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Trayner KMA, Yeung A, Palmateer NE, McAuley A, Wilkinson M, Craik J, Metcalfe R, Peters E, Shepherd SJ, Gunson RN, Carter D, Sills L, Hutchinson SJ. Impact of the COVID-19 Pandemic on HIV Test Uptake Among People Who Inject Drugs in the Context of an HIV Outbreak. AIDS Behav 2024; 28:2131-2147. [PMID: 38649554 PMCID: PMC11161428 DOI: 10.1007/s10461-024-04311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
Glasgow, Scotland's largest city, has been experiencing an HIV outbreak among people who inject drugs (PWID) since 2015. A key focus of the public health response has been to increase HIV testing among those at risk of infection. Our aim was to assess the impact of COVID-19 on HIV testing among PWID in Glasgow. HIV test uptake in the last 12 months was quantified among: (1) PWID recruited in six Needle Exchange Surveillance Initiative (NESI) surveys (n = 6110); linked laboratory data for (2) people prescribed opioid agonist therapy (OAT) (n = 14,527) and (3) people hospitalised for an injecting-related hospital admission (IRHA) (n = 12,621) across four time periods: pre-outbreak (2010-2014); early-outbreak (2015-2016); ongoing-outbreak (2017-2019); and COVID-19 (2020-June 21). From the pre to ongoing period, HIV testing increased: the highest among people recruited in NESI (from 28% to 56%) and on OAT (from 17% to 54%) while the lowest was among people with an IRHA (from 15% to 42%). From the ongoing to the COVID-19 period, HIV testing decreased markedly among people prescribed OAT, from 54% to 37% (aOR 0.50, 95% CI 0.48-0.53), but increased marginally among people with an IRHA from 42% to 47% (aOR 1.19, 95% CI 1.08-1.31). In conclusion, progress in increasing testing in response to the HIV outbreak has been eroded by COVID-19. Adoption of a linked data approach could be warranted in other settings to inform efforts to eliminate HIV transmission.
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Affiliation(s)
- Kirsten M A Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
- Public Health Scotland, Glasgow, UK.
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Norah E Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Max Wilkinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Julie Craik
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rebecca Metcalfe
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Erica Peters
- Brownlee Centre for Infectious Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow, UK
| | - Daniel Carter
- Public Health Protection Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Laura Sills
- NHS Greater Glasgow and Clyde Addiction Services, Glasgow, UK
| | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
- Public Health Scotland, Glasgow, UK.
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Boardman E, Boffito M, Chadwick DR, Cheserem E, Kabagambe S, Kasadha B, Elliott C. Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era. Int J STD AIDS 2024; 35:244-253. [PMID: 38016099 PMCID: PMC10908195 DOI: 10.1177/09564624231202287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Late diagnosis of HIV is associated with increased morbidity and mortality, and an increased risk of non-infectious comorbidities. On a societal level, late diagnosis leads to higher treatment and healthcare costs and is a major driver of HIV transmission. Despite improvements in other areas of the HIV care pathway, late diagnosis remains an individual and public health concern globally. OBJECTIVE To examine the barriers to HIV testing and highlight successful strategies to improve prompt diagnosis. This review describes the prevalence of late diagnosis in the UK and discusses key factors that contribute to late diagnosis, including the effect of the COVID-19 pandemic. Late HIV diagnosis is lower in the UK than in most other European countries. In this review, pilot projects and ongoing initiatives that have reduced late diagnosis in the UK are highlighted; moreover, further strategies for improving prompt diagnosis are suggested. CONCLUSIONS Insufficient testing is the fundamental reason for late HIV diagnosis, with societal, systemic, and individual factors all contributing to inadequate testing. Improving access to testing, removing barriers to health-seeking behaviour, and ensuring all people with HIV indicator conditions are promptly tested are key to reducing the rates of late diagnosis globally.
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Affiliation(s)
- Emily Boardman
- The Northern Contraception, Sexual Health and HIV Service, Manchester Royal Infirmary, Manchester, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | | | | | | | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Trayner KM, McAuley A, Palmateer NE, Yeung A, Goldberg DJ, Glancy M, Hunter C, Ritchie T, Craik J, Raeburn F, McTaggart S, Barnsdale L, Campbell J, Shepherd SJ, Bradley-Stewart A, Gunson RN, Templeton K, Hutchinson SJ. Examining the impact of the first wave of COVID-19 and associated control measures on interventions to prevent blood-borne viruses among people who inject drugs in Scotland: an interrupted time series study. Drug Alcohol Depend 2022; 232:109263. [PMID: 35120807 PMCID: PMC8802039 DOI: 10.1016/j.drugalcdep.2021.109263] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND COVID-19 has likely affected the delivery of interventions to prevent blood-borne viruses (BBVs) among people who inject drugs (PWID). We examined the impact of the first wave of COVID-19 in Scotland on: 1) needle and syringe provision (NSP), 2) opioid agonist therapy (OAT) and 3) BBV testing. METHODS An interrupted time series study design; 23rd March 2020 (date of the first 'lockdown') was chosen as the key date. RESULTS The number of HIV tests and HCV tests in drug services/prisons, and the number of needles/syringes (N/S) distributed decreased by 94% (RR=0.062, 95% CI 0.041-0.094, p < 0.001), 95% (RR=0.049, 95% CI 0.034-0.069, p < 0.001) and 18% (RR = 0.816, 95% CI 0.750-0.887, p < 0.001), respectively, immediately after lockdown. Post-lockdown, an increasing trend was observed relating to the number of N/S distributed (0.6%; RR = 1.006, 95% CI 1.001-1.012, p = 0.015), HIV tests (12.1%; RR = 1.121, 95% CI 1.092-1.152, p < 0.001) and HCV tests (13.2%; RR = 1.132, 95 CI 1.106-1.158, p < 0.001). Trends relating to the total amount of methadone prescribed remained stable, but a decreasing trend in the number of prescriptions (2.4%; RR = 0.976, 95% CI 0.959-0.993, p = 0.006) and an increasing trend in the quantity prescribed per prescription (2.8%; RR = 1.028, 95% CI 1.013-1.042, p < 0.001) was observed post-lockdown. CONCLUSIONS COVID-19 impacted the delivery of BBV prevention services for PWID in Scotland. While there is evidence of service recovery; further effort is likely required to return some intervention coverage to pre-pandemic levels in the context of subsequent waves of COVID-19.
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Affiliation(s)
- Kirsten M.A. Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK,Corresponding author at: School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Norah E. Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - David J. Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Carole Hunter
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Trina Ritchie
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Julie Craik
- Public Health Protection Unit, Gartnaval Royal Hospital, NHS Greater Glasgow and Clyde, Glasgow, G12 0XH, UK
| | - Fiona Raeburn
- NHS Grampian Drug and Alcohol Services, Fulton Clinic, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, UK
| | - Stuart McTaggart
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - Lee Barnsdale
- Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
| | - John Campbell
- NHS Greater Glasgow and Clyde Addiction Services, 150 Brand Street, Glasgow, G51 1DH, UK
| | - Samantha J. Shepherd
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | | | - Rory N. Gunson
- West of Scotland Specialist Virology Centre, New Lister Building, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Royal Infirmary, Edinburgh, EH16 4SA, UK
| | - Sharon J. Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK,Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QQ, UK
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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