1
|
Hernandez-Con P, Wilson DL, Tang H, Unigwe I, Riaz M, Ourhaan N, Jiang X, Song HJ, Joseph A, Henry L, Cook R, Jayaweera D, Park H. Hepatitis C Cascade of Care in the Direct-Acting Antivirals Era: A Meta-Analysis. Am J Prev Med 2023; 65:1153-1162. [PMID: 37380088 PMCID: PMC10749988 DOI: 10.1016/j.amepre.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The hepatitis C virus (HCV) epidemic remains a public health problem worldwide. A systematic review and meta-analysis were conducted to provide evidence of outcomes attained across the HCV care cascade in the era of direct-acting antivirals. METHODS Studies from North America, Europe, and Australia (January 2014 through March 2021) reporting on HCV care cascade outcomes (screening to cure) were included. When calculating the proportions of individuals completing each step, the numerator for Steps 1-8 was the number of individuals completing each step; the denominator was the number of individuals completing the previous step for Steps 1-3 and Step 3 for Steps 4-8. In 2022, random effects meta-analyses were conducted to estimate pooled proportions with 95% CIs. RESULTS Sixty-five studies comprising 7,402,185 individuals were identified. Among individuals with positive HCV ribonucleic acid test results, 62% (95% CI=55%, 70%) attended their first care appointment, 41% (95% CI=37%, 45%) initiated treatment, 38% (95% CI=29%, 48%) completed treatment, and 29% (95% CI=25%, 33%) achieved cure. HCV screening rates were 43% (95% CI=22%, 66%) in prisons or jails and 20% (95% CI=11%, 31%) in emergency departments. Linkage to care rates were 62% (95% CI=46%, 75%) for homeless individuals and 26% (95% CI=22%, 31%) for individuals diagnosed in emergency departments. Cure rates were 51% (95% CI=30%, 73%) in individuals with substance use disorder and 17% (95% CI=17%, 17%) in homeless individuals. Cure rates were lowest in the U.S. DISCUSSION Despite the availability of effective all-oral direct-acting antiviral therapies, persistent gaps remain across the HCV care cascade, especially among traditionally marginalized populations. Public health interventions targeting identified priority areas (e.g., emergency departments) may improve screening and healthcare retention of vulnerable populations with HCV infection (e.g., substance use disorder populations).
Collapse
Affiliation(s)
- Pilar Hernandez-Con
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Debbie L Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Huilin Tang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Ikenna Unigwe
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Munaza Riaz
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Natalie Ourhaan
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Hyun Jin Song
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Amanda Joseph
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Linda Henry
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Robert Cook
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Dushyantha Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, College of Pharmacy, University of Florida, Gainesville, Florida.
| |
Collapse
|
2
|
Lyons MS, Chawarski MC, Rothman R, Whiteside L, Cowan E, Richardson LD, Hawk K, Tsui JI, Schwartz RP, O’Connor P, D’Onofrio G, Fiellin DA, Edelman EJ. Missed Opportunities for HIV and Hepatitis C Screening Among Emergency Department Patients With Untreated Opioid Use Disorder. J Addict Med 2023; 17:210-214. [PMID: 36170184 PMCID: PMC10023471 DOI: 10.1097/adm.0000000000001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed the frequency of emergency department (ED) HIV and hepatitis C (HCV) screening in a high-risk cohort of ED patients with untreated opioid use disorder (OUD). METHODS This analysis used data from a prospective, observational study of English-speaking adults with untreated OUD enrolled from April 2017 to December 2018 in 4 urban, academic EDs. Two cohorts were defined for this analysis by self-reported negative/unknown status for HIV (cohort 1) and HCV (cohort 2). Sites featured structured screening programs throughout the entire enrollment period for HIV and during at least part of the enrollment period for HCV. We calculated the proportion tested for HIV and HCV during the study enrollment ED visit. RESULTS Among 394 evaluated ED patients, 328 of 394 (83.2%) were not tested for HIV or HCV and 244 of 393 (62.1%) lacked a usual medical care provider. In cohort 1, 375 reported negative or unknown HIV status; 59/375 (15.7%) overall and 33/218 (15.1%) of those reporting recent injection drug use were tested for HIV. In cohort 2, 231 reported negative of unknown HCV status; 22/231 (9.5%) overall and 9/98 (9.2%) of those reporting recent injection drug use were tested for HCV. The proportion tested by the ED ranged from 3% to 25% for HIV and 4% to 32% for HCV across study sites. CONCLUSIONS Emergency department HIV and HCV screening remains infrequent among patients with untreated OUD, including those who inject drugs, even in EDs committed to screening. Targeted HIV/HCV screening should be considered as an adjunct strategy until the ideal of universal screening is more fully achieved.
