Adan Matthew A, Psaros Christina, Kehoe Laura, Macias-Konstantopoulos Wendy L, Parker Robert A, Kanjilal Diane, Fernandes Lilly, Caramazza Francesca, Bassett Ingrid V, Ard Kevin L
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
AIDS Care. 2025 Jul 25:1-12. doi: 10.1080/09540121.2025.2536183.
Suffolk County, Massachusetts is an Ending the HIV Epidemic priority area with an ongoing cluster of HIV transmission among people who inject drugs, many of whom accessed care in emergency departments prior to diagnosis but were not offered HIV testing. Emergency-department-based HIV testing and pre-exposure prophylaxis initiation have thus become local public health priorities. We conducted a content analysis of in-depth interviews with 26 people who inject drugs recruited from a substance use disorder clinic in Suffolk County serving people who received initial care in the emergency department. Interview questions investigated acceptability, barriers, and facilitators to HIV testing and pre-exposure prophylaxis initiation in the emergency department for people who inject drugs. Mean age was 38y (SD 9.4); 62% were male, with 69% identifying as white and 27% as Latinx. We identified five themes: 1) Support for emergency-department-based HIV testing, 2) Need for multimodal HIV testing, 3) Creating a safe and supportive environment, 4) Pre-exposure prophylaxis misconceptions, and 5) Addressing competing priorities. People who inject drugs are supportive of HIV testing and pre-exposure prophylaxis initiation in emergency departments but acknowledge reasons for declining. Possible modifications to increase acceptance include offering multiple HIV testing modalities and creating safe, confidential spaces to discuss testing and pre-exposure prophylaxis.
马萨诸塞州萨福克县是“终结艾滋病流行”的重点地区，在注射毒品者中存在持续的艾滋病病毒传播集群，其中许多人在确诊前曾在急诊科接受治疗，但未接受艾滋病病毒检测。因此，基于急诊科的艾滋病病毒检测和暴露前预防启动已成为当地公共卫生的重点。我们对从萨福克县一家物质使用障碍诊所招募的26名注射毒品者进行了深入访谈的内容分析，该诊所为在急诊科接受初始治疗的人员提供服务。访谈问题调查了注射毒品者在急诊科接受艾滋病病毒检测和暴露前预防启动的可接受性、障碍和促进因素。平均年龄为38岁（标准差9.4）；62%为男性，69%为白人，27%为拉丁裔。我们确定了五个主题：1）支持基于急诊科的艾滋病病毒检测，2）需要多模式艾滋病病毒检测，3）营造安全和支持性环境，4）暴露前预防误解，5）解决相互竞争的优先事项。注射毒品者支持在急诊科进行艾滋病病毒检测和启动暴露前预防，但也承认拒绝的原因。为提高接受度可能进行的调整包括提供多种艾滋病病毒检测方式，以及创建安全、保密的空间来讨论检测和暴露前预防。
