From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs

Abstract An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within home...

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Bibliographic Details
Published in:The Journal of infectious diseases 2020-09, Vol.222 (Supplement_5), p.S410-S419
Main Authors: Metcalfe, Rebecca, Ragonnet-Cronin, Manon, Bradley-Stewart, Amanda, McAuley, Andrew, Stubbs, Harrison, Ritchie, Trina, O’Hara, Regina, Trayner, Kirsten, Glover, Claire, Laverty, Lynn, Sills, Laura, Brown, Kathryn, Gunson, Rory, Campbell, John, Milsoevic, Catriona, Anderson, Patricia, Peters, S Erica
Format: Article
Language:English
Subjects:
Antiretroviral drugs
Antiretroviral therapy
Antirheumatic Agents - therapeutic use
Community Health Services - methods
Community Health Services - organization & administration
Contact Tracing - methods
Disease Outbreaks - prevention & control
Female
HIV
HIV - genetics
HIV - isolation & purification
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV Infections - transmission
HIV Testing - methods
Homeless Persons
Human immunodeficiency virus
Humans
Male
Medication Adherence
Models, Organizational
Nurses - organization & administration
Outbreaks
Pharmacies - organization & administration
Phylogenetics
Phylogeny
Scotland - epidemiology
Substance Abuse, Intravenous - complications
Substance Abuse, Intravenous - therapy
Supplement
Viral Load
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Summary:Abstract An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa336