scholarly journals Syndrome Development to Assess IDU, HIV, and Homelessness in MA Emergency Departments

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Stefanie P. Albert ◽  
Rosa Ergas ◽  
Sita Smith ◽  
Gillian Haney ◽  
Monina Klevens
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Drug Use ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
Syndromic Surveillance ◽  
Injection Drug ◽  
Free Text ◽  
Increased Risk ◽  
Ed Visits

ObjectiveWe sought to measure the burden of emergency department (ED) visits associated with injection drug use (IDU), HIV infection, and homelessness; and the intersection of homelessness with IDU and HIV infection in Massachusetts via syndromic surveillance data.IntroductionIn Massachusetts, syndromic surveillance (SyS) data have been used to monitor injection drug use and acute opioid overdoses within EDs. Currently, Massachusetts Department of Public Health (MDPH) SyS captures over 90% of ED visits statewide. These real-time data contain rich free-text and coded clinical and demographic information used to categorize visits for population level public health surveillance.Other surveillance data have shown elevated rates of opioid overdose related ED visits, Emergency Medical Service incidents, and fatalities in Massachusetts from 2014-20171,2,3. Injection of illicitly consumed opioids is associated with an increased risk of infectious diseases, including HIV infection. An investigation of an HIV outbreak among persons reporting IDU identified homelessness as a social determinant for increased risk for HIV infection.MethodsTo accomplish our objectives staff used an existing MDPH SyS IDU syndrome definition4, developed a novel syndrome definition for HIV-related visits, and adapted Maricopa County's homelessness syndrome definition. Syndromes were applied to Massachusetts ED data through the CDC’s BioSense Platform. Visits meeting the HIV and homelessness syndromes were randomly selected and reviewed to assess accuracy; inclusion and exclusion criteria were then revised to increase specificity. The final versions of all three syndrome definitions incorporate free-text elements from the chief complaint and triage notes, as well as International Statistical Classification of Diseases and Related Health Problems, 9th (ICD-9) and 10th Revision (ICD-10) diagnostic codes. Syndrome categories were not mutually exclusive, and all reported visits occurring at Massachusetts EDs were included in the analysis.Syndromes CreatedFor the HIV infection syndrome definition, we incorporated the free-text term “HIV” in both the chief complaint and triage notes. Visit level review demonstrated that the following exclusions were needed to reduce misspellings, inclusion of partial words, and documentation of HIV testing results: “negative for HIV”, “HIV neg”, “negative test for HIV”, “hive”, “hivies”, and “vehivcle”. Additionally, the following diagnostic codes were incorporated: V65.44 (Human immunodeficiency virus [HIV] counseling), V08 (asymptomatic HIV infection status), V01.79 (contact with or exposure to other viral diseases), 795.71 (nonspecific serologic evidence of HIV), V73.89 (special screening examination for other specified viral diseases), 079.53 (HIV, type 2 [HIV-2]), Z20.6 (contact with and (suspected) exposure to HIV), Z71.7 (HIV counseling), B20 (HIV disease), Z21 (asymptomatic HIV infection status), R75 (inconclusive laboratory evidence of HIV), Z11.4 (encounter for screening for HIV), and B97.35 (HIV-2 as the cause of diseases classified elsewhere).Building on the Maricopa County homeless syndrome definition, we incorporated a variety of free-text inclusion and exclusion terms. To meet this definition visits had to mention: “homeless”, or “no housing”, or, “lack of housing”, or “without housing”, or “shelter” but not animal and domestic violence shelters. We also selected the following ICD-10 codes for homelessness and inadequate housing respectively, Z59.0 and Z59.1.We analyzed MDPH SyS data for visits occurring from January 1, 2016 through June 30, 2018. Rates per 10,000 ED visits categorized as IDU, HIV, or homeless were calculated. Subsequently, visits categorized as IDU, HIV, and meeting both IDU and HIV syndrome definitions (IDU+HIV) were stratified by homelessness.ResultsSyndrome Burden on EDThe MDPH SyS dataset contains 6,767,137 ED visits occurring during the study period. Of these, 82,819 (1.2%) were IDU-related, 13,017 (0.2%) were HIV-related, 580 (<0.01%) were related to IDU + HIV, and 42,255 visits (0.6%) were associated with homelessness.The annual rate of IDU-related visits increased 15% from 2016 through June of 2018 (from 113.63 to 130.57 per 10,000 visits); while rates of HIV-related and IDU + HIV-related visits remained relatively stable. The overall rate of visits associated with homelessness increased 47% (from 49.99 to 73.26 per 10,000 visits).Rates of IDU, HIV, and IDU + HIV were significantly higher among visits associated with homelessness. Among visits that met the homeless syndrome definition compared to those that did not: the rate of IDU-related visits was 816.0 versus 118.03 per 10,000 ED visits (X2= 547.12, p<0. 0001); the rate of visits matching the HIV syndrome definition was 145.54 versus 18.44 per 10,000 ED visits (X2= 99.33, p<0.0001); and the rate of visits meeting the IDU+HIV syndrome definition was 15.86 versus 0.76 per 10,000 visits (X2= 13.72, p= 0.0002).ConclusionsMassachusetts is experiencing an increasing burden of ED visits associated with both IDU and homelessness that parallels increases in opioid overdoses. Higher rates of both IDU and HIV-related visits were associated with homelessness. An understanding of the intersection between opioid overdoses, IDU, HIV, and homelessness can inform expanded prevention efforts, introduction of alternatives to ED care, and increase consideration of housing status during ED care.Continued surveillance for these syndromes, including collection and analysis of demographic and clinical characteristics, and geographic variations, is warranted. These data can be useful to providers and public health authorities for planning healthcare services.References1. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017. MMWR Morbidity and Mortality Weekly Report 2018; 67(9);279–285 DOI: http://dx.doi.org/10.15585/mmwr.mm6709e12. Massachusetts Department of Public Health. Chapter 55 Data Brief: An assessment of opioid-related deaths in Massachusetts, 2011-15. 2017 August. Available from: https://www.mass.gov/files/documents/2017/08/31/data-brief-chapter-55-aug-2017.pdf3. Massachusetts Department of Public Health. MA Opioid-Related EMS Incidents 2013-September 2017. 2018 Feb. Available from: https://www.mass.gov/files/documents/2018/02/14/emergency-medical-services-data-february-2018.pdf4. Bova, M. Using emergency department (ED) syndromic surveillance to measure injection-drug use as an indicator for hepatitis C risk. Powerpoint presented at: 2017 Northeast Epidemiology Conference. 2017 Oct 18 – 20; Northampton, Massachusetts, USA.

