Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States

Bini, Edmund J.; Kritz, Steven; Brown, Lawrence S.; Robinson, Jim; Calsyn, Donald A.; Alderson, Don; Tracy, Kathlene; McAuliffe, Patrick; Smith, Cheryl C.; Rotrosen, John

doi:10.1016/j.jsat.2011.09.007

Cited by 10 publications

(8 citation statements)

References 48 publications

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“…46 The barriers we identified are similar to those reported in National Drug Abuse Treatment Clinical Trials Network programs and by providers in other settings such as emergency rooms, prenatal clinics, and community-based organizations. [10][11][12][13]17,47 However, characteristics that distinguished programs offering testing from those who do not in national studies differed in some respects in our study. For example, unlike reports from other studies, testing in Arkansas was not provided by programs offering opiate substitution, medical detoxification, or programs with licensed medical staff.…”

Section: Routine Testing Has Also Been Successfully Integrated Incontrasting

confidence: 66%

A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State

Wright

Curran

Stewart

et al. 2013

The Journal of Rural Health

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Purpose Integrating HIV testing programs into substance use treatment is a promising avenue to help increase access to HIV testing for rural drug users. Yet few outpatient substance abuse treatment facilities in the United States provide HIV testing. The purpose of this study was to identify barriers to incorporating HIV testing with substance use treatment from the perspectives of treatment and testing providers in Arkansas. Methods We used purposive sampling from state directories to recruit providers at state, organization, and individual levels to participate in this exploratory study. Using an interview guide, the first and second authors conducted semi-structured individual interviews in each provider’s office or by telephone. All interviews were recorded, transcribed verbatim, and entered into ATLAS.ti software (ATLAS.ti Scientific Sofware Development GmbH, Berlin, Germany). We used constant comparison and content analysis techniques to identify codes, categories, and primary patterns in the data. Findings The sample consisted of 28 providers throughout the state, 18 from the substance use system and 10 from the public/ community health system. We identified 7 categories of barriers: environmental constraints, policy constraints, funding constraints, organizational structure, limited inter- and intra-agency communication, burden of responsibility, and client fragility. Conclusions This study presents the practice-based realities of barriers to integrating HIV testing with substance use treatment in a small, largely rural state. Some system and/or organization leaders were either unaware of or not actively pursuing external funds available to them specifically for engaging substance users in HIV testing. However, funding does not address the system-level need for coordination of resources and services at the state level.

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Section: Routine Testing Has Also Been Successfully Integrated Incontrasting

confidence: 66%

A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State

Wright

Curran

Stewart

et al. 2013

The Journal of Rural Health

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“…Testing substance abuse treatment program clients for HCV represents an important opportunity to identify and cure chronically infected individuals in order to fully realize the potential of new, highly effective and well‐tolerated HCV therapies . However, in a survey of community‐based substance abuse treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) only 28% of programs offered HCV antibody testing on‐site or through referral to other testing sites, and in a survey of out‐patient substance abuse treatment programs only 29% of clients had received HIV testing on‐ or off‐site . A more recent survey found a significant reduction in the proportion of opioid treatment programs conducting HIV testing between 2005 and 2011 and a significantly higher likelihood of testing in publicly owned programs , suggesting that lack of reimbursement may be playing an increasing role in decisions about whether to offer testing in private for‐profit and non‐profit programs.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of rapid hepatitisCvirus (HCV) testing and simultaneous rapidHCVandHIVtesting in substance abuse treatment programs

et al. 2014

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Aims To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Design We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer, and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody positive, and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV (HEP-CE) and HIV (CEPAC). Setting and Participants Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the USA. Measurements Lifetime costs (2011 US dollars) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs) Findings On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in approximately 90% of probabilistic sensitivity analyses. Conclusions On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/ quality-adjusted life years threshold.

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“…In some cases, these facilities employ multidisciplinary teams that may be capable of addressing the medical comorbidities and the social service needs of PWID on-site. The majority of OAT facilities, however, do not have the capacity or the infrastructure necessary to offer this level of care (Bini et al, 2011, 2012); even among those venues where primary care medical services are available on-site, few programs seem to offer HCV-related care. Other barriers to the engagement of PWID in hepatitis C treatment, such as patients’ lack of knowledge, must also be addressed to obtain their full participation in care.…”

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confidence: 99%

Hepatitis C Virus–Related Knowledge and Willingness to Receive Treatment Among Patients on Methadone Maintenance

Zeremski

Dimova

Zavala

et al. 2014

Journal of Addiction Medicine

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Objectives Although persons who inject drugs have high prevalence of hepatitis C virus (HCV) infection, few receive treatment mostly because of lack of knowledge about the infection and its treatment. We assessed the level of HCV-related knowledge and willingness to participate in HCV treatment among methadone-maintained patients. Methods A 30-item survey covering HCV-related knowledge and willingness to engage in HCV-related education and treatment was developed and completed by 320 methadone-maintained patients. Results Respondents’ mean age was 53 ± 8.7 years, 59.5% were male, 55.1% were African American, and 38.3% were Hispanic. The mean duration of methadone maintenance was 7 ± 6.7 years. In the preceding 6 months, 6.9% of patients reported injection drug use, whereas 37.3% used noninjection drugs. Hepatitis C virus seropositivity was self-reported by 46.3% of patients. The majority of patients (78%) expressed willingness to participate in HCV-related education and to receive HCV treatment. Most patients (54.7%) correctly answered 5 or more of 7 questions assessing HCV knowledge. Hepatitis C virus–seropositive individuals and prior attendees at HCV-related educational activities demonstrated a higher level of HCV-related knowledge (P < 0.001 and P = 0.002, respectively). Younger patients (P = 0.014), those willing to attend an HCV-related educational activity (P < 0.001), and those with higher–HCV-related knowledge (P = 0.029) were more accepting of HCV treatment. Fear of medication-related side effects was the most common reason for treatment avoidance. Conclusions The majority of patients reported willingness to receive HCV-related education and treatment. Treatment willingness was significantly associated with previous attendance at an HCV educational activity and a higher level of HCV-related knowledge.

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Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States

Cited by 10 publications

References 48 publications

A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State

A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State

Cost‐effectiveness of rapid hepatitisCvirus (HCV) testing and simultaneous rapidHCVandHIVtesting in substance abuse treatment programs

Hepatitis C Virus–Related Knowledge and Willingness to Receive Treatment Among Patients on Methadone Maintenance

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