General hospital psychiatry · 2026
HIV diagnosis following psychiatric hospitalization among a large cohort of privately-insured people in the United States, 2003-2024.
СтатьяПоддержка NIH: внешняя программаПоддержка службы здравоохранения СШАПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Bunting Samuel R, Hyman Max J, Shetty Raj, Hazra Aniruddha
Аннотация
INTRODUCTION: People with mental illnesses and substance use disorders experience elevated HIV incidence. Psychiatric hospitalization may represent a critical but understudied opportunity to identify HIV risk and initiate preventive services, including pre-exposure prophylaxis (PrEP). This study describes new HIV diagnoses following psychiatric hospitalization among a large, privately-insured U.S.
METHODS: We conducted a retrospective cohort study using the Merative™ MarketScan® Commercial Database (2003-2024). Up to five psychiatric hospitalizations among individuals ≥14 years old were identified using diagnosis-related groups. Enrollees with evidence of pre-existing HIV were excluded using a conservative, claims-based algorithm. Enrollees were followed for up to 12-months after discharge. New HIV diagnoses were identified using diagnosis and antiretroviral therapy prescription criteria, excluding prescriptions for PrEP and post-exposure prophylaxis. We calculated frequencies, rates per 100,000 hospitalizations, and time to diagnosis, stratified by primary psychiatric admission reason and demographics.
RESULTS: Among 577,364 enrollees with 860,438 psychiatric hospitalizations, 314 new HIV diagnoses were identified. Most diagnoses occurred among males (78.8%) and individuals aged 14-24 years (36.6%). Mean time to HIV diagnosis was 144 days (median 123) following discharge across all admissions. The highest incidence rate was observed following hospitalization for stimulant use disorder (321 per 100,000) with a mean time to diagnosis of 116 days (median 71).
CONCLUSIONS: New HIV diagnoses following psychiatric hospitalization were concentrated among young males and individuals with stimulant use disorder. Findings highlight psychiatric hospitals as promising sites for HIV risk screening and PrEP initiation, particularly for populations with limited access to or engagement with primary care.
METHODS: We conducted a retrospective cohort study using the Merative™ MarketScan® Commercial Database (2003-2024). Up to five psychiatric hospitalizations among individuals ≥14 years old were identified using diagnosis-related groups. Enrollees with evidence of pre-existing HIV were excluded using a conservative, claims-based algorithm. Enrollees were followed for up to 12-months after discharge. New HIV diagnoses were identified using diagnosis and antiretroviral therapy prescription criteria, excluding prescriptions for PrEP and post-exposure prophylaxis. We calculated frequencies, rates per 100,000 hospitalizations, and time to diagnosis, stratified by primary psychiatric admission reason and demographics.
RESULTS: Among 577,364 enrollees with 860,438 psychiatric hospitalizations, 314 new HIV diagnoses were identified. Most diagnoses occurred among males (78.8%) and individuals aged 14-24 years (36.6%). Mean time to HIV diagnosis was 144 days (median 123) following discharge across all admissions. The highest incidence rate was observed following hospitalization for stimulant use disorder (321 per 100,000) with a mean time to diagnosis of 116 days (median 71).
CONCLUSIONS: New HIV diagnoses following psychiatric hospitalization were concentrated among young males and individuals with stimulant use disorder. Findings highlight psychiatric hospitals as promising sites for HIV risk screening and PrEP initiation, particularly for populations with limited access to or engagement with primary care.