Background
People living with mental illnesses (PLMI) and substance use disorders experience disproportionate incidence of HIV. Domestic and international policy agendas emphasize developing methods for expanding access to HIV testing, pre-exposure prophylaxis (PrEP), and linkage to care. The purpose of the present study was to quantify new HIV diagnoses following discharge from psychiatric hospitalization as a possible site of intervention for HIV prevention for PLMI.
Methods
The MarketScan database of medical and pharmaceutical claims for commercially insured people in the US was used to identify enrollees who were hospitalized with diagnosis-related groups corresponding to a primary psychiatric illness. A conservative approach was used to define the cohort. We excluded enrollees with previous claims-based evidence of HIV (1 inpatient or 2 outpatient claims on different dates), and enrollees with antiretroviral prescriptions for agents other than PrEP. Inclusion required at least 1 year of continuous medical and prescription drug coverage prior to date of psychiatric admission (index date). Enrollees were followed for 1 year after discharge or until HIV diagnosis. We did not include re-admissions.
Results
The final cohort included 492,363 individuals who were psychiatrically hospitalized between 2004-2022. There were 277 HIV diagnoses following discharge. New diagnoses were more frequent among males (n=186; 67.2%), in the Western US (n=110; 39.7%). The most common, primary diagnoses at hospitalization were depression (n=101; 36.5%), alcohol use disorder (n=33; 11.9%), bipolar disorder (n=32; 11.6%). Median time to HIV diagnosis was 154 days after discharge (IQR: 61-243). Enrollees who were hospitalized for a primary diagnosis of stimulant use disorder (SUD) had the shortest median time to HIV diagnosis following discharge (40 days; 32-70). (Figure 1)
Conclusions
In this retrospective, claims-based study, we identified many new HIV diagnoses in the 1-year follow-up period after discharge from inpatient psychiatry. The mean time to new diagnosis was less than 6-months for all diagnosis groups and the shortest mean duration was identified for enrollees hospitalized primarily for SUD. Future research is needed to better understand screening for PrEP eligibility among patients receiving inpatient psychiatric care and to develop models of care to integrate PrEP prescription in the settings where people with psychiatric illnesses are already engaged in care.
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