Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment

William Bradford, Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA. wsbradford@uabmc.edu.
Hana Akselrod, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA.
John Bassler, School of Public Health, University of Alabama at Birmingham, Birmingham, USA.
Kelly W. Gagnon, Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
Greer Burkholder, Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.
Joseph Edward Carpenter, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA.
Alaina Steck, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA.
Jillian Catalanotti, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA.
Irene Kuo, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, USA.
Keanan McGonigle, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA.
William Mai, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA.
Melissa Notis, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, USA.
Christopher Brokus, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
Sarah Kattakuzhy, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
Elana Rosenthal, Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
Ellen F. Eaton, Division of Infectious Diseases, University of Alabama at Birmingham, Boshell Building 8th Floor 1808 7th Ave S, Birmingham, AL, 35233, USA.

Document Type

Letter to the Editor

Publication Date

3-26-2024

Journal

Addiction science & clinical practice

Volume

19

Issue

1

DOI

10.1186/s13722-024-00451-z

Keywords

CHOICE; HIV; Missed opportunity; OUD; PWH; PrEP; SIRI

Abstract

BACKGROUND: Hospitalization is a "reachable moment" for people who inject drugs (PWID), but preventive care including HIV testing, prevention and treatment is rarely offered within inpatient settings. METHODS: We conducted a multisite, retrospective cohort study of patients with opioid use disorder with infectious complications of injection drug use hospitalized between 1/1/2018-12/31/2018. We evaluated HIV care continuum outcomes using descriptive statistics and hypothesis tests for intergroup differences. RESULTS: 322 patients were included. Of 300 patients without known HIV, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 (59%) had a viral load collected during admission of whom all were viremic and 10 (45%) were successfully linked to care post-discharge. Rates of readmission, Medicaid or uninsured status, and unstable housing were high in both groups. DISCUSSION: We observed poor provision of HIV testing, PrEP and other HIV services for hospitalized PWID across multiple U.S. medical centers. Future initiatives should focus on providing this group with comprehensive HIV testing and treatment services through a status neutral approach.

Department

Epidemiology

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