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Addressing Suboptimal HIV and Hepatitis C Testing Among Inpatient Drug Users

Recent research showcased in Open Forum Infectious Diseases has highlighted a significant healthcare issue – suboptimal testing rates for Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) among hospitalized patients who have a history of drug use. A unique study conducted across 11 hospital sites across the United States employed a unique unit of analysis – the hospitalization instead of the individual patient – and spanned from January 2020 to April 2022.

Data gathered for each site comprised the total number of hospitalizations, successful HIV antigen/antibody tests and positive test findings, HCV antibody tests and their positive results, and HCV viral load tests. Standardized testing and positivity rates were calculated per site, with the total number of hospitalizations acting as the denominator.

Crucially, the study also reviewed the influence of state-regulated consent requirements on testing rates and compared testing rates across different sites through the use of Student t-testing. Notably, the study encompassed an analysis of over 65,000 inpatient encounters with patients with a history of drug use.

A striking revelation of this study was the mean rate of HIV and HCV antibody screening – alarmingly low at 40% and 32%, respectively. Evidence of wide-ranging heterogeneity in testing rates for HIV and HCV was visible, with a standard deviation of 23% for HIV and 15% for HCV.

In-depth analysis indicated lower HIV testing rates at sites requiring verbal consent and higher rates at sites adopting opt-out testing policies. The study, however, did not find a significant variation in HCV viral load testing rates between sites using or not using reflex HCV antibody testing protocols.

Interestingly, the average positivity rate was 2.9% for HIV and 41% for HCV, with a negative correlation observed between test positivity and antibody testing rates for both diseases.

The research does come with certain limitations, including a potential lack of scalability to other US hospitals, especially those in rural regions, and the plausible impact of COVID-19 related interruptions in clinical testing protocols. However, the research concludes with an important recommendation – leveraging inpatient admissions of drug users as an opportunity to initiate tests, connect this marginalized community to healthcare services, and prevent new infections and comorbid conditions.

This crucial research reinforces the call for more approachable opportunities for HIV and HCV testing among hospitalized drug users, an area that is currently subpar and requires attention.


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