Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study

Behrends, Czarina N.; Kapadia, Shashi N; Schackman, Bruce R.; Frimpong, Jemima A.

doi:10.1097/phh.0000000000001262

Cited by 8 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surveys are, however, conducted at OTP facilities to record methadone administration. 19 A series of surveys [20][21][22]…”

Section: Discussionmentioning

confidence: 99%

“…Surveys are, however, conducted at OTP facilities to record methadone administration. 19 A series of surveys 20 , 21 , 22 conducted via National Drug and Alcohol Testing Systems in 2008 to 2017 documented both dosage patterns in methadone use and found that many practitioners dose underrecommended levels, particularly in racially underrepresented populations. However, the National Survey of Substance Abuse Treatment Services and National Drug and Alcohol Testing Systems do not have data on individual patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes

et al. 2023

View full text Add to dashboard Cite

ImportanceA significant proportion of Medicare beneficiaries have a diagnosed opioid use disorder (OUD). Methadone and buprenorphine are both effective medications for the treatment of OUD (MOUDs); however, Medicare did not cover methadone until 2020.ObjectiveTo examine trends in methadone and buprenorphine dispensing among Medicare Advantage (MA) enrollees after 2 policy changes in 2020 related to methadone access.Design, Setting, and ParticipantsThis cross-sectional analysis of temporal trends in methadone and buprenorphine treatment dispensing assessed MA beneficiary claims from January 1, 2019, through March 31, 2022, captured by Optum’s Clinformatics Data Mart. Of 9 870 791 MA enrollees included in the database, 39 252 had at least 1 claim for methadone, buprenorphine, or both during the study period. All available MA enrollees were included. Subanalyses by age and dual eligibility for Medicare and Medicaid status were conducted.ExposuresStudy exposures were (1) the Centers for Medicare &amp; Medicaid Services (CMS) Medicare bundled payment reimbursement policy for OUD treatment and (2) the Substance Abuse and Mental Health Administration and CMS Medicare policies designed to facilitate access to treatment for OUD, specifically during the COVID-19 pandemic.Main Outcomes and MeasuresStudy outcomes were trends in methadone and buprenorphine dispensing by beneficiary characteristics. National methadone and buprenorphine dispensing rates were calculated as claims-based dispensing rates per 1000 MA enrollees.ResultsAmong the 39 252 MA enrollees with at least 1 MOUD dispensing claim (mean age, 58.6 [95% CI, 58.57-58.62] years; 45.9% female), 195 196 methadone claims and 540 564 buprenorphine pharmacy claims were identified, for a total of 735 760 dispensing claims. The methadone dispensing rate for MA enrollees was 0 in 2019 because the policy did not allow any payment until 2020. Claims rates per 1000 MA enrollees were low initially, increasing from 0.98 in the first quarter of 2020 to 4.71 in the first quarter of 2022. Increases were primarily associated with dually eligible beneficiaries and beneficiaries younger than 65 years. National buprenorphine dispensing rates were 4.64 per 1000 enrollees in quarter 1 of 2019, increasing to 7.45 per 1000 enrollees in quarter 1 of 2022.Conclusions and RelevanceThis cross-sectional study found that methadone dispensing increased among Medicare beneficiaries after the policy changes. Rates of buprenorphine dispensing did not provide evidence that beneficiaries substituted buprenorphine for methadone. The 2 new CMS policies represent an important first step in increasing access to MOUD treatment for Medicare beneficiaries.

show abstract

“…Surveys are, however, conducted at OTP facilities to record methadone administration. 19 A series of surveys [20][21][22]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Yet, despite the need, feasibility and value of on-site HIV testing in these viable settings, most programs do not offer testing, with less than half of U.S. SUD programs and less than one-third of OTPs offering on-site HIV testing [ 14 ]. Prior research has noted many significant organizational-level and client-level barriers preventing widespread HIV testing uptake in these treatment settings, including lack of reimbursement and insufficient billing systems, constraints surrounding staffing, resources, training and workflow, and concerns about delivering HIV test results and linkage to care [ 14 – 16 ]. In addition, research has shown greater prioritization and perceived need for hepatitis C virus (HCV) testing compared to HIV testing, given the higher prevalence of HCV compared to HIV within this population [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs

Frimpong,

Parish,

Feaster

et al. 2023

Trials

Self Cite

View full text Add to dashboard Cite

Background People with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the USA offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance. Methods/design In this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based “practice coaching” (PC) interventions on the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e.g., HIV and HCV testing at 6-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7–12 months after randomization. Discussion Innovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health. Trial registration ClinicalTrials.gov NCT03135886. Registered on 2 May 2017.

show abstract

“…Yet, despite the need, feasibility and value of on-site HIV testing in these viable settings, most programs do not offer testing, with less than half of U.S. SUD programs and less than one-third of OTPs offering on-site HIV testing (14). Prior research has noted many significant organizational-level and client-level barriers preventing widespread HIV testing uptake in these treatment settings, including lack of reimbursement and insufficient billing systems, constraints surrounding staffing, resources, training and workflow, and concerns about delivering HIV test results and linkage to care (14)(15)(16). In addition, research has shown greater prioritization and perceived need for Hepatitis C virus (HCV) testing compared to HIV testing, given the higher prevalence of HCV compared to HIV within this population (17,18).…”

Section: Introductionmentioning

confidence: 99%

A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs

Frimpong,

Parish,

Feaster

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background People with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the United States offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance. Methods/Design In this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based “practice coaching” (PC) interventions on: the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e,g., HIV and HCV testing at six-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7-12 months after randomization. Discussion Innovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health. Trial registration ClinicalTrials.gov: NCT03135886. (02 05 2017)

show abstract

Addressing Barriers to On-site HIV and HCV Testing Services in Methadone Maintenance Treatment Programs in the United States: Findings From a National Multisite Qualitative Study

Cited by 8 publications

References 28 publications

Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes

Trends in Methadone Dispensing for Opioid Use Disorder After Medicare Payment Policy Changes

A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs

A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs

Contact Info

Product

Resources

About