Viral Hepatitis and Human Immunodeficiency Virus Testing and Linkage to Care for Individuals Enrolled in an Opioid Treatment Program

Abstract

Background In the United States, many opioid treatment programs (OTPs) do not offer viral hepatitis (VH) or human immunodeficiency virus (HIV) testing despite high prevalence among OTP clients. We initiated an opt-out VH and HIV testing and linkage-to-care program within our OTP. Methods All OTP intakes are screened for VH and HIV and evaluated for rescreening annually. A patient navigator reviews laboratory results and provides counseling in the OTP clinic. The medical record is queried to identify individuals with previously diagnosed, untreated VH or HIV. Navigation support is provided for linkage or relinkage to VH or HIV care. Results Between March 2018 and Februrary 2019, 532 individuals were screened for hepatitis C virus (HCV), 180 tested HCV antibody positive (34%), and 108 were HCV-ribonucleic acid (RNA) positive (20%). Sixty individuals were identified with previously diagnosed, untreated HCV. Of all HCV RNA+, 49% reported current injection drug use (82 of 168). Ninety-five individuals were seen by an HCV specialist (57% of HCV RNA+), 72 started treatment (43%), and 69 (41%) completed treatment. Individuals with primary care providers were most likely to start treatment. Four individuals were diagnosed with hepatitis B; 0 were diagnosed with HIV. Conclusions The implementation of an OTP-based screening and navigation protocol has enabled significant gains in the identification and treatment of VH in this high prevalence setting.

Improving HIV and HCV Testing in Substance Use Disorder Programs (SUDs) That Provide Medications for Opiate Use Disorder (MOUD): Role of Addressing Barriers and Implementing Universal and Site-Specific Approaches

“…As seen in SUD A’s experience, the retirement of the initial champion and the hiring of a replacement staff impacted the testing rates as well as the follow-up of treatment referrals and outcomes. Rowan et al implemented a patient navigator role to review all laboratory results and provide support for linkage or relinkage to care at a MOUD clinic with improvements in testing and treatment of HCV (Rowan et al, 2020). This role in SUD A also resulted in successful relinkage to HIV and referrals for HCV care and this may be particularly relevant for sites that do not provide on-site HCV treatment (Butner et al, 2017).…”

Integrating Management of Hepatitis C Infection into Primary Care: the Key to Hepatitis C Elimination Efforts

“…13,16 Many studies have shown that targeted HCV screening at opioid treatment programs, drug detoxification centers, and halfway houses increases HCV diagnosis rates, and colocalizing HCV treatment at these locations increases HCV treatment uptake and completