On-site bundled rapid HIV/HCV testing in substance use disorder treatment programs: study protocol for a hybrid design randomized controlled trial

Abstract

BackgroundMore than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25 % of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD).Methods/designIn this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs.DiscussionNovel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades.Trial registrationClinicalTrials.gov: NCT02355080. (30 January 2015)

Barriers to Hepatitis C Screening in a Minority Population: A Comparison of Hepatitis C and Human Immunodeficiency Virus Screening Rates at a Community STD Clinic in Miami, Florida

“…Stigma associated with sexually transmitted diseases may also prevent individuals from seeking screening exams. When individuals are unaware of their infection, they are more like to transmit their infection, less likely to benefit from early treatment and thus more prone to the morbidity, mortality and complications of the disease [10]. …”

“…Certain populations, such as substance users are more susceptible to being infected by both HIV and HCV. HIV co-infection is associated with increased HCV related liver disease and mortality [10]. This study presents a unique opportunity to improve HCV screening by promoting HIV/HCV co-screening.…”

Point-of-Care Screening for a Current Hepatitis C Virus Infection: Influence on Uptake of a Concomitant Offer of HIV Screening

“…In fact, the findings are contrary to studies showing that individuals often attempt to hide their interest in having a HIV test by undergoing other less stigmatized tests at the same time 26 . With the WHO backing the use platforms such as GeneXpert for HIV and HCV screening 27 , and advocacy for integrated testing strategies to improve efficiency and decrease cost 15 , 28 , the design of screening programmes should keep this potential pitfall into consideration, especially where opt-in strategies are pursued or indeed preferred by the targeted population 15 . Further studies are needed to determine whether these findings are generalizable across different populations of the UK and beyond, and whether the language used to encourage POCT participation and educational initiatives may help address the barrier.…”

Spillover effects of HIV testing policies: changes in HIV testing guidelines and HCV testing practices in drug treatment programs in the United States

“…Thus, an increase in on-site HCV testing may be facilitated by the adoption of rapid HCV testing [ 53 ]. Interventions that effectively integrate rapid HIV and rapid HCV testing and treatment services are needed [ 15 , 54 ].…”