scholarly journals Patients with infective endocarditis and history of injection drug use in a Swedish referral hospital during 10 years

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Damlin ◽  
Katarina Westling
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Clinical Characteristics ◽  
National Registry ◽  
Injection Drug ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Increased Risk ◽  
History Of

Abstract Background Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. Methods Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. Results Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). Conclusions This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.

HIV Infection in Young Men in Northern Thailand, 1991–1998: Increasing Role of Injection Drug Use

2002 ◽  
Vol 29 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Kenrad E. Nelson ◽  
Sakol Eiumtrakul ◽  
David D. Celentano ◽  
Chris Beyrer ◽  
Noya Galai ◽  
...  
Keyword(s):  
Drug Use ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
Young Men ◽  
Injection Drug ◽  
Northern Thailand

scholarly journals Missed Opportunities for Human Immunodeficiency Virus (HIV) Testing During Injection Drug Use–Related Healthcare Encounters Among a Cohort of Persons Who Inject Drugs With HIV Diagnosed During an Outbreak—Cincinnati/Northern Kentucky, 2017–2018

2020 ◽  
Author(s):  
Nathan W Furukawa ◽  
Erin F Blau ◽  
Zach Reau ◽  
David Carlson ◽  
Zachary D Raney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Hiv Testing ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Hiv Diagnosis ◽  
Persons Who Inject Drugs ◽  
Missed Opportunities ◽  
Immunodeficiency Virus

