National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals

Leo Knudsen Westgard; Taisuke Sato; William S Bradford; Ellen F Eaton; Finlay Pilcher; Andrew J Hale; Devika Singh; Marlene Martin; Ayesha A Appa; Jaimie P Meyer; Melissa B Weimer; Lydia A Barakat; Uriel R Felsen; Matthew J Akiyama; Jessica P Ridgway; Emily D Grussing; Kinna Thakarar; Amy White; John Mutelayi; Martin Krsak; Brian T Montague; Ank Nijhawan; Harini Balakrishnan; Laura R Marks; Alysse G Wurcel

doi:10.1093/ofid/ofae204

National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals

Open Forum Infect Dis. 2024 Apr 16;11(5):ofae204. doi: 10.1093/ofid/ofae204. eCollection 2024 May.

Authors

Leo Knudsen Westgard¹, Taisuke Sato¹, William S Bradford², Ellen F Eaton², Finlay Pilcher³, Andrew J Hale^{3

4}, Devika Singh^{3

4}, Marlene Martin^{5

6}, Ayesha A Appa⁶, Jaimie P Meyer^{7

8}, Melissa B Weimer^{7

9}, Lydia A Barakat⁷, Uriel R Felsen^{10

11}, Matthew J Akiyama^{10

11}, Jessica P Ridgway¹², Emily D Grussing^{1

13}, Kinna Thakarar^{13

14

15

16}, Amy White¹⁴, John Mutelayi¹⁴, Martin Krsak¹⁷, Brian T Montague¹⁷, Ank Nijhawan¹⁸, Harini Balakrishnan¹⁸, Laura R Marks¹⁹, Alysse G Wurcel^{1

13}

Affiliations

¹ Tufts Medical Center, Boston, Massachusetts, USA.
² University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
⁴ University of Vermont Medical Center, Burlington, Vermont, USA.
⁵ Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
⁶ University of California, San Francisco, California, USA.
⁷ Yale School of Medicine, New Haven, Connecticut, USA.
⁸ Yale University School of Public Health, New Haven, Connecticut, USA.
⁹ Yale New Haven Hospital, New Haven, Connecticut, USA.
¹⁰ Montefiore Medical Center, Bronx, New York, USA.
¹¹ Albert Einstein College of Medicine, Bronx, New York, USA.
¹² University of Chicago, Chicago, Illinois, USA.
¹³ Tufts University School of Medicine, Boston, Massachusetts, USA.
¹⁴ Maine Medical Center Research Institute, Portland, Maine, USA.
¹⁵ Maine Medical Center, Portland, Maine, USA.
¹⁶ Maine Medical Partners Adult Infectious Diseases, South Portland, Maine, USA.
¹⁷ University of Colorado School of Medicine, Denver, Colorado, USA.
¹⁸ University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹⁹ Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

Abstract

Background: To end the HIV and hepatitis C virus (HCV) epidemics, people who use drugs (PWUD) need more opportunities for testing. While inpatient hospitalizations are an essential opportunity to test people who use drugs (PWUD) for HIV and HCV, there is limited research on rates of inpatient testing for HIV and HCV among PWUD.

Methods: Eleven hospital sites were included in the study. Each site created a cohort of inpatient encounters associated with injection drug use. From these cohorts, we collected data on HCV and HIV testing rates and HIV testing consent policies from 65 276 PWUD hospitalizations.

Results: Hospitals had average screening rates of 40% for HIV and 32% for HCV, with widespread heterogeneity in screening rates across facilities. State consent laws and opt-out testing policies were not associated with statistically significant differences in HIV screening rates. On average, hospitals that reflexed HCV viral load testing on HCV antibody testing did not have statistically significant differences in HCV viral load testing rates. We found suboptimal testing rates during inpatient encounters for PWUD. As treatment (HIV) and cure (HCV) are necessary to end these epidemics, we need to prioritize understanding and overcoming barriers to testing.

Keywords: HIV testing; hepatitis C testing; hospitalization; injection drug use; people who inject drugs.

Abstract

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