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

Abstract

BackgroundTo examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement.MethodsWe analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services.ResultsThe effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type.ConclusionsOur findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.

Spillover Effect of Evidence-Based Postoperative Opioid Prescribing

“…19 Similarly, after legislative changes removed the requirement for HIV pretest counseling in an effort to increase the rate of providers offering HIV testing to patients, providers were also more likely to offer testing for hepatitis C virus as well. 10 Despite the lack of data about postoperative opioid use, requests for refills increased for only one procedure. In addition, all procedures saw a significant reduction in prescription size regardless of baseline prescriptions size.…”

“…Targeted interventions in other areas of healthcare have been shown to influence provider practice beyond the specific issue they address. 10 Insofar as prescribing recommendations raise awareness about appropriate opioid prescribing in general, that effect can spill over into other operations and specialties.…”

Mitigation through on-site testing & education among formerly incarcerated individuals against Covid-19 – The MOSAIC study: Design and rationale

“…In this study, we seek to reduce COVID-19 spread among recently incarcerated individuals by offering routine CHW-led SARS-CoV-2 testing and education at a carceralfocused CBO. This trial draws on past studies that increased HIV testing uptake by offering testing services onsite at community-based programs, 64,65 and increased HCV testing through peer-delivered counseling and education. [66][67][68] If successful, this intervention could provide a strategy to improve COVID-19 mitigation among CLS-involved individuals and deepen understanding of CBOs and CHWs' potential roles in improving public health interventions for hard-to-reach populations.…”

Association of Utilization Management Policy With Uptake of Hypofractionated Radiotherapy Among Patients With Early-Stage Breast Cancer

“…Second, we found that, conditional on clinician exposure to the utilization management policy, there were significant spillover associations between the utilization management policy and uptake in the use of hypofractionated radiotherapy among patients not subject to the policy. Spillover effects of policies have been suggested in other evaluations of clinical guidelines and reimbursement policies not related to utilization management . The mechanisms of this spillover effect may be rooted in behavioral economic theory; radiation oncologists’ therapeutic norms may be associated with utilization management programs that reduce choice overload .…”