Implementation of a bundle to improve HIV testing during hospitalization for people who inject drugs

Abstract

Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

Natural Language Processing For Identification of Hospitalized People with Substance Use Disorder (Preprint)

“…Building on work done that identified low HIV testing rates, we plan to use NLP to augment PWUD cohort creation in a study examining patterns of HIV testing. 33,34 NLP could indeed become a valuable tool for identifying PWUD prior to discharge and facilitating intervention during hospitalization if electronic medical records could use NLP to trigger clinical decision support tools that trigger clinicians to consider SUD treatment, prescribe overdose prevention medications at discharge, order labs to prepare for pre-exposure prophylaxis (PrEP), or offer vaccines.…”

National HIV and HCV Screening Rates for Hospitalized People who Use Drugs Are Suboptimal and Heterogeneous Across 11 US Hospitals

“…Protocolized care, such as a “PWID service bundle” as proposed by the CDC [ 40 ], should include testing for HIV, hepatitis B and C, and sexually transmitted infections (STIs); treatment for infectious diseases; vaccination for hepatitis A and B; syringe service resources; medications for opioid use disorder; naloxone distribution; and PrEP. Bundled testing (eg, HIV + STIs, HIV + HCV, bundled reflex testing for HCV) has been shown to increase testing in nontraditional infectious diseases health care settings [ 41 , 42 ], including in clinics that serve unhoused populations [ 43 , 44 ]. Clinical decision support systems, such as electronic health record (EHR) reminders for patients with a history of SUD who have not recently received a test and including consent for HIV in the nursing intake process, could also be used to support bundled care [ 45 ].…”

A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility

“…This approach allows the simultaneous addressing of multiple risk behaviors, leveraging synergies for impact. The bundling of HIV prevention efforts creates an opportunity to reach individuals who are disproportionately impacted and may be reluctant to seek care ( 63 ), thereby eliminating barriers to preventive measures like PrEP. Similar to SBIRT, HIV prevention services have the potential to be consolidated or bundled within organizations possessing clinical capacity (such as emergency rooms, drug treatment centers, prisons, and shelters) as well as those lacking clinical facilities (including faith-based organizations, beauty salons, bars, and areas associated with drug and sex trade).…”