Missed Opportunities for Prevention: Prevalence and Incidence of HIV and HCV Diagnoses Among a Cohort of Individuals Discharged from an Urban Hospital with Injection Drug Related Diagnoses, 2012-2019.

Abstract

Risk for HIV and hepatitis C virus (HCV) infections have increased due to the on-going opioid epidemic and unsafe injection practices. We estimated prevalence and incidence of HIV and HCV diagnoses among people who inject drugs (PWID) from hospital-based clinical encounters. We linked clinical encounters at an Atlanta hospital during 2012-2018 with state HIV and HCV surveillance records to examine prevalence of infections at discharge and incidence of infections post-clinical encounter. At discharge, 32.9% and 28.6% of patients with IDU-related clinical encounters had an HIV or HCV diagnosis, respectively. HIV and HCV diagnoses at time of discharge were mostly among 40-64 year-old patients, males, and Black/African Americans. Post-clinical encounter, 3.8% of patients were later diagnosed with HIV, and 16.5% were later diagnosed with HCV, translating to incidence rates of 9.3 per 1,000 person-years and 41.5 per 1,000 person-years, respectively. The majority of HIV and HCV diagnoses post-clinical encounter occurred among Black/African Americans and males. Of patients with HIV and HCV diagnoses post-clinical encounter, 27.3% and 11.9% had been tested during their clinical encounter, respectively. Targeted interventions for HIV/HCV prevention, screening, diagnosis and linkage to treatment are needed to reduce incidence of new infections among PWID.