Effectiveness of an Embedded Infectious Disease Screening, Treatment, and Prevention Intervention Within an Inpatient Substance Use Treatment Program.

BACKGROUND

People with substance use disorders (SUDs) are at higher risk for infectious diseases (IDs). Co-locating ID screening services within inpatient SUD treatment programs may decrease barriers to care; however, the impact of such screening has not been evaluated.

METHODS

We conducted an effectiveness study evaluating comprehensive ID screening within an 18-bed inpatient SUD program. During usual care (September 2021-June 2022), ID screening was completed at the discretion of the admitting psychiatrist. During the intervention (September 2022-June 2023), an ID-trained nurse met with patients to support completion of screening for HIV, viral hepatitis (hepatitis A [HAV], B [HBV], and C [HCV]), latent tuberculosis [LTBI], and sexually transmitted infections [STI]. Hepatitis vaccinations, HIV preexposure prophylaxis, and/or ID treatments were offered during admission.

RESULTS

Demographics were similar between the groups (n = 261, usual care; n = 207, intervention). Screening for ≥1 ID increased significantly during the intervention (60.2% vs 90.8%, P < .001), with the greatest increases in HAV (6.1% vs 90.3%, P < .001), HBV (8.8% vs 91.3%, P < .001), and LTBI (1.9% vs 67.8%, P < .001). HAV and HBV vaccinations increased from 0% to 58% and 71%, respectively. HCV viremia was identified in 15 usual care and 19 intervention patients, of whom 0% and 36.8% initiated direct-acting antiviral therapy within 2 weeks of testing. STIs were identified in 9.2% and 13.5% (P = .09) of the patients in the usual care and intervention groups.

CONCLUSIONS

Comprehensive ID screening within inpatient SUD programs can increase uptake of testing and facilitate low-barrier delivery of preventive and therapeutic treatment.