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. 2020 Jun 4;15(6):e0233927.
doi: 10.1371/journal.pone.0233927. eCollection 2020.

High prevalence of injection drug use and blood-borne viral infections among patients in an urban emergency department

Erik S Anderson  1 , Carly Russell  1 , Kellie Basham  1 , Martha Montgomery  1 , Helen Lozier  1 , Abigail Crocker  1 , Marisa Zuluaga  1 , Douglas A E White  1
Affiliations

High prevalence of injection drug use and blood-borne viral infections among patients in an urban emergency department

Erik S Anderson et al. PLoS One. .

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.

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Conflict of interest statement

We have read the journal's policy and the authors of this manuscript have the following competing interests: ESA, CR, KB, HL, AC, and DAEW received funding from Gilead Sciences FOCUS Grant. The grant provided partial salary support and program support for HIV and HCV screening in the emergency department. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Details of study enrollment and survey completion at Highland Hospital from November 2018 through April 2019.
Fig 2
Fig 2
(a) Prevalence of current injection drug use by age and race among 2,200 surveyed emergency department patients. (b) Prevalence of former injection drug use by age and race among 2,200 surveyed emergency department patients. Legend: Non-white includes Hispanic/Latino, Black, Asian, and other race and ethnicity categories. Current injection drug use indicates surveyed patients who report injecting drugs in the previous 12 months; former injection drug use indicates surveyed patients who report injecting drugs, but not in the past 12 months. Prevalence is based on the total number of patients surveyed in each age group, and ‘n’ indicates the number of patients that report current or former injection drug use.
See this image and copyright information in PMC

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