Background:
To end the HIV and HCV epidemics, people who use drugs (PWUD) need more robust opportunities for HIV and hepatitis C virus (HCV) testing, confirmation of infection and linkage to care. While inpatient hospitalizations are an essential opportunity to test PWUD for HIV and HCV there is limited research on rates of inpatient testing for HIV and HCV among PWUD and no data comparing testing rates between hospitals or parts of the country. This primary aim of this study is to quantify aggregate testing rates across a cohort of U.S. hospitals and hospital systems. Secondarily, we aim to explore how HIV consent requirements impact testing rates.
Methods:
Eleven hospital sites were included in the study. Nine established a cohort of inpatient encounters from 1/1/2020 to 4/1/2022 tied to the presence of ICD-10 drug use diagnosis codes (Table 1). Two sites (CT and TX) identified inpatient cohorts from the same study period using Addiction Medicine consults. The unit of analysis was hospitalization. Data collected included: the number of hospitalizations, HIV antigen/antibody tests, HCV antibody tests, and HCV viral loads. HIV and HCV testing rates and positivity were derived as a percentage of total PWUD hospitalizations. All sites detailed their HIV screening and consent policies, where consent requires either written or oral patient approval. The impact of state consent requirements on screening was analyzed using a Student’s t-test comparing hospitals with and without these mandates.
Results:
We included 65,276 hospitalizations of PWUD at across 11 hospitals. Sites had an average HIV screening rate of 40.08% (SD = 23.29%) and an average HCV Ab screening rate of 31.58% (SD = 15.14%), with widespread heterogeneity in screening rates across facilities. HIV screening rates did not significantly differ between states that require consent and those that did not (p-value = 0.389). Average test positivity across hospitals was 4.5% for HIV tests and 41.4% for HCV tests.
Conclusions:
In a study of 11 hospitals and hospital systems across the U.S., we found suboptimal HIV and HCV testing rates during inpatient encounters for PWUD. Testing rates for HCV were lower than those for HIV, with widespread heterogeneity across hospitals, regardless of consent requirements. Hospitalizations are a missed opportunity to offer HIV and HCV testing. As treatment (HIV) and cure (HCV) are necessary to end these epidemics, understanding and overcoming barriers to HIV and HCV testing need to be prioritized.
