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Background: Adolescent girls and young women account for a disproportionate fraction of new HIV infections in Africa and are a priority population for HIV prevention, including provision of pre-exposure prophylaxis (PrEP). Anchoring PrEP delivery to care settings like family planning (FP) services that women already access routinely may offer an efficient platform to reach HIV at-risk women. However, context-specific implementation science evaluation is needed.Methods: The Family Planning Plus Project is a prospective, pragmatic implementation evaluation, designed as a stepped wedge, cluster randomized trial, at 12 clinics in Kenya. In collaboration with the Kenya Ministry of Health and Kisumu County Department of Health, we will introduce integration of HIV risk screening and PrEP delivery in public health FP clinics. The core multifaceted implementation strategies to integrate PrEP in FP clinics will include: 1) PrEP delivery by existing FP clinic staff; 2) health provider training; 3) PrEP technical assistance to coach and mentor providers; 4) joint supervision with Kisumu County health officials; and 5) stakeholder engagement. All core components of PrEP delivery– including screening for HIV risk, HIV testing, dispensing, adherence and risk reduction counseling, assessment of side effects, and provision of refills, or safety assessment– will be conducted by existing FP clinic staff as part of a standard care service package. The goal is to catalyze sustainable scale-up within existing infrastructures beyond the project. We will rigorously evaluate implementation outcomes and impact, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework and we will use Organizational Readiness for Implementing Change (ORIC) and the Consolidated Framework for Implementation Science Research (CFIR) to assess readiness to implement and contextual enablers and barriers of implementation, including how clinics innovate efficient delivery systems.Discussion: Anchoring PrEP delivery to existing FP systems and staffing has tremendous potential to address barriers that women face in accessing HIV prevention and PrEP care, including lack of time, cost, and stigma of visiting a facility solely for HIV prevention. The FP Plus Project will initiate preparation for full-scale and sustainable model of integration of comprehensive HIV prevention services, including PrEP implementation, in public health FP clinics in low-income settings. Trial registration: Registered with ClinicalTrials.gov on December 14, 2020: NCT04666792.

Coxiella burnetii, the causative agent of Query fever (Q fever), is among the most highly infectious zoonotic pathogens transmitted among livestock, with chronic effects challenging to veterinary and medical detection and care systems. Transmission among domestic livestock species can vary regionally due to herd management practices that determine which livestock species are raised, whether or not livestock are in contact with wildlife, and the susceptibility of these livestock to infection. To explore how different livestock management practices are associated with the risk of infection in multispecies environments, we carried out a comparative study of three types of herd management systems in the central Kenyan county of Laikipia: agro‐commercial, mixed conservancy/commercial, and smallholder ranches. We tested C. burnetii antibody seroprevalence in four common livestock species. Across all management types, the highest seroprevalence was in camels (20%), followed by goats (18%), sheep (13%), and cattle (6%). We observed a lower odds of testing seropositive for young compared to adult animals (adjusted OR = 0.44 [95% CI 0.24, 0.76]), and for males compared to females (adjusted OR = 0.52 [95% CI 0.33, 0.80]). Animals from mixed conservancy/commercial and smallholder operations had a higher odds of testing seropositive compared to animals from agro‐commercial ranches (adjusted OR = 5.17 [95% CI 2.71, 10.44] and adjusted OR = 2.21 [95% CI 1.17, 4.43] respectively). These data suggest that herd management practices might affect the transmission dynamics of C. burnetiiin arid African ecosystems like those seen in Kenya where several transmission modes are possible, risk of drought has promoted new livestock species such as camels, and multiple wildlife species may co‐occur with livestock on the landscape. Further longitudinal studies are needed to disentangle the mechanisms underlying these patterns, and further explore transmission patterns between wildlife, domestic animal, and human populations.

Background Reduction of healthcare-associated infections (HAIs) is critical to improve patient safety and hospital quality. However, not all HAI-associated outcomes are well studied. We examined several of these—the financial and length of stay (LOS) burden of HAIs and patient experience of care. Methods National Healthcare Safety Network-reported catheter-associated urinary tract infections (CAUTI), C. difficile infections (CDI), central line-associated bloodstream infections (CLABSI), MRSA bacteremia, and colon surgery surgical site infections (SSI-COLO) were queried for the first 9 months of 2016 from 43 hospitals. Patients with an HAI were matched to controls on hospital and primary diagnosis to create a retrospective case–control study. CAUTI and CLABSI patients were matched to controls with associated device codes. LOS and total direct variable cost (TDVC) were collected for all HAI and control patients. If patients returned a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, their likelihood to recommend (LTR) response was additionally analyzed. Results Data were analyzed for 123 CAUTI, 1,116 CDI, 166 CLABSI, 58 MRSA, and 127 SSI-COLO case–control pairs across 43 hospitals. TDVC per case was significantly higher among HAI cases than controls for CDI ($6,484), CLABSI ($14,646), and SSI-COLO ($9,770; figure 1). LOS was significantly higher for cases across all HAI groups, with attributable differences of 7.6 days for CAUTI, 6.4 for CDI, 9.7 for CLABSI, 7.4 for MRSA, and 4.5 for SSI-COLO (Figure 2). Of 3,180 subjects, 198 returned HCAHPS surveys. Response rate of “Yes, definitely” to LTR for 85 HAI patients was 63.5% compared with 72.6% for 113 control patients (Figure 3). Conclusion This is the first investigation to our knowledge pairing patient experience of care data with TDVC and LOS for HAI patients. HAIs have a significant impact on patient experience, cost, and length of stay―further supporting the importance of preventing HAIs. Disclosures R. Olmsted, Ethicon, Inc.: Speaker’s Bureau, Speaker honorarium; APIC: External faculty HRET/CDC STRIVE project, Speaker honorarium.