Collapse
Affiliation(s)
- Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marek C. Chawarski
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Richard Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine Seattle WA USA
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Lynne D. Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, NY, NY, USA
| | - Kathryn Hawk
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Judith I. Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Patrick O’Connor
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David A. Fiellin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - E. Jennifer Edelman
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
3
|
Knaub RJ, Evans J, Yang C, Roura R, McGinn T, Verschoore B, Ricketts EP, Rothman RE, Latkin CA, Hsieh YH. A pilot study of a mixed-method approach to design an ED-based peer mHealth referral tool for HIV/HCV and opioid overdose prevention services. Drug Alcohol Depend 2022; 238:109585. [PMID: 35926299 PMCID: PMC9620482 DOI: 10.1016/j.drugalcdep.2022.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The intersecting epidemics of opioid misuse, injection drug use, and HIV/HCV have resulted in record overdose deaths and sustained high levels of HIV/HCV transmissions. Literature on social networks suggests opportunities to connect people who use drugs (PWUD) and their peers to HIV/HCV and opioid overdose prevention services. However, little evidence exists on how to design such peer referral interventions in emergency department (ED) settings. METHODS A mixed-method study was conducted to assess the feasibility of an mHealth-facilitated 'patient to peer social network referral program' for PWUD. In-depth interviews (IDIs) and quantitative surveys were conducted with urban ED patients (n = 15), along with 3 focus group discussions (FGDs) (n = 19). RESULTS Overall, 34 participants were enrolled (71 % males, 53 % Black). 13/15 IDI participants reported a history of opioid overdose; all had witnessed overdose events; all received HIV/HCV testing. From survey responses, most would invite their peers for HIV/HCV testing and naloxone training; and anticipated peers to accept referrals (HIV: 60 %, HCV: 73 %, naloxone: 93 %). Qualitative data showed PWUD shared health-related information with each other but preferred word of mouth rather than text messages. Participants used smartphones regularly and suggested using Internet advertising for prevention services. Participants expressed enthusiasm for ED-based peer mHealth referral platform to prevention services, as well as referring their peers to proposed services, with monetary incentives. CONCLUSION ED-based peer referral intervention to HIV/HCV testing and naloxone training was viewed favorably by PWUD. Frequent smartphone use among PWUD suggests that the medium could be a promising mode for peer referral.
Collapse
Affiliation(s)
- Ross J. Knaub
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Julie Evans
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Tanner McGinn
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Benjamin Verschoore
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Erin P. Ricketts
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
4
|
Plasma virome and the risk of blood-borne infection in persons with substance use disorder. Nat Commun 2021; 12:6909. [PMID: 34824209 PMCID: PMC8617242 DOI: 10.1038/s41467-021-26980-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
There is an urgent need for innovative methods to reduce transmission of bloodborne pathogens like HIV and HCV among people who inject drugs (PWID). We investigate if PWID who acquire non-pathogenic bloodborne viruses like anelloviruses and pegiviruses might be at greater risk of acquiring a bloodborne pathogen. PWID who later acquire HCV accumulate more non-pathogenic viruses in plasma than matched controls who do not acquire HCV infection. Additionally, phylogenetic analysis of those non-pathogenic virus sequences reveals drug use networks. Here we find first in Baltimore and confirm in San Francisco that the accumulation of non-pathogenic viruses in PWID is a harbinger for subsequent acquisition of pathogenic viruses, knowledge that may guide the prioritization of the public health resources to combat HIV and HCV. Spread of bloodborne infections, such as HCV and HIV, is a problem, particularly amongst people who inject drugs (PWID). Here, the authors describe and then confirm in observational PWID cohorts that those with more non-pathogenic viruses in plasma were more likely later to acquire HCV than PWID who had fewer of these non-pathogenic viruses.
Collapse
|
5
|
Spencer SE, Laeyendecker O, Dyson L, Hsieh YH, Patel EU, Rothman RE, Kelen GD, Quinn TC, Hollingsworth TD. Estimating HIV, HCV and HSV2 incidence from emergency department serosurvey. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13261.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background: Our understanding of pathogens and disease transmission has improved dramatically over the past 100 years, but coinfection, how different pathogens interact with each other, remains a challenge. Cross-sectional serological studies including multiple pathogens offer a crucial insight into this problem. Methods: We use data from three cross-sectional serological surveys (in 2003, 2007 and 2013) in a Baltimore emergency department to predict the prevalence for HIV, hepatitis C virus (HCV) and herpes simplex virus, type 2 (HSV2), in a fourth survey (in 2016). We develop a mathematical model to make this prediction and to estimate the incidence of infection and coinfection in each age and ethnic group in each year. Results: Overall we find a much stronger age cohort effect than a time effect, so that, while incidence at a given age may decrease over time, individuals born at similar times experience a more constant force of infection over time. Conclusions: These results emphasise the importance of age-cohort counselling and early intervention while people are young. Our approach adds value to data such as these by providing age- and time-specific incidence estimates which could not be obtained any other way, and allows forecasting to enable future public health planning.
