitated team meetings were held weekly during which themes of calls were identified.

RESULTS

During a three-month period, five students participated in the outreach program. Two hundred sixteen patients were identified for outreach calls, of which 174 (75.9%) were successfully reached by telephone. Rate of completed phone call did not differ by age or gender. Sixty patients had a preferred language other than English of which 95.6% were reached in their preferred language.

CONCLUSIONS

Virtual proactive outreach can be used as a tool to support patients and engage students in clinical care when access to in-person care is limited. This model of care could be adapted to other ambulatory practices and integrated into pre-clerkship curriculum as an introduction to the social history and structural drivers of health (SDOH) (245/350).

596. Case Study of Motivational Interviewing Intervention in Patients Non-Adherent to Antiretroviral Therapy

Background

Motivational interviewing (MI) may have a positive impact on antiretroviral therapy (ART) adherence. However, few studies focus on non-adherent patients at high risk of viral transmission, as identified by unsuppressed viral load.

Methods

Patients on ART with detectable viral load (VL) were identified from a major academic HIV clinic and referred to the study by physicians. Inclusion criteria were patients with over two clinic visits in the year prior, with most recent VL over 200 copies/mL. An MI trained social worker recruited participants, obtained written consent and provided a small financial incentive, and conducted MI sessions. After initial session, patients chose whether to continue further follow-up sessions. Patient VLs were compared between those measured before and after the intervention. Statistical analysis was limited by small sample size.

Results

Of 700 active patients in May 2014, 62 patients met enrollment criteria by chart review. Of those, 29 were referred by physicians for enrollment. Nine declined participation and four were lost to follow-up before the first session. Three participants were excluded in this analysis due to missing VL measurements. Average sessions per participant were 3 (range 1–8). Average VLs measured after intervention were 8 (range 1–19), spanning an average of 25 months (range 2–36).

Of the 13 patients enrolled, 10 achieved VL suppression after the intervention. Six of these patients had a reemergence of VL >200 copies/mL, but five were able to lower their VL again below 200 copies/mL. Thus by the end of study dates, 9/13 (69%) had a viral load <200 copies/mL. Of the eight who had not had a recorded VL <200 copies/mL in the year prior to study dates, six achieved suppression at some point after the intervention. At the end of the study dates, of 13 initial participants, eight remain engaged with the social worker, two had discontinued sessions after agreeing their goals had been accomplished, and three were lost to follow-up. There was an average 52% decrease in the log 10 VL of patients after intervention as compared with before.

Conclusion

Although small and descriptive, this study shows potential impact of MI on a population of non-adherent patients at high risk of viral transmission.

Disclosures

All authors: No reported disclosures.

Non-nucleoside inhibitors of HCV polymerase NS5B. Part 4: structure-based design, synthesis, and biological evaluation of benzo[d]isothiazole-1,1-dioxides

A series of benzo[d]isothiazole-1,1-dioxides were designed and evaluated as inhibitors of HCV polymerase NS5B. Structure-based design led to the incorporation of a high affinity methyl sulfonamide group. Structure-activity relationship (SAR) studies of this series revealed analogues with submicromolar potencies in the HCV replicon assay and moderate pharmacokinetic properties. SAR studies combined with structure based drug design focused on the sulfonamide region led to a novel and potent cyclic analogue.

Non-nucleoside inhibitors of HCV polymerase NS5B. Part 2: Synthesis and structure-activity relationships of benzothiazine-substituted quinolinediones

A new series of benzothiazine-substituted quinolinediones were evaluated as inhibitors of HCV polymerase NS5B. SAR studies on this series revealed a methyl sulfonamide group as a high affinity feature. Analogues with this group showed submicromolar potencies in the HCV cell based replicon assay. Pharmacokinetic and toxicology studies were also performed on a selected compound (34) to evaluate in vivo properties of this new class of inhibitors of HCV NS5B polymerase.

HPLC retention behavior on hydride-based stationary phases

Two stationary phases attached to a silica hydride surface, cholesterol and bidentate C18, are investigated with a number of pharmaceutically related compounds in order to illustrate the various retention mechanisms that are possible for these bonded materials. The test solutes range from hydrophilic to hydrophobic based on log P (octanol/water partition coefficient) and pKa values. The mobile phases consist of acidified (formic and perchloric acid) water/methanol or water/ACN mixtures. Of particular interest are the high organic content mobile phase compositions where the retention would increase if the bonded material was operating in the aqueous normal phase (ANP) mode. Plots of retention factor (k) versus mobile phase composition are used to elucidate the retention mechanism. A number of examples are presented where solutes are retained based on RP, ANP, or dual retention mechanisms. The silica hydride-based stationary phases can also retain compounds in the organic normal phase.

Discovery of S-[5-amino-1-(4-fluorophenyl)-1H-pyrazol-4-yl]-[3-(2,3-dihydroxypropoxy)phenyl]methanone (RO3201195), an orally bioavailable and highly selective inhibitor of p38 MAP kinase

A novel class of highly selective inhibitors of p38 MAP kinase was discovered from high throughput screening. The synthesis and optimization of a series of 5-amino-N-phenyl-1H-pyrazol-4-yl-3-phenylmethanones is described. An X-ray crystal structure of this series bound in the ATP binding pocket of unphosphorylated p38alpha established the presence of a unique hydrogen bond between the exocyclic amine of the inhibitor and threonine 106 which likely contributes to the selectivity for p38. The crystallographic information was used to optimize the potency and physicochemical properties of the series. The incorporation of the 2,3-dihydroxypropoxy moiety on the pyrazole scaffold resulted in a compound with excellent drug-like properties including high oral bioavailability. These efforts identified 63 (RO3201195) as an orally bioavailable and highly selective inhibitor of p38 which was selected for advancement into Phase I clinical trials.