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Introduction: The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers., Methods: A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery., Results: Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them., Conclusion: A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery., Competing Interests: CP was employed by the Healthspring Global Inc. CP reports receiving consulting fees from Abbott Molecular and Rapid Diagnostics. ET has been a consultant for Biomeme, Inc., has a patent pending for Methods to Diagnose and Treat Acute Respiratory Infections (US20180245154A1), and is currently employed by Danaher Corp. MC-W reports receiving support for research from the NIH (1U24-MD016258), National Institute of Allergy and Infectious Diseases (HHSN272201500006I, 1K24-AI143971), U.S. Food and Drug Administration (5U18-FD006298), and industry for drug development in adults and children. CW reports grants or contracts from DARPA, NIH-ARLG/NIAID/VTEU/NIMHO/NIGMS, Sanofi, Najit, CDC, Patient-Centered Outcomes Research Institute, USAMRAA, DOD, Abbott, and Pfizer; consulting fees from Arena Pharmaceuticals, BioFire, FHI Clinical, Giner, Karius, and SeLux Diagnostics; support for attending meetings and/or travel from American Society for Microbiology; patents planned, issued or pending for: biomarkers for the molecular classification of bacterial infection, methods to diagnose and treat acute respiratory infections, gene expression signatures useful to predict or diagnose sepsis and methods of using the same, host based molecular signatures of human infection with SARS-CoV-2 (COVID19), methods of identifying infectious disease and assays for identifying infectious disease, and nasopharyngeal protein biomarkers of acute respiratory virus infection and methods of using same; participation on a Data Safety Monitoring Board or Advisory Board for IDbyDNA, Janssen, Regeneron, Roche Molecular Sciences; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid for American Society for Microbiology and American Society of Tropical Medicine and Hygiene; and other financial or non-financial interests with Biomeme and Predigen, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Johannesson, Glover, Petti, Veldman, Tsalik, Taylor, Hendren, Neighbors, Tillekeratne, Kennedy, Harper, Kibbe, Corbie, Cohen-Wolkowiez, Woods and Lee.)

Background: The Treatment as Prevention for Hepatitis C program started in 2016 in Iceland, offering treatment with direct-acting antivirals to hepatitis C virus (HCV)-infected individuals. Reinfections through injection drug use (IDU) can hamper elimination efforts. We determined reinfection rates of HCV among patients in the program., Methods: Clinical data were gathered prospectively. The study cohort consisted of HCV-cured patients with an estimated sustained virologic response between 1 February 2016 and 20 November 2018, with follow-up until 20 November 2019. The observation period and time until reinfection was estimated using a single random point imputation method coupled with Monte Carlo simulation. The reinfection rates were expressed as reinfections per 100 person-years (PY)., Results: In total, 640 treatments of 614 patients (417 male; mean age, 44.3 years) resulted in cure, with 52 reinfections subsequently confirmed in 50 patients (37 male). Follow-up was 672.1 PY, with a median time to reinfection of 232 days. History of IDU was reported by 523 patients (84.8%) and recent IDU with 220 treatments (34.4%). Stimulants were the preferred injected drug in 85.5% of patients with a history of IDU. The reinfection rate was 7.7/100 PY. Using multivariate Cox proportional hazards models for interval-censored data, age (hazard ratio, 0.96 [95% confidence interval, .94-.99]) and recent IDU (2.91 [1.48-5.76]) were significantly associated with reinfection risk., Conclusions: The reinfection rate is high in a setting of widespread stimulant use, particularly in young people with recent IDU. Regular follow-up is important among high-risk populations to diagnose reinfections early and reduce transmission., Clinical Trials Registration: NCT02647879., Competing Interests: Potential conflicts of interest. S. O. and M. G. report consultancy and speaker’s fees from Gilead Sciences. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed, (© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.)

Fever complicated by delirium is a common problem in emergency departments and inpatient wards. There are various possible causes that must all be contemplated. Infections are prominent causes due to acuteness and severity, but when generating a differential diagnosis, other causes may be life-threatening and require swift diagnosis and management. We present here a case of a 58 year old man presenting at the emergency department with fever and delirium. After comprehensive history-taking and examination, alongside targeted testing, the correct diagnosis was ascertained, leading to appropriate treatment.