title: Trends in use of health care and HIV prevention services for persons who inject drugs in San Francisco: results from National HIV Behavioral Surveillance 2005-2012.
abstract: BACKGROUND
  Multiple developments addressing health of people who inject drugs (PWIDs) in San Francisco were initiated from 2003 to 2012, including expanded health care coverage, syringe access, HIV testing and universal HIV treatment.
  
  
  METHODS
  We evaluated 3 PWID cycles of the National HIV Behavioral Surveillance for several healthcare measures related to the expanded services. Using RDSAT estimators, we applied the Cochran-Armitage test for trend to evaluate signals of improvement during the time in which health system changes were made.
  
  
  RESULTS
  Participant demographics were similar (n=565, 535, and 570 in 2005, 2009, and 2012, respectively). There was a substantial increase in healthcare coverage (37.6 to 82.5%, P<0.0001). Obtaining syringes from pharmacies (17.8 to 32.1%, P<0.0001) increased substantially. Past year hepatitis C testing increased (16.5 to 33.1%, P<0.0001) with stable self-reported prevalence (45.7-54.2%, P=0.8). Among those with known HIV, antiretroviral treatment was reported among 46.6% in 2005 and 66.3% in 2012. Past year HIV testing declined from 74.2 to 42.1%, (P<0.0001) and the prevalence of unrecognized HIV among PWIDs was 42.2-42.7% in 2009 and 2012.
  
  
  CONCLUSIONS
  There is evidence of improvement in some health measures for PWIDs in San Francisco from 2005 to 2012. However, there are also some concerning findings, such as declining prevalence of HIV testing and high prevalence of undiagnosed HIV. There is a need for renewed attention and innovative ideas to track and address HIV and other medical sequelae among PWIDs.
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, United States.
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, United States.
authors.forename: Harry
authors.initials: H
authors.lastname: Jin
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, United States.
authors.forename: Emalie
authors.initials: E
authors.lastname: Huriaux
authors.affiliation: University of California, San Francisco, CA, United States.
authors.forename: Ali
authors.initials: A
authors.lastname: Mirzazadeh
authors.affiliation: San Francisco Department of Public Health, San Francisco, CA, United States. Electronic address: hfisherraymond@yahoo.com.
authors.forename: Henry F
authors.initials: HF
authors.lastname: Raymond
mesh_terms: D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health / Q000639:trends; D008297:Male; D008403:Mass Screening / Q000639:trends*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012495:San Francisco / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology; D013594:Syringes / Q000639:trends
keywords: Care; HIV; Hepatitis; People who inject drugs; San Francisco