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In the midst of an opioid epidemic, health care workers are encountering an increasing number of patients who have opioid use disorder in addition to complex social, behavioral and medical issues. Of all the clinicians in the hospital, nurses spend the most time with hospitalized patients who have opioid use disorder, yet there has been little research exploring their experiences in caring for this population. The objective of this study was to assess the attitudes, perceptions, and training needs of nurses in the inpatient setting when caring for patients who have opioid use disorder. One-on-one in-depth interviews were conducted with nurses working at a large academic medical center in Boston, MA, using a semi-structured interview guide. Nurses were recruited via email notifications and subsequent snowball sampling. Interviews were recorded, transcribed and analyzed using a grounded theory approach. Data from in-depth interviews with 22 nurses were grouped into six themes: (1) stigma, (2) assessing & treating pain, (3) feelings of burn out, (4) communication between providers, (5) safety & security, and (6) opportunities for change. These themes were organized within four ecological levels of the Socio-Ecological Model: I) societal context, II) hospital environment, III) interpersonal interactions, and IV) individual factors. Nurses were cognizant of the struggles that patients who have opioid use disorder confront during hospitalization such as pain, withdrawal and stigma, and elaborated on how these challenges translate to professional and emotional strain among nurses. Nurses offered recommendations by which the hospital could streamline care for this population, including expanded role support for nurses and more structured policies regarding care for patients who present with a comorbid opioid use disorder. Our results highlight the need for the development of programs targeting both organizational culture and the inpatient nurse quality of life to ultimately enhance quality of care for patients who present with opioid use disorder.

The Medicaid Inmate Exclusion Policy (MIEP) prohibits using federal funds for ambulatory care services and medications (including for infectious diseases) for incarcerated persons. More than one quarter of states, including California and Massachusetts, have asked the federal government for authority to waive the MIEP. To improve health outcomes and continuation of care, those states seek to cover transitional care services provided to persons in the period before release from incarceration. The Massachusetts Sheriffs' Association, Massachusetts Department of Correction, Executive Office of Health and Human Services, and University of Massachusetts Chan Medical School have collaborated to improve infectious disease healthcare service provision before and after release from incarceration. They seek to provide stakeholders working at the intersection of criminal justice and healthcare with tools to advance Medicaid policy and improve treatment and prevention of infectious diseases for persons in jails and prisons by removing MIEP barriers through Section 1115 waivers.

Background The persistent incidence of HIV among people who inject drugs (PWID) underscores the urgency for HIV prevention efforts to end the HIV epidemic. Little is known about the role carceral settings play as touchpoints for HIV testing in this population. The objectives of this study were to characterize patterns and sources of HIV testing among PWID and to understand how carceral facilities fit into this population’s HIV testing landscape. Methods Secondary analysis of cross-sectional survey data of PWID in the Boston metro area from the 2015 and 2018 cycles of the National HIV Behavioral Surveillance (NHBS). Among self-reported HIV-negative participants, we examined incarceration and HIV testing histories and used a multivariable modified Poisson regression model to evaluate the association between incarceration history (main exposure) and past-year HIV testing (primary outcome). Results Among 957 participants, average age was 38.9 (SD 11.1) years, 70.1% were male, 15.2% were Hispanic (of any race), 8.4% were non-Hispanic Black, and 68.1% were non-Hispanic White. Regarding incarceration experiences, 43.5% of participants reported past-year incarceration, and 41.8% reported a history of incarceration but only prior to the past year. Among those with past-year incarceration, 23.4% said their last HIV test was done at a jail or prison. Adjusting for other characteristics, compared to no incarceration history, past-year incarceration (PR 1.39; 95% CI: 1.29, 1.49) and incarceration prior to the past year (PR 1.19; 95%CI: 1.02, 1.38) were both associated with a greater prevalence of past-year HIV testing. Conclusions Among PWID, incarceration was very common and was a substantial source of HIV testing. However, more testing is still needed—in both community and carceral settings—to reach optimal testing rates in this key population.

