Hepatitis C testing in substance use disorder treatment: the role of program managers in adoption of testing services

Frimpong, Jemima A.; D’Aunno, Thomas

doi:10.1186/s13011-016-0057-2

Cited by 5 publications

(3 citation statements)

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“…The majority of these (88%) were from high-income countries, mainly the United States and Western Europe, with only 6 from LMICs. These reports described testing programmes in a range of populations including: 13 of HCV birth-cohort testing in the context of the United States national recommendation to screen all adults living in the United States born between 1945 and 1965 at least once [ 8 , 16 , 19 , 22 – 25 , 38 , 42 , 45 , 47 , 51 , 53 ]; 10 of HCV and one of both HBV and HCV in people who use drugs or harm reduction settings [ 10 , 12 , 20 , 21 , 32 , 34 , 35 , 39 – 41 , 51 ]; 4 of HCV in prisons [ 7 , 15 , 17 , 54 ]; 3 of HBV testing in pregnant women [ 29 , 46 , 52 ]; and one of HBV and one of HCV in migrants [ 14 , 43 ]. Of note, most of the programmes described were also community based or implemented in primary health care or prevention services.…”

Section: Discussionmentioning

confidence: 99%

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

et al. 2017

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BackgroundThere have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up.MethodsHepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these.ResultsWe interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers.ConclusionsAt this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing.Electronic supplementary materialThe online ver...

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Section: Discussionmentioning

confidence: 99%

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

et al. 2017

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“…Random sampling per strata was adjusted by replacement if the overall sample did not have representation from different regions, Medicaid expansion state status, leadership score (composite score of 8 questions on leadership efforts to learn about developments in SUD treatment coded as high if equal or above median score and low if below median score),13 and participation in an accountable care organization or patient-centered medical home. Our selection of these inclusion criteria was informed by findings from prior studies on barriers to testing 9,10…”

Section: Methodsmentioning

confidence: 99%

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

Kapadia

Schackman

et al. 2020

Journal of Public Health Management and Practice

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Context: Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective. Objective: To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing. Design: We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes. Setting: Seven MMT programs located in 6 states in the United States. Participants: Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing. Main Outcome Measure: Themes related to integration of on-site HIV/HCV testing. Results: Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination. Conclusion:Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.

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“…This rise in HCV incidence is related to the addiction epidemic (Grebely & Dore, 2014). More than 80% of patients with opioid use disorders (OUDs) who inject drugs are infected with HCV, and 75% of all new HCV cases in the United States are patients who inject drugs (Frigpong & D'Aunno, 2016). The Centers for Disease Control and Prevention (CDC) recommended further testing recommendations of hepatitis panels, full STD testing, and early follow-up care (CDC, 2017).…”

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confidence: 99%

A Quality Improvement Project

Joy,

Gunn,

Mulekar

2022

UJAN

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Purpose This quality improvement project was introduced at an addiction treatment center to implement the Centers for Disease Control and Prevention's (CDC's) hepatitis C virus (HCV) treatment guidelines and offer anticraving medications to patients to improve standards of care of patients with substance use disorders. Literature Review Patients with opioid use disorders are at the highest risk of contracting HCV. More than 80% of people in the United States with opioid use disorders who use intravenous drugs have contracted HCV. Despite the high prevalence of HCV, patients at treatment centers are being screened only for HCV antibodies (HCV-AB) and are not receiving the CDC's HCV treatment guidelines. The CDC has treatment recommendations of hepatitis panels, full STD testing, and early follow-up care. Method This quality improvement project utilized the Plan-Do-Study-Act tool. With the application of Plan-Do-Study-Act, for patients identified with HCV-AB, the established CDC HCV treatment guidelines were followed, and the clinical progress of the implementation of the guidelines was monitored. Chart reviews comparing compliance of guidelines before and after the study were implemented. Participants A convenience sample of 125 patients were collected, and of these, 32 patients were found to be HCV-AB+. Findings The findings revealed that 18.75% of patients followed the CDC's HCV recommendations after the quality improvement project compared with 6.25% of patients before the intervention. The number of HIV testing offered increased by 40.00% as a result of the implementation of the project.

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Hepatitis C testing in substance use disorder treatment: the role of program managers in adoption of testing services

Cited by 5 publications

References 51 publications

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

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

A Quality Improvement Project

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