Abstract Background Persons who inject drugs (PWID) have frequent healthcare encounters related to their injection drug use (IDU) but are often not tested for human immunodeficiency virus (HIV). We sought to quantify missed opportunities for HIV testing during an HIV outbreak among PWID. Methods PWID with HIV diagnosed in 5 Cincinnati/Northern Kentucky counties during January 2017–September 2018 who had ≥1 encounter 12 months prior to HIV diagnosis in 1 of 2 Cincinnati/Northern Kentucky area healthcare systems were included in the analysis. HIV testing and encounter data were abstracted from electronic health records. A missed opportunity for HIV testing was defined as an encounter for an IDU-related condition where an HIV test was not performed and had not been performed in the prior 12 months. Results Among 109 PWID with HIV diagnosed who had ≥1 healthcare encounter, 75 (68.8%) had ≥1 IDU-related encounters in the 12 months before HIV diagnosis. These 75 PWID had 169 IDU-related encounters of which 86 (50.9%) were missed opportunities for HIV testing and occurred among 46 (42.2%) PWID. Most IDU-related encounters occurred in the emergency department (118/169; 69.8%). Using multivariable generalized estimating equations, HIV testing was more likely in inpatient compared with emergency department encounters (adjusted relative risk [RR], 2.72; 95% confidence interval [CI], 1.70–4.33) and at the healthcare system receiving funding for emergency department HIV testing (adjusted RR, 1.76; 95% CI, 1.10–2.82). Conclusions PWID have frequent IDU-related encounters in emergency departments. Enhanced HIV screening of PWID in these settings can facilitate earlier diagnosis and improve outbreak response.

scholarly journals Why the Treatment of Mental Disorders Is an Important Component of HIV Prevention among People Who Inject Drugs

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth Buckingham ◽  
Ezra Schrage ◽  
Francine Cournos
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Drug Use ◽  
Mental Disorders ◽  
Hiv Infection ◽  
Injection Drug Use ◽  
People Who Inject Drugs ◽  
Injection Drug ◽  
Hiv Care ◽  
Hiv Positive

People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.

Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use

2021 ◽  
Author(s):  
Wendy Macias-Konstantopoulos ◽  
Alan Heins ◽  
Carolyn J. Sachs ◽  
Paula J. Whiteman ◽  
Neil-Jeremy G. Wingkun ◽  
...  
Keyword(s):  
Emergency Department ◽  
Drug Use ◽  
Harm Reduction ◽  
Injection Drug Use ◽  
Emergency Department Visits ◽  
Injection Drug

scholarly journals When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Matayo Baluku ◽  
Twaibu Wamala
Keyword(s):  
Drug Use ◽  
Injection Drug Use ◽  
Drug Users ◽  
Time Lag ◽  
Rapid Assessment ◽  
Injecting Drug Users ◽  
Hcv Infection ◽  
Injection Drug ◽  
Structured Interviews ◽  
Increased Risk

Abstract Background In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country’s efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants. Results All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants’ social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting—which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater “high” (26.4%) which could reflect drug-tolerance, and 12% out of curiosity. Conclusions Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

scholarly journals Validation of a Syndromic Case Definition for Detecting Emergency Department Visits Potentially Related to Marijuana

2017 ◽  
Vol 132 (4) ◽  
pp. 471-479 ◽  
Author(s):  
Kathryn DeYoung ◽  
Yushiuan Chen ◽  
Robert Beum ◽  
Michele Askenazi ◽  
Cali Zimmerman ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Health Impact ◽  
Case Definition ◽  
Emergency Department Visits ◽  
Free Text ◽  
Search Term ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
The Impact

Objectives: Reliable methods are needed to monitor the public health impact of changing laws and perceptions about marijuana. Structured and free-text emergency department (ED) visit data offer an opportunity to monitor the impact of these changes in near-real time. Our objectives were to (1) generate and validate a syndromic case definition for ED visits potentially related to marijuana and (2) describe a method for doing so that was less resource intensive than traditional methods. Methods: We developed a syndromic case definition for ED visits potentially related to marijuana, applied it to BioSense 2.0 data from 15 hospitals in the Denver, Colorado, metropolitan area for the period September through October 2015, and manually reviewed each case to determine true positives and false positives. We used the number of visits identified by and the positive predictive value (PPV) for each search term and field to refine the definition for the second round of validation on data from February through March 2016. Results: Of 126 646 ED visits during the first period, terms in 524 ED visit records matched ≥1 search term in the initial case definition (PPV, 92.7%). Of 140 932 ED visits during the second period, terms in 698 ED visit records matched ≥1 search term in the revised case definition (PPV, 95.7%). After another revision, the final case definition contained 6 keywords for marijuana or derivatives and 5 diagnosis codes for cannabis use, abuse, dependence, poisoning, and lung disease. Conclusions: Our syndromic case definition and validation method for ED visits potentially related to marijuana could be used by other public health jurisdictions to monitor local trends and for other emerging concerns.

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