Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.
Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.
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DOI：
10.1016/j.jsat.2020.108266
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发表时间：
2021-05
影响因子：
3.9
通讯作者：
Wurcel A
中科院分区：
文献类型：
--
作者：
Zubiago J;Murphy M;Guardado R;Daudelin D;Patil D;Wurcel A
吸毒者（PWUD）经常遇到预防性医疗保健的障碍。在2019冠状病毒病大流行期间，由于减少伤害服务的失误，多位公共卫生专家预测PWUD中艾滋病毒的诊断随后会增加。由于许多住院医院在COVID-19激增期间重新安排了患者流量，我们假设PWUD的HIV检测将减少。为了回答这个问题，我们编制了一份去识别化的住院患者名单，这些患者具有物质使用的电子病历指标-阳性尿液毒理学筛查，处方药物治疗阿片类药物使用障碍，阳性CIWA评分或阳性CAGE评分-在2020年1月至2020年8月期间入院。关注的结局是在住院期间完成HIV检测。该研究使用逻辑回归来检查物质使用类型和接受艾滋病毒检测之间的关联。该研究将物质使用类型分为四组：（1）阿片类药物（羟考酮、芬太尼或其他阿片类药物）或阿片类药物使用障碍治疗（美沙酮、丁丙诺啡、纳洛酮）;（2）兴奋剂使用（可卡因或安非他明）;（3）酒精使用（存在阳性CAGE或CIWA评分或毒理学筛查中存在酒精）;和（4）苯二氮卓类药物使用（毒理学筛查中存在苯二氮卓类药物）。接受艾滋病毒检测的PWUD比例从2020年1月的10. 4%上升至2020年4月的28. 2%，并于8月回落至12%。值得注意的是，随着时间的推移，因吸毒住院的人数呈相反趋势，从1月的259人到4月的85人，然后到2020年8月的217人。与我们的假设相反，HIV检测在COVID-19大流行期间增加，我们讨论了这一发现的解释。大流行高峰期后艾滋病毒检测的减少提醒我们，我们必须努力制定干预措施，使所有人，特别是艾滋病毒感染者的艾滋病毒检测率保持在较高水平。
People who use drugs (PWUD) often experience barriers to preventative health care. During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, we hypothesized that HIV testing in PWUD would decrease. To answer this question, we compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use—a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score—admitted between January, 2020 and August, 2020. The outcome of interest was HIV test completion during inpatient hospitalization. The study used logistic regression to examine associations between type of substance use and receipt of HIV test. The study grouped substance use type into four groups (1) opioids (oxycodone, fentanyl, or other opiates) or opioid use disorder treatments (methadone, buprenorphine, naltrexone); (2) stimulant use (cocaine or amphetamines); (3) alcohol use (presence of a positive CAGE or CIWA score or alcohol present on toxicology screen); and (4) benzodiazepine use (benzodiazepines present on toxicology screen). The proportion of PWUD who were tested for HIV increased from 10.4% in January, 2020 to 28.2% in April, 2020 and back down to 12% in August. Notably, there was an inverse trend over time for number of people hospitalized with drug use, from 259 in January to a nadir of 85 in April, and then up to 217 in August, 2020. Contrary to our hypothesis, HIV testing increased during the COVID-19 pandemic, and we discuss explanations for this finding. The decrease in HIV testing post-pandemic peak is a reminder that we must work to develop interventions that lead to sustained high rates of HIV testing for all people, and especially for PWUD.
影响因子：
33.9
作者：
Cranston, Kevin;Alpren, Charles;Demaria, Alfred, Jr.
通讯作者：
Demaria, Alfred, Jr.
影响因子：
4.4
作者：
Hochstatter, Karli R.;Akhtar, Wajiha Z.;Westergaard, Ryan P.
通讯作者：
Westergaard, Ryan P.
影响因子：
4.4
作者：
Shiau, Stephanie;Krause, Kristen D.;Halkitis, Perry N.
通讯作者：
Halkitis, Perry N.