Collapse
|
6
|
Daniel Moore J, Galbraith J, Humphries R, Havens JR. Prevalence of Hepatitis C Virus Infection Identified From Nontargeted Screening Among Adult Visitors in an Academic Appalachian Regional Emergency Department. Open Forum Infect Dis 2021; 8:ofab374. [PMID: 34381848 PMCID: PMC8351802 DOI: 10.1093/ofid/ofab374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We describe the initial results of an adult academic emergency department (ED) nontargeted hepatitis C virus (HCV) screening program serving Appalachia, which is disproportionately affected by the opioid epidemic. METHODS The study was a retrospective screening study of ED systematic, nontargeted, opt-out HCV testing outcomes from July 2018 through September 2020. Eligibility requirements for "nontargeted" HCV testing included age ≥18 years, verbally able to communicate, receiving bloodwork already as part of routine clinical care, and not opting out of testing. For eligible individuals who did not opt out of testing, an HCV antibody (Ab) test was performed. Reactive Ab tests were confirmed with reflexive HCV RNA testing. The primary study outcome was the characterization of HCV Ab and RNA prevalence. RESULTS There were 75 722 unique adult visitors during the period studied. Of these, 54 931 individuals were verbally engaged regarding testing and did not opt out. A total of 34 848 individuals received HCV Ab testing, with 3665 patients (10.5%) having reactive results. RNA confirmatory testing was reflexively performed in all Ab-positive patients, with 1601 (50.3%) positive. The majority of HCV Ab- and RNA-positive patients were young, born after 1965, and were more likely to be White, male, Medicaid insured, and report a history of injection drug use. CONCLUSIONS ED nontargeted, opt-out testing can identify a high prevalence of HCV infection among adult visitors. HCV infection was disproportionately high among younger, White individuals, likely reflecting the escalating syndemic of opioid injection and HCV transmission in Appalachia.
Collapse
Affiliation(s)
- J Daniel Moore
- Department of Emergency Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - James Galbraith
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Roger Humphries
- Department of Emergency Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jennifer R Havens
- Center of Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| |
Collapse
|
7
|
Mohareb AM, Patel AV, Laeyendecker OB, Toerper MF, Signer D, Clarke WA, Kelen GD, Quinn TC, Haukoos JS, Rothman RE, Hsieh YH. The HIV Screening Cascade: Current Emergency Department-Based Screening Strategies Leave Many Patients With HIV Undiagnosed. J Acquir Immune Defic Syndr 2021; 87:e167-e169. [PMID: 33769768 PMCID: PMC8026541 DOI: 10.1097/qai.0000000000002609] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Amir M. Mohareb
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Anuj V. Patel
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oliver B. Laeyendecker
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Matthew F. Toerper
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Danielle Signer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - William A. Clarke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gabor D. Kelen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Thomas C. Quinn
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jason S. Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, United States
- University of Colorado School of Medicine, Aurora, Colorado, United States
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, United States
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
8
|
Yax JA, Niforatos JD, Summers DL, Bigach MH, Schmotzer C, Gripshover BM, Avery A. A Model for Syphilis Screening in the Emergency Department. Public Health Rep 2020; 136:136-142. [PMID: 33166486 DOI: 10.1177/0033354920967302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of syphilis infections is on the rise, particularly among African American men and men who have sex with men, and it is reaching epidemic levels in these communities throughout the United States. Although syphilis is relatively inexpensive to treat and cure and is a predictor for HIV incidence among men and transgender women who have sex with men, rates of co-screening for syphilis are low in the emergency department setting, with a dearth of literature on this topic since the 1990s and early 2000s. In this case study, we describe an operational model for routine syphilis screening implemented in June 2017 at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. We describe the advantages of screening using a reverse testing algorithm rather than the traditional method and the necessity of partnering with the Cleveland Department of Public Health for both diagnostic and follow-up logistics.
