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. 2021 Jun 1;72(11):1961-1967.
doi: 10.1093/cid/ciaa507.

Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use-Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak-Cincinnati/Northern Kentucky, 2017-2018

Nathan W Furukawa  1   2 , Erin F Blau  2   3   4 , Zach Reau  5 , David Carlson  6 , Zachary D Raney  7 , Tisha K Johnson  4 , Nicholas P Deputy  2   3   8 , Samira Sami  1   2 , Robert P McClung  1   3 , Robyn Neblett-Fanfair  1   3 , Sietske de Fijter  5 , Tim Ingram  6 , Doug Thoroughman  3   4   9 , Stephanie Vogel  7 , Sheryl B Lyss  1   3
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Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use-Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak-Cincinnati/Northern Kentucky, 2017-2018

Nathan W Furukawa et al. Clin Infect Dis. .

Abstract

Background: Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID.

Methods: PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017-September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months.

Results: Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70-4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10-2.82).

Conclusions: PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

Keywords: HIV testing; injection drug use; outbreak response; overdose; skin/soft-tissue infections.

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Conflict of interest statement

Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Flow diagram of defining missed opportunities for HIV testing using a 12-month interval—Cincinnati/Northern Kentucky, 2017–2018. Abbreviations: HIV, human immunodeficiency virus; IDU, injection drug use.
See this image and copyright information in PMC

References

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