HIV outbreak in persons who inject drugs (PWID): Supplement to MDH health advisory

Purpose

• Hennepin County is providing updated screening recommendations for emergency departments, inpatient hospitals, and outpatient clinics.
• These updates increase screening for those at risk of HIV. 
• These recommendations do not replace MDH’s HAN from February 6, 2020, but provide further guidance. 

Updated screening recommendations for health care providers 

Emergency departments and inpatient hospitals 

If HIV testing for all patients is not possible, the best practice is to test the following populations at every encounter, pending available resources: 

• Patients presenting for complications of IVDU such as: abscess/cellulitis, endocarditis, bacteremia, osteomyelitis, sepsis  
• Patients presenting for overdose reversal  
• All patients experiencing unsheltered homelessness  

Outpatient clinics 

Persons who are at high risk of HIV infection should be tested when requested or willing, or at least every 3 months. Persons likely to be at high risk include:  

• People who inject drugs 
• Sex partners of people who inject drugs  
• People who exchange sex for income or other things they need  

Rationale for updated screening recommendations 

The HIV outbreak in Hennepin and Ramsey Counties continues.

• As of December 19, 2021, 86 cases have been included in the outbreak 
• 41 cases have been newly diagnosed since MDH’s February 6, 2020 HAN was published 

Cases are visiting the ED prior to diagnosis but are not receiving screening and testing. A cross-section of data* shows that: 

• In the 90 days prior to diagnosis, 24% of people on the outbreak list made 47 ED visits where no testing was done  
• In the 3 years prior to diagnosis, 59% of people on the outbreak list visited the ED at least once; 82% of those people did not receive HIV testing 

In the 3 years prior to HIV diagnosis, cases visited the ED for IVDU-related complications. 

• 30% of visits were for mental, behavioral, and neurodevelopmental disorders including opioid-related disorders, stimulant-related disorders, other specified substance-related disorders, and alcohol-related disorders  
• 11% of cases were diagnosed with cellulitis/abscess 
• 13% of cases were seen for drug poisoning 
• 10% of cases were seen for bacterial infections or septicemia  

Resources 

• A copy of this supplement to the MDH HAN is available at hennepin.us/hiv-outbreak
• Contact Martha Trevey, DNP, MPH, Hennepin County Health Care for the Homeless Clinical Services Manager, at Martha.Trevey@hennepin.us with questions or comments 

All cases of HIV should be reported to MDH by phone to 651-201-5414, 877-676-5414 or by filling out a HIV/AIDS Confidential Case Report Form and faxing to MDH’s confidential fax number. 

*Data is limited to the HCMC ED