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

Addict Sci Clin Pract. 2024 Mar 26;19(1):22. doi: 10.1186/s13722-024-00451-z.

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.

Keywords: CHOICE; HIV; Missed opportunity; OUD; PWH; PrEP; SIRI.

Publication types

  • Letter
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aftercare
  • Anti-HIV Agents* / therapeutic use
  • HIV Infections* / complications
  • HIV Infections* / diagnosis
  • HIV Infections* / prevention & control
  • HIV Testing
  • Hospitalization
  • Humans
  • Patient Discharge
  • Pre-Exposure Prophylaxis*
  • Retrospective Studies
  • Substance Abuse, Intravenous* / complications
  • Substance Abuse, Intravenous* / epidemiology
  • Substance Abuse, Intravenous* / therapy

Substances

  • Anti-HIV Agents