Abstract
BackgroundWe conducted a medical record review for healthcare utilization, risk factors, and clinical data among people who inject drugs (PWID) in Massachusetts to aid HIV outbreak response decision-making and strengthen public health practice.SettingTwo large community health centers (CHCs) that provide HIV and related services in northeastern Massachusetts.MethodsBetween May and July 2018, we reviewed medical records for 88 people with HIV (PWH) connected to the outbreak. The review period included care received from May 1, 2016, through the date of review. Surveillance data were used to establish date of HIV diagnosis and assess viral suppression.ResultsSixty-nine (78%) people had HIV infection diagnosed during the review period, including 10 acute infections. Persons had a median of 3 primary care visits after HIV diagnosis and zero before diagnosis. During the review period, 72% reported active drug or alcohol use, 62% were prescribed medication assisted treatment, and 41% were prescribed antidepressants. The majority (68, 77%) had a documented ART prescription. HIV viral suppression at < 200 copies/mL was more frequent (73%) than the overall across the State (65%); it did not correlate with any of the sociodemographic characteristics studied in our population. Over half (57%) had been hospitalized at least once during the review period, and 36% had a bacterial infection at hospitalization.ConclusionsMedical record review with a field investigation of an outbreak provided data about patterns of health care utilization and comorbidities not available from routine HIV surveillance or case interviews. Integration of HIV screening with treatment for HIV and SUD can strengthen prevention and care services for PWID in northeastern Massachusetts.
Highlights
Worldwide, 9% of new Human immunodeficiency virus (HIV) infections are attributed to injection drug use (IDU) [1]
An outbreak case was defined as a person diagnosed with HIV infection in Massachusetts during January 2015 to May 2018 and who received medical care, experienced homelessness, resided, or injected drugs in Lawrence or Lowell; was epidemiologically linked as an injecting or sex partner of a person with HIV infection connected to Lawrence or Lowell; or had an HIV-1 pol nucleotide sequence molecularly linked at a genetic distance of ≤1.5% to that of another person in the investigation
We examined healthcare utilization before and after HIV diagnosis during the review period, and stratified according to whether patients achieved viral suppression at the most recent viral load (VL) measurement during the review period, or the 4 months thereafter based on surveillance data
Summary
9% of new HIV infections are attributed to injection drug use (IDU) [1]. In the United States (U.S.), 6% of diagnoses of HIV infection are attributed IDU [2]. In the context of the opioid crisis in the US, increasing frequency of IDU and fentanyl use may increase HIV transmission risk among PWID [13, 14]. This has been documented in several HIV outbreaks around the U.S [15,16,17]. We conducted a medical record review for healthcare utilization, risk factors, and clinical data among people who inject drugs (PWID) in Massachusetts to aid HIV outbreak response decision-making and strengthen public health practice.
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