Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)—Estimating HCV incidence in an urban emergency department population

Abstract

High seroprevalence of HCV antibody (anti-HCV) is common among urban emergency department (ED) patients. Little is known regarding incidence of HCV infection in ED patients. We conducted a longitudinal chart-review (2003-2016) of a subset of ED patients between December 2015 and January 2016 (the ‘index period’) in an urban ED that began an ED-based HCV screening program since November 2015. Patients were eligible for inclusion if they presented to the ED during the ‘index period’ and had at least one negative anti-HCV test between 2003 and 2015, and at least one test after the ‘index visit’. Follow-up time (person-years) was calculated for each patient. Incidence ratio (IR) and corresponding 95% CI was used to present the relative incidence between groups. 2% (6/299) patients included had HCV seroconversion during 1706.0 person-years, resulting in an HCV incidence of 3.5/1,000 person-years (95% CI: 1.4, 7.3). Incidence was significantly higher in white patients (IR: 12.9), people who inject drugs (IR: 17.4), and patients with unknown/unaware HIV status (IR: 8.3). The relatively high HCV incidence in urban ED patients, especially in subgroups disproportionately impacted by opioid use and/or HIV, indicate that EDs represent a critical venue for detecting HCV and should consider prevention services against these intersecting epidemics.

Estimating HIV, HCV and HSV2 incidence from emergency department serosurvey

“…The observed declines in HCV incidence in young black males and females are consistent with reported declines in HCV incidence in a predominantly-black cohort of community-based people who inject drugs in Baltimore 43 . In addition, and consistent with our model-based estimates, the observed incidence of HCV between 2003 and 2016 was significantly higher in white ED patients as compared to black ED patients 44 . The observed declines in HCV incidence in young black populations compared to white populations were also seen recently in New York City (NYC) 45 .…”

A Model for Syphilis Screening in the Emergency Department

“…1,2 The increase in screening has led not only to the development of more efficient, validated screening tools, such as the Denver HIV Risk Score, 3,4 but also to co-testing for other chronic infections, such as hepatitis C virus, and highlights the importance of the ED's role in public health interventions. 5,6 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. 7 Although syphilis infection is relatively inexpensive to treat and cure and is a predictor for HIV infection among men and transgender women who have sex with men, 8 co-screening occurs infrequently in the ED setting.…”

“…1,2 The increase in screening has led not only to the development of more efficient, validated screening tools, such as the Denver HIV Risk Score, 3,4 but also to co-testing for other chronic infections, such as hepatitis C virus, and highlights the importance of the ED’s role in public health interventions. 5,6…”

Clinical knowledge of human immunodeficiency virus and sexually transmitted infections among emergency medicine providers

“…The growing movement in social emergency medicine has recognized the ED as a critical access point for the timely screening of both acute and asymptomatic undiagnosed HIV. 29 Given the results of our study, validated clinical prediction tools 4,6 integrated into the electronic health record may prove beneficial and eliminate variability in provider testing patterns observed in this study. 30 Testing for HIV infection remains the first in a series of important interventions aimed at closing the undiagnosed gap, and emergency department-based screening for HIV infection continues to play an important role in this initiative, though with room for clinical knowledge improvements.…”