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Purpose: The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education programs collaboratively created the evidence-based, comprehensive Arizona Pain and Addiction Curriculum which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state.Materials and Methods: Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities.Results: Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives.Conclusion: In < 1 year after creation of the Arizona Pain and Addiction Curriculum, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.

Purpose: The U.S. is struggling with dual crises of chronic pain and opioid overdoses. To improve statewide pain and addiction care, the Arizona Department of Health Services and 18 health education programs collaboratively created the evidence-based, comprehensive Arizona Pain and Addiction Curriculum which includes a Toolbox for Operationalization with adult learning theory applications and an annual program survey to assess curriculum implementation. The purpose of this study is to analyze the first year's survey data to better understand the implementation of a novel curriculum across all programs in the state. Materials and Methods: Program surveys were sent 6 months after curriculum publication to all 18 health education programs in Arizona to assess the 6 Ds of curriculum implementation: Degree of implementation, Difficulty of implementation, Delivery methods, Faculty Development, Didactic dissonance and Discussion Opportunities. Results: Responses from all program types (14/18 programs) indicated that there was widespread implementation of the curriculum, with 71% reporting that all ten Core Components had been included in the past academic year. The majority of programs did not find the Components difficult to implement and had implemented them through lectures. Seventy-seven percent of programs did not have a process to ensure clinical rotation supervisors are teaching content consistent with the curriculum, 77% reported not addressing student's didactic dissonance, and 77% of programs did not report asking students about their interactions with industry representatives. Conclusion: In < 1 year after creation of the Arizona Pain and Addiction Curriculum, all program types reported wide implementation with little difficulty. This may represent a first step toward the transformation of pain and addiction education, and occurred statewide, across program types. Further focus on didactic dissonance, problem solving and faculty development is indicated, along with systematic education on pharmaceutical and industry influence on learners. Other programs may benefit from adopting this curriculum and may not experience significant challenges in doing so.

Background We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. Methods Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection case-patients. Measles-specific IgG was measured to assess detainee immunity levels. We compared attack rates (ARs) among detainees and staff, between IgG-negative and IgG-positive detainees, and by detainee housing units and sexes. Results We identified 32 measles case-patients (23 detainees, 9 staff); rash onsets were during 6 May-26 June 2016. High IgG avidity and neutralizing-antibody titers >40000 to measles (indicating reinfection) were identified in 18 (95%) and 15 (84%) of 19 tested case-patients, respectively. Among 205 unit A detainees tested for presumptive immunity, 186 (91%) had detectable IgG. Overall, the AR was 1.65%. ARs were significantly higher among detainees in unit A (7.05%) compared with units B-F (0.59%), and among male (2.33%) compared with female detainees (0.38%); however, ARs were not significantly different between detainees and staff or between IgG-negative and IgG-positive detainees. Control measures included the vaccination of 1424 of 1425 detainees and 190 of 510 staff, immunity verification for 445 staff, case-patient isolation, and quarantine of affected units. Conclusions Although ARs were low, measles outbreaks can occur in intense-exposure settings, despite a high population immunity, underscoring the importance of high vaccination coverage and containment in limiting measles transmission.

Background Key risk factors for tuberculosis (TB) in the United States include HIV-positive status, birth outside of the United States, incarceration and homelessness. Despite advances in antiretroviral therapy (ART) and declining HIV-TB comorbidity, TB remains an important opportunistic infection for all people living with HIV. Few studies exist which characterize HIV-TB co-infection in geographic populations within the United States In this study, we cross-reference the HIV and TB registries in Arizona from 1993 through 2016 and compare features of HIV-TB co-infected individuals with HIV-negative TB cases and the broader population living with HIV. Methods Case records were identified by cross-referencing two separate databases maintained by the Arizona Department of Health Services, the Report of Verified Case of Tuberculosis (RVCT) and the Enhanced HIV/AIDS Reporting System (eHARS). Data were organized and analyzed in SAS and comparisons evaluated with Pearson chi-square test. Results A total of 361 unique cases of HIV-TB co-infection in Arizona were identified during the study period. Annual TB diagnoses in people living with HIV range from 25 (1995) to 7 (2008 and 2016). Significant differences in birth sex and age were observed in HIV-TB co-infections compared with HIV-negative TB cases. Homelessness was more common among people living with HIV (22.6% vs. 9.0%, χ2 = 70.22, P < 0.001). TB disease manifestations differed (χ2 = 159.7604, P < 0.001) and HIV-positive individuals more frequently had concurrent pulmonary and extrapulmonary TB disease. Outcomes of TB treatment were less favorable among individuals living with HIV (χ2 = 45.33, P < 0.001) as more HIV-positive patients failed to complete the full course of TB therapy or died before therapy completion. Finally, among all people living with HIV, our study revealed significant differences in race (χ2 = 243.53, P < 0.001), country of birth (χ2 = 441.88, P < 0.001), HIV transmission risk factors (χ2 = 125.19, P < 0.001), and correctional status (χ2 = 347.90, P < 0.001) for those who had a TB diagnosis. Conclusion Our study reveals important trends in HIV-TB comorbidity in Arizona and may inform public health strategies for addressing TB and its burden among people living with HIV. Disclosures All authors: No reported disclosures.