Poster Abstracts • OFID 2017:4 (Suppl 1) • S419 1352. Improved HIV markers and decreased emergencyroom usage and hospital admission with initiation of a pilot specialty pharmacy at a southeastern Ryan -White -funded clinic over a three year period Background. Specialty pharmacy (SP) provides timely medication delivery to patients and seeks to improve patient adherence through monthly pharmacist medication therapy management (MTM). Patients living with HIV/AIDS have both high cost medications

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... complex disease states and thus will benefit from SP. We report on the outcome of HIV therapy after 3 years of a pilot SP ina southern inner city RW funded clinic. Methods. This is a single center retrospective chart review of patients at our clinic who were enrolled in the SP from 6/3/13-5/1/16 for at least 6 months. Baseline demographic characteristics and HIV markers (CD4, viral load) were collected. Outcomes of interest were: change in CD4 count, percent with viral suppression (VS), emergency room (ER) and hospital admission usage, as well as percent of scheduled providers' appointment kept. Each individual had the same follow up time before and after SP initiation. Bivariate analysis compared outcomes preSP and during SP using Chi-square or Fisher exact tests for categorical and Wilcoxon rank-sum test for continuous variables. Results. During the 3-year period, there were 212 individuals referred to SP, of which 170 participated in the program. There were 92(54%) men, 136 (80%) black. The median age was 48.3 years (IQR: 28.5-56.3). The average duration of follow up pre and during SP was 22.1(IQR: 16.5-27) months. In terms of insurance, 69(40%) had Medicare, 22(13%) had Medicaid, 22(13%) had private insurance, 54(32%) received AIDS drug Assistance Program (ADAP), and 3(2%) had Ryan White. Patients resided an average distance from the clinic of 17.4(IQR: 8.8-25) miles. The respective outcomes before and during SP were: CD4: 350(IQR: 181-551) vs. 413(IQR: 263-611 cells/mL (P < 0.0001), VS in 78 ± 30% vs. 91 ± 20% (P < 0.0001). The proportion of patients with emergency room usage or hospital admissions was 68(40%) vs. 49(29%) (P = 0.036). There was no difference in the rate of kept providers' appointment (66.6 %(IQR: 53.8-78.6%) vs. 63.8 %(50-77%) (P = 0.19). There was no reported death during the follow -up period. Conclusion. This pilot SP program at the RW clinic showed statistically significant improvement of CD4 count and VS, as well as 40 % decrease in odds of using ER or hospital admission. Further studies are needed to determine whether SP is beneficial to people living with HIV/AIDS in other settings. Disclosures. M. Patel, ViiV: Scientific Advisor, Consulting fee HIV Risk Assessment using Longitudinal Electronic Health Records Background. The traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons with HIV interact with the healthcare system. Methods. We conducted a retrospective analysis of patients with ≥ 1 HIV clinic visit at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Healthcare utilization was characterized by four indicators: clinic attendance in each half of the calendar year (yes/no), number of emergency department (ED) visits (0, 1 or 2+), inpatient admissions per year (0, 1, 2+), and viral suppression (never, intermittent, always). Healthcare engagement patterns were modeled using latent class/latent transition analysis, with model fit assessed using the Bayesian Information Criterion. Results. The cohort included 2686 patients (median age 42.9 years, 72% male, 56% black). A three-class model best fit the data: "Adherent" "Non-adherent" and "Sick". "Adherent" patients had high rates of clinic attendance in each half of the year (84%), rarely visited the ED (3.6% with ≥1 ED visit per year), and moderate rates of (54%) viral suppression. "Non-adherent" patients rarely attended clinic visits in both halves of the year (1.5%), used the ED more than "adherent" patients (10.3% with ≥1 ED visit per year), and had low rates of viral suppression (19%). "Sick" patients also had high rates of clinic attendance (75%), were frequent users of the ED (53% with ≥1 ED visit per year), and comparable rates of viral suppression to the "adherent" group (55%) viral suppression. Non-white race (OR 1.9) and age ≤ 40 (OR 3.76) were associated with membership in the "non-adherent" class. Movement between classes was dynamic, especially in the "sick" group (30-40% of whom moved to a different class the following year). Across all years, persons in the "non-adherent" class were more likely to completely disengage from care the following year than "adherent" persons (23.6% v. 0.2%, P <0.001). Conclusion. A broader definition of healthcare engagement revealed distinct and dynamic patterns among persons with HIV that would have been hidden had only clinic attendance and viral suppression been considered. These patterns may be useful for designing engagement-targeted interventions. Disclosures. All authors: No reported disclosures.