(P97) IMPLEMENTATION OF MPOX TESTING AND TREATMENT AT A LARGE URBAN INDIAN HEALTH SERVICE FACILITY

Background:
Mpox is a viral infection which can be sexually transmitted. We examined mpox testing, treatment, and symptom improvement in an American Indian and Alaska Native (AI/AN) population at an urban Indian Health Service (IHS) facility during 2022.

Methods:
The electronic medical record was used to review patients who were tested for mpox from 7/13/22 to 12/21/22 using polymerase chain reaction (PCR). Among confirmed mpox cases, any recent STI, interval from mpox diagnosis to treatment, and intervals from treatment (tecovirimat 600mg PO x 14 days) to symptom improvement were evaluated.

Results:
In total, 61 symptomatic patients were tested; 18 (29.5%) were PCR positive. Testing occurred in the urgent care/emergency department (27 tested, 6 confirmed), HIV/PrEP clinic (26 tested, 11 confirmed), and inpatient ward (6 tested, 1 confirmed). The median age was 32.5 years (n=18, range 21-47); Among cases, 16 (89%) reported male-to-male sexual contact (MSM), and 6 (37.5%) were persons living with HIV (PLWH).  Among tested cases, 39% had a diagnosed STI 3 months before or after mpox diagnosis. In PLWH and mpox (n = 6), 83% were virally suppressed. Among HIV-negative mpox cases reporting MSM, 5 were on PrEP and 3 started PrEP near mpox diagnosis.  Twelve cases (67%) were considered severe infections and received treatment with tecovirimat, 6 (50%) were PLWH. Of the 12 treated patients, 5 (42%) had 10 to 100 lesions; 7 (58%) had less than 10 lesions. 

A majority of patients received tecovirimat on the day of lab confirmation (67%); Five (42%) reported symptom improvement by day 3, 4 (33%) by day 6 and all (100%) upon treatment completion.

Conclusion:
This IHS site successfully identified mpox cases in multiple departments and provided prompt treatment to patients with severe mpox symptoms. Most (75%) patients reported symptom improvement a week after treatment initiation.