February 20, 2020
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90% of injection drug users miss opportunities for HIV or HCV testing

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Using data from more than 840,000 health care encounters, researchers estimated that around 90% of people who inject drugs missed opportunities for HIV or hepatitis C virus testing during a recent 8-year period — especially rural males seeking care for skin infections or endocarditis.

“We were interested in assessing HIV and hepatitis C infection testing rates for patients with substance use disorders, and in understanding opportunities for increasing testing rates at clinical visits,” Lara Bull-Otterson, PhD, MPH, an epidemiologist in the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told Healio. “Currently there is not a specific billing code to indicate that a person injects drugs. Such a code would be helpful to identify people who inject drugs (PWID) who might require HIV and hepatitis C testing and other important health care services, such as substance use treatment or overdose prevention interventions.”

Bull-Otterson and colleagues used a nationwide health insurance database to assess the prevalence of testing for HIV and HCV infection among patients with claims filed between 2010 and 2017 who had at least one diagnosis, procedure or medication dispensed that was indicative of injection drug use. The researchers then estimated the percentage of PWID tested for HIV or HCV and assessed demographic and clinical factors associated with testing.

Overall, they found that approximately 90% of 844,242 PWID missed opportunities for testing — 71,938 (8.5%) were tested for HIV and 65,188 (7.7%) for HCV. According to the study, missed opportunities were independently associated with being male (OR for HIV = 0.5; 95% CI, 0.49-0.50; OR for HCV = 0.66; 95% CI, 0.65-0.72), having a rural residence (OR for HIV = 0.67; 95% CI, 0.65-0.69; OR for HCV = 0.75; 95% CI, 0.73-0.77) and receiving services for skin infections or endocarditis (adjusted OR [aOR] for HIV = 0.91; 95% CI, 0.87-0.95; aOR for HCV = 0.90; 95% CI, 0.86-0.95). 


Using data from more than 840,000 health care encounters, researchers estimated that around 90% of people who inject drugs missed opportunities for HIV or hepatitis C virus testing during a recent 8-year period.

Bull-Otterson told Healio that testing rates for HIV and HCV in PWID are probably low because clinicians have “competing priorities” for care while treating patients for conditions related to their substance use disorder, such as overdose, endocarditis or a soft tissue infection. She said algorithms can be developed that use diagnoses, procedures, tests and medications in a patient’s electronic health record as indicators of injection drug use and these algorithms can be used to generate EHR prompts for health providers to perform HIV testing and could be effective in increasing HCV testing.

“Health care providers should consider testing for HIV and hepatitis C among patients seen for a substance use disorder, overdose, or treatment; or those who are under the age of 50 and present with a skin or soft tissue infection or endocarditis,” Jones concluded. “Such tests could enable early diagnosis and treatment of HIV and HCV. ... These interactions should be viewed as a valuable occasion to provide high-impact health care.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.