HIV and hepatitis C virus (HCV) testing for all people in jail is recommended by the CDC. In the community, there are barriers to HIV and HCV testing for minoritized people. We examined the relationship between race and infectious diseases (HIV, HCV, syphilis) testing in one Massachusetts jail, Middlesex House of Corrections (MHOC). This is a retrospective analysis of people incarcerated at MHOC who opted-in to infectious diseases testing between 2016–2020. Variables of interest were race/ethnicity, self-identified history of psychiatric illness, and ever having experienced restrictive housing. Twenty-three percent (1,688/8,467) of people who were incarcerated requested testing at intake. Of those, only 38% received testing. Black non-Hispanic (25%) and Hispanic people (30%) were more likely to request testing than white people (19%). Hispanic people (16%, AOR 1.69(1.24–2.29) were more likely to receive a test result compared to their white non-Hispanic (8%, AOR 1.54(1.10–2.15)) counterparts. Black non-Hispanic and Hispanic people were more likely to opt-in to and complete infectious disease testing than white people. These findings could be related to racial disparities in access to care in the community. Additionally, just over one-third of people who requested testing received it, underscoring that there is room for improvement in ensuring testing is completed. We hope our collaborative efforts with jail professionals can encourage other cross-disciplinary investigations.

Objective Disparities in testing and treatment of pulmonary nontuberculous mycobacteria (P-NTM) warrant further investigation into language and race’s impact on treatment initiation. The objective of the study is to compare the length of treatment initiation for P-NTM patients assessed in the pulmonary and infectious diseases clinics through language and race. Results The cohort included 63 patients; 28 patients received treatment, and 35 patients did not receive treatment. According to the IDSA/ATS guidelines for diagnosis of pulmonary NTM, 55% of patients met all three categories, 40% of patients did not fulfill all three categories and 5% of patient charts were inconclusive. Charts were considered inconclusive if a comprehensive NTM evaluation was not conducted, such as no CT imaging, only one culture sent, or lost to follow up.

Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. We sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails. We conducted semi-structured interviews with people incarcerated in Middlesex County Jail (North Billerica, MA), clinicians working in jail and community settings, corrections administrators, and representatives from public health, government, and industry between November 2018-April 2019. 51/120 (42%) of people agreed to be interviewed including 21 incarcerated men (mean age 32 [IQR 25, 39], 60% non-White). Themes that emerged from these interviews included gaps in knowledge about HCV testing and treatment opportunities in jail, the impact of captivity and transience, and interest in improving linkage to HCV care after release. Many stakeholders discussed stigma around HCV infection as a factor in reluctance to provide HCV testing or treatment in the jail setting. Some stakeholders expressed that stigma often led decisionmakers to estimate a lower \"worth\" of incarcerated individuals living with HCV and therefore to decide against paying for HCV testing.\". All stakeholders agreed that HCV in the jail setting is a public health issue that needs to be addressed. Exploring stakeholders' many ideas about how HCV testing and treatment can be approached is the first step in developing feasible and acceptable strategies.

Background Injection drug use and needle sharing remains a public health concern due to the associated risk of HIV, HCV and skin and soft tissue infections. Studies have shown gendered differences in the risk environment of injection drug use, but data are currently limited to smaller urban cohorts. Methods To assess the relationship between gender and needle sharing, we analyzed publicly available data from the 2010–2019 National Survey on Drug Use and Health (NSDUH) datasets. Chi-square tests were conducted for descriptive analyses and multivariable logistic regression models were built adjusting for survey year, age, HIV status, and needle source. Results Among the entire sample, 19.8% reported receptive needle sharing, 18.8% reported distributive sharing of their last needle, and 37.0% reported reuse of their own needle during last injection. In comparison with men, women had 34% increased odds (OR 1.34, 95% CI 1.11–1.55) of receptive needle sharing and 67% increased odds (OR 1.67, 95% CI 1.41–1.98) of distributive needle sharing. Reuse of one's own needle did not differ by gender. Conclusions In this nationally representative sample, we found that women are more likely in comparison with men to share needles both through receptive and distributive means. Expansion of interventions, including syringe service programs, to increase access to sterile injection equipment is of great importance.

Background Eliminating infectious diseases epidemics requires resources for testing, prevention, and treatment in jails. The 2022 Centers for Diseases Control and Prevention guidelines recommend offering hepatitis C virus (HCV), HIV, and STI testing at jail intake. Currently, the impact of offering testing at intake in jails has only been analyzed in the context of multi-modal strategies to increase testing. There is a lack of real-world data about the impact of offering testing at jail intake as a strategy to increase testing. In May 2022, Plymouth County Correctional Facility in Massachusetts added questions to their intake form offering HIV, HCV, syphilis, gonorrhea, and chlamydia testing. The goal of this project was to assess frequency of testing before and after the addition of infectious diseases testing questions to the intake form. Case presentation Data about infectious diseases testing completion per month were compared between February-April 2022 and May 2022-June 2023. The transition from rapid to venipuncture HIV testing was also compared between September 2021-June 2023. Data was assessed in monthly intervals. The median number of urine tests decreased from 39 to 28, and the median number of blood tests decreased from 21 to 15 after testing was offered during intake. Conclusion There were no significant trends in the run chart after the intervention. Although offering testing at intake is one important part of healthcare in jails, intake testing should be supported with other systems including access to phlebotomy, facilitated movement from the housing areas to the medical unit, and stigma reduction tools.