Collapse
Affiliation(s)
- Justin A Yax
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western University School of Medicine, Cleveland, OH, USA
| | - Joshua D Niforatos
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,161821 Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel L Summers
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret H Bigach
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- Case Western University School of Medicine, Cleveland, OH, USA.,24575 Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara M Gripshover
- Case Western University School of Medicine, Cleveland, OH, USA.,365856 John T. Carey Special Immunology Unit, Department of Medicine, Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ann Avery
- Case Western University School of Medicine, Cleveland, OH, USA.,2559 Division of Infectious Diseases, MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
9
|
Anderson ES, Russell C, Basham K, Montgomery M, Lozier H, Crocker A, Zuluaga M, White DAE. High prevalence of injection drug use and blood-borne viral infections among patients in an urban emergency department. PLoS One 2020; 15:e0233927. [PMID: 32497108 PMCID: PMC7272082 DOI: 10.1371/journal.pone.0233927] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/14/2020] [Indexed: 01/03/2023] Open
Abstract
Background The opioid epidemic has led to an increase in the number of persons who inject drugs, and this population accounts for 12% of new human immunodeficiency virus (HIV) and 60% of new hepatitis C virus (HCV) infections in the United States annually. While persons who inject drugs disproportionately utilize the emergency department (ED), accurate data is lacking on the prevalence and patterns of injection drug use, and prevalence of co-occurring HIV and HCV infections among ED patients. Objective The primary outcome was to assess the prevalence of injection drug use and co-occurring HIV and HCV infection among patients presenting to an urban ED. Methods This was a cross sectional study conducted at an urban ED, with an annual census of 65,000 visits. A closed-response questionnaire was developed based on publicly available validated surveys to assess patterns of injection drug use and HIV and HCV infection status, and administered by trained research assistants to all registered adult patients during 4-hour blocks of time. Results Of the 2,319 eligible patients, 2,200 (94.9%) consented and completed the survey. 241 (11.0%) had ever used injection drugs, 103 (4.7%) currently used injection drugs, and 138 (6.3%) formerly used injection drugs. White patients age 25 to 34 years and white patients age 55 to 64 years had the highest prevalence of current (25.6%) and former (27.1%) injection drug use, respectively. Persons who use injection drugs had a higher prevalence of HCV infection (52.7% vs. 3.4%) and HIV infection (6.2% vs. 1.8%) than the rest of the population. Conclusion A high prevalence of ED patients report injection drug use, and this population self-reports a high prevalence of HIV and HCV infection. Emergency departments are in a unique position to engage with this population with regards to substance use treatment and linkage to care for HIV and HCV infection.
Collapse
Affiliation(s)
- Erik S. Anderson
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
- * E-mail:
| | - Carly Russell
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Kellie Basham
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Martha Montgomery
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Helen Lozier
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Abigail Crocker
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Marisa Zuluaga
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| | - Douglas A. E. White
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, United States of America
| |
Collapse
|
10
|
Ruffner AH, Ancona RM, Hamilton C, Fernandez FJ, Faryar KA, Lane BH, Lyons MS. Identifying ED patients with previous abnormal HIV or hepatitis C test results who may require additional services. Am J Emerg Med 2020; 38:1831-1833. [PMID: 32739853 DOI: 10.1016/j.ajem.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Routine emergency department (ED) HIV or HCV screening may inadvertently capture patients already diagnosed but does not specifically prioritize identification of this group. Our objective was to preliminarily estimate the volume of this distinct group in our ED population through a pilot electronic health record (EHR) build that identified all patients with indications of HIV or HCV in their EHR at time of ED presentation. METHODS Cross-sectional study of an urban, academic ED's HIV/HCV program for previously diagnosed patients August 2017-July 2018. Prevention program staff, alerted by the EHR, reviewed records and interviewed patients to determine if confirmatory testing or linkage to care was needed. Primary outcome was total proportion of ED patients for whom the EHR generated an alert. Secondary outcome was the proportion of patients assessed by program staff who required confirmatory testing or linkage to HIV/HCV medical care. RESULTS There were 65,374 ED encounters with 5238 (8.0%, 95% CI: 7.8%-8.2%) EHR alerts. Of these, 3741 were assessed by program staff, with 798 (21%, 95% CI: 20%-23%) requiring HIV/HCV confirmatory testing or linkage to care services, 163 (20%) for HIV, 551 (69%) for HCV, and 84 (11%) for both HIV and HCV services. CONCLUSIONS Patients with existing indication of HIV or HCV infection in need of confirmatory testing or linkage to care were common in this ED. EDs should prioritize identifying this population, outside of routine screening, and intervene similarly regardless of whether the patient is newly or previously diagnosed.
Collapse
Affiliation(s)
- Andrew H Ruffner
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America
| | - Rachel M Ancona
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
| | - Catherine Hamilton
- University of Cincinnati Health, 3200 Burnet Ave, Cincinnati, OH 45229, United States of America.
| | - Francisco J Fernandez
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
| | - Kiran A Faryar
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
| | - Bennett H Lane
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
| | - Michael S Lyons
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
| |
Collapse
|