Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital
Abstract Background Addiction medicine providers have a key role in HIV prevention amidst rising HIV incidence in persons who inject drugs (PWID). Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are vastly underutilized in this population. Inpatient hospitalization represents a p...
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| Language: | English |
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BMC
2024-11-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-024-00502-5 |
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| author | Hallie Rozansky Paul J. Christine Morgan Younkin Jason M. Fox Zoe M. Weinstein Sebastian Suarez Jessica Stewart Natalija Farrell Jessica L. Taylor |
| author_facet | Hallie Rozansky Paul J. Christine Morgan Younkin Jason M. Fox Zoe M. Weinstein Sebastian Suarez Jessica Stewart Natalija Farrell Jessica L. Taylor |
| author_sort | Hallie Rozansky |
| collection | DOAJ |
| description | Abstract Background Addiction medicine providers have a key role in HIV prevention amidst rising HIV incidence in persons who inject drugs (PWID). Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are vastly underutilized in this population. Inpatient hospitalization represents a potential touchpoint for initiation of HIV prophylaxis, though little research explores the role of addiction providers. Here we describe rates of PrEP/PEP delivery to hospitalized PWID seen by an Addiction Consult Service (ACS) at an urban, essential hospital. Methods We performed a cross-sectional study of hospitalized patients who were seen by the ACS from January 1, 2020 to December 31, 2022 and had plausible injection drug use. We calculated the proportion of patients who received a new prescription for PrEP/PEP at discharge. We used descriptive statistics to characterize demographics, substance use, reason for admission, and indications for PrEP/PEP. Secondarily, we calculated the monthly proportion of all patients discharged from the hospital with PrEP/PEP who were seen by the ACS compared to those not seen by the ACS. Results The average monthly proportion of ACS consults with plausible injection drug use who received PrEP/PEP was 6.4%. This increased from 4.2% in 2020 to 7.5% in 2022. Those seen by the ACS who received PrEP/PEP had high rates of opioid use disorder (97.5%), stimulant use disorder (77.8%), and homelessness (58.1%); over half were admitted for an injection-related infection. The indications for PrEP/PEP were injection drug use only (70.6%), followed by combined injection and sexual risk (20.2%); 71.9% of prescriptions were for PrEP and 28.1% for PEP. Overall, the ACS was involved in 83.9% of hospital-wide discharges with PrEP/PEP prescriptions (n = 242). Conclusions PWID who were seen by the ACS received PrEP/PEP prescriptions at rates exceeding national averages. The ACS was also involved with the care of the majority of admitted patients who received PrEP/PEP at discharge. While PrEP/PEP use for PWID remains low, the inpatient ACS represents a key resource to improve uptake by leveraging the reachable moment of an inpatient hospitalization. |
| format | Article |
| id | doaj-art-accb5593e60148dda993bdc24e9d39d1 |
| institution | Kabale University |
| issn | 1940-0640 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-accb5593e60148dda993bdc24e9d39d12024-11-10T12:36:34ZengBMCAddiction Science & Clinical Practice1940-06402024-11-011911810.1186/s13722-024-00502-5Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospitalHallie Rozansky0Paul J. Christine1Morgan Younkin2Jason M. Fox3Zoe M. Weinstein4Sebastian Suarez5Jessica Stewart6Natalija Farrell7Jessica L. Taylor8Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical CenterDivision of General Internal Medicine, University of Colorado School of MedicineBoston Healthcare for the Homeless ProgramSection of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical CenterSection of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical CenterDivision of Hospital Medicine, University of Miami Miller School of MedicineCenter for Infectious Diseases, Boston Medical CenterDepartment of Quality and Patient Safety, Boston Medical CenterSection of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical CenterAbstract Background Addiction medicine providers have a key role in HIV prevention amidst rising HIV incidence in persons who inject drugs (PWID). Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are vastly underutilized in this population. Inpatient hospitalization represents a potential touchpoint for initiation of HIV prophylaxis, though little research explores the role of addiction providers. Here we describe rates of PrEP/PEP delivery to hospitalized PWID seen by an Addiction Consult Service (ACS) at an urban, essential hospital. Methods We performed a cross-sectional study of hospitalized patients who were seen by the ACS from January 1, 2020 to December 31, 2022 and had plausible injection drug use. We calculated the proportion of patients who received a new prescription for PrEP/PEP at discharge. We used descriptive statistics to characterize demographics, substance use, reason for admission, and indications for PrEP/PEP. Secondarily, we calculated the monthly proportion of all patients discharged from the hospital with PrEP/PEP who were seen by the ACS compared to those not seen by the ACS. Results The average monthly proportion of ACS consults with plausible injection drug use who received PrEP/PEP was 6.4%. This increased from 4.2% in 2020 to 7.5% in 2022. Those seen by the ACS who received PrEP/PEP had high rates of opioid use disorder (97.5%), stimulant use disorder (77.8%), and homelessness (58.1%); over half were admitted for an injection-related infection. The indications for PrEP/PEP were injection drug use only (70.6%), followed by combined injection and sexual risk (20.2%); 71.9% of prescriptions were for PrEP and 28.1% for PEP. Overall, the ACS was involved in 83.9% of hospital-wide discharges with PrEP/PEP prescriptions (n = 242). Conclusions PWID who were seen by the ACS received PrEP/PEP prescriptions at rates exceeding national averages. The ACS was also involved with the care of the majority of admitted patients who received PrEP/PEP at discharge. While PrEP/PEP use for PWID remains low, the inpatient ACS represents a key resource to improve uptake by leveraging the reachable moment of an inpatient hospitalization.https://doi.org/10.1186/s13722-024-00502-5Pre-exposure prophylaxisHIV preventionOpioid use disorderPeople who inject drugs |
| spellingShingle | Hallie Rozansky Paul J. Christine Morgan Younkin Jason M. Fox Zoe M. Weinstein Sebastian Suarez Jessica Stewart Natalija Farrell Jessica L. Taylor Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital Addiction Science & Clinical Practice Pre-exposure prophylaxis HIV prevention Opioid use disorder People who inject drugs |
| title | Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital |
| title_full | Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital |
| title_fullStr | Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital |
| title_full_unstemmed | Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital |
| title_short | Addiction consult service involvement in PrEP and PEP delivery for patients who inject drugs admitted to an urban essential hospital |
| title_sort | addiction consult service involvement in prep and pep delivery for patients who inject drugs admitted to an urban essential hospital |
| topic | Pre-exposure prophylaxis HIV prevention Opioid use disorder People who inject drugs |
| url | https://doi.org/10.1186/s13722-024-00502-5 |
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