Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital

Hamdan, Sami; Smyth, Emma; Murphy, Meghan; Grussing, Emily D; Wei, Mingrui; Guardado, Rubeen; Wurcel, Alysse G.

doi:10.1089/apc.2022.0165

Cited by 5 publications

(7 citation statements)

References 60 publications

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“…During IDU‐related encounters, Black/African American patients were less likely to be tested for both HIV and HCV compared with White patients; findings that are consistent with a similar study reporting racial and ethnic disparities in HIV testing among people who use drugs 33 . However, in our sensitivity analysis examining HIV or HCV testing during non‐IDU‐related encounters within 12 months of an IDU‐related encounter, there were no statistically significant differences with race/ethnicity and HIV or HCV testing.…”

Section: Discussionsupporting

confidence: 86%

“…During IDU-related encounters, Black/African American patients were less likely to be tested for both HIV and HCV compared with White patients; findings that are consistent with a similar study reporting racial and ethnic disparities in HIV testing among people who use drugs. 33 However, in our sensitivity analysis examining HIV or HCV testing during non-IDU-related encounters within 12 months of an IDU-related encounter, there were no statistically significant differences with race/ethnicity and HIV or HCV testing. Thus, our initial study findings of racial disparities in HIV and HCV testing during IDU-related encounters may be less significant if providers recently tested patients during a recent non-IDU-related encounter and did not deem it necessary to test the patient again during their IDU-related encounter.…”

Section: Discussionmentioning

confidence: 72%

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HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

Evans,

Vettese,

Wortley

et al. 2023

Journal of Viral Hepatitis

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People who inject drugs (PWID) with unsafe injection practices have substantial risk for HIV and hepatitis C virus (HCV) infections. We describe frequency of, and factors associated with, HIV and HCV testing during clinical encounters with PWID. Inpatient and Emergency Department clinical encounters at an Atlanta hospital were abstracted from medical records spanning January 2013–December 2018. We estimated frequency of HIV and HCV testing during injection drug use (IDU)‐related encounters among PWID without previous diagnoses. We assessed associations between patient factors and testing using generalized estimating equations models. HIV testing occurred in 39.3% and HCV testing occurred in 17.1% of eligible IDU‐related encounters. Testing was more likely in IDU‐related encounters during 2017–2018 than in encounters during 2013–2014; (HIV, AOR = 2.14, 95% CI, 1.32–3.49, p < .01). Testing was less likely among Black/African American patients compared to White patients (adjusted odds ratio [AOR]: HIV, AOR = 0.48, 95% confidence interval [CI], 0.33–0.72, p < .01); HCV, AOR = 0.41, 95% CI, 0.24–0.70, p < .01). This difference may be attributable to recent testing among Black patients in non‐IDU related encounters. HIV and HCV testing improved over time; however, missed opportunities for testing still existed. Strategies should aim to improve equitable HIV and HCV testing among PWID.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 72%

HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

Evans,

Vettese,

Wortley

et al. 2023

Journal of Viral Hepatitis

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“…However, major gaps in HIV testing remain, especially for people with opioid use disorder and people who inject drugs (PWID) (Zhang et al, 2020). We previously reported data from our institution that about 10% of hospitalized people who used drugs received HIV testing, with Black and Hispanic patients being less likely to receive HIV testing (Zubiago et al, 2021;Hamdan et al, 2022). This low rate of testing occurred in the wake of persistent HIV outbreaks in the communities our hospital serves (Gonsalves et al, 2021;Hamdan et al, 2022).…”

Section: Introductionmentioning

confidence: 95%

“…The project was conducted at Tufts Medical Center, a tertiary not-for-profit 415-bed academic center (Who We Are, 2022) located in Boston, Massachusetts, and a referral center for two local hospitals: Lowell General Hospital and Melrose-Wakefield Hospital. Previous data published by our research team using toxicology screening, billing codes, and medication review estimated that 200 people who use drugs (i.e., inject, snort, or consume) are admitted to Tufts Medical Center (Hamdan et al, 2022). Patients admitted to the Tufts Medical Center medical units are often cared for by various inpatient services, but many PWID are cared for by the infectious disease service because of the overlap between injection drug use and infections.…”

Section: Settingmentioning

confidence: 99%

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

D. Grussing,

Pickard,

Khalid

et al. 2023

Implementation Research and Practice

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Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

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“…However, despite recommendations for inpatient HIV screening, a Boston hospital reported that only about 10% of hospitalized PWID between 2017 and 2020 were tested for HIV. People who identified as Black and Hispanic/Latinx had decreased odds of HIV testing [ 22 , 23 ]. Another study of hospitalized PWID with serious infections seen by infectious disease providers found that 86% received testing for HCV and 88% received testing for HIV [ 24 ].…”

mentioning

confidence: 99%

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

Westgard,

Sato,

Bradford

et al. 2024

Open Forum Infectious Diseases

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To end the HIV and HCV epidemics, people who use drugs (PWUD) need more opportunities for testing. While inpatient hospitalizations are an essential opportunity to test PWUD for HIV and HCV, there is limited research on rates of inpatient testing for HIV and HCV among PWUD. 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. 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, understanding and overcoming barriers to testing need to be prioritized.

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Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital

Cited by 5 publications

References 60 publications

HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

HIV and HCV testing at clinical encounters among people who inject drugs, 2013–2018—Opportunities for increased testing and prevention

Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

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

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