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

Rebecca Metcalfe*, Manon Ragonnet-Cronin, Amanda Bradley-Stewart, Andrew McAuley, Harrison Stubbs, Trina Ritchie, Regina O'Hara, Kirsten Trayner, Claire Glover, Lynn Laverty, Laura Sills, Kathryn Brown, Rory Gunson, John Campbell, Catriona Milsoevic, Patricia Anderson, S. Erica Peters

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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.

Original languageEnglish
Pages (from-to)S410-S419
Number of pages10
JournalJournal of Infectious Diseases
Volume222
Issue numberSupplement_5
Early online date2 Sep 2020
DOIs
Publication statusPublished - 1 Oct 2020

Keywords

  • Antirheumatic Agents/therapeutic use
  • Community Health Services/methods
  • Contact Tracing/methods
  • Disease Outbreaks/prevention & control
  • Female
  • HIV Infections/drug therapy
  • HIV Testing/methods
  • HIV/genetics
  • Homeless Persons
  • Humans
  • Male
  • Medication Adherence
  • Models, Organizational
  • Nurses/organization & administration
  • Pharmacies/organization & administration
  • Phylogeny
  • Scotland/epidemiology
  • Substance Abuse, Intravenous/complications
  • Viral Load

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