Background Studies on the impact of the novel SARS-CoV-2 virus (COVID) for healthcare workers (HCWs) rarely include the full spectrum of hospital workers, including less visible patient support roles. In the early days of the pandemic, COVID testing was preferentially available to HCWs. The objective of this study was to understand how individual experiences for all HCWs during the pandemic were associated with perceptions of access to, and receipt of COVID testing . Methods All hospital employees ( n  = 6736) in a single academic medical center in Boston, Massachusetts were invited to participate in a cross-sectional survey regarding perceived access to, and receipt of COVID testing during the first wave of the pandemic (March – August 2020). Responses were linked to human resources data. Log binomial univariate and multivariable models were used to estimate associations between individual and employment variables and COVID testing. Results A total of 2543 employees responded to the survey (38 %). The mean age was 40 years (± 14). Respondents were female (76 %), white (55 %), worked as nurses (27 %), administrators (22 %) and patient support roles (22 %); 56 % of respondents wanted COVID testing. Age (RR 0.91, CI 0.88–0.93), full time status (RR 0.85, CI 0.79–0.92), employment tenure (RR 0.96, CI 0.94–0.98), changes in quality of life (RR 0.94, CI 0.91–0.96), changes in job duties (RR 1.19, CI 1.03–1.37), and worry about enough paid sick leave (RR 1.21, CI 1.12–1.30) were associated with interest in testing. Administrators (RR 0.64, CI 0.58–0.72) and patient support staff (RR 0.85, CI 0.78–0.92) were less likely than nurses to want testing. Age (RR 1.04, CI 1.01–1.07), material hardships (RR 0.87, CI 0.79–0.96), and employer sponsored insurance (RR 1.10, CI 1.00-1.22) were associated with receiving a COVID test. Among all employees, only administrative/facilities staff were less likely to receive COVID testing (RR 0.69, CI 0.59–0.79). Conclusions This study adds to our understanding of how hospital employees view availability of COVID testing. Hazard pay or other supports for hospital workers may increase COVID testing rates. These findings may be applicable to perceived barriers towards vaccination receipt.

Background The CDC recommends that all individuals who are hospitalized be offered HIV testing. Low HIV testing rates have been reported among hospitalized patients. We investigated expanding HIV testing among hospitalized patients at our medical center, and hospital leadership consistently recommended exploring nursing-driven, universal HIV testing. The goal of this study was to use qualitative methods to evaluate Tufts Medical Center inpatient nurses’ perspectives about the barriers and facilitators of implementing an inpatient nursing-based HIV testing protocol. Methods The study employed a qualitative research design through in-depth interviews and focus groups; these guides were developed based on Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Any inpatient nurse employed at Tufts Medical Center in January 2023 was eligible to participate, including case managers and travel nurses. Nurses were recruited through in-person recruitment, email, or flyers. Results 42 inpatient nurses participated in ten focus groups and two interviews. Eight primary themes emerged that were categorized into barriers and facilitators/strategies. The barriers were (1) concern that HIV testing would increase the nurse charting burden, (2) belief that HIV testing is not a priority for hospitalized patients, (3) concern that HIV testing consent is outside the scope of nursing practice, (4) misinformation about the required HIV testing consenting process, and (5) concern about offending patients. The facilitators/strategies were (6) belief that HIV testing is necessary for personal health, beneficial to public health and necessary for occupational safety; (7) ability to leverage existing systems of care support to HIV testing; and (8) ability to leverage current systems of education to increase HIV testing. Results showed that fostering trust within treatment teams and between patients and nurses would enable nurses to obtain patient consent for HIV testing without fear of negative consequences. Conclusions While nurses have concerns about offering HIV testing to all hospitalized patients, there are existing systems that can be leveraged to make implementing of universal, nursing-driven HIV testing acceptable and sustainable; these include protocolization; engagement and trust; and nursing champions of expanding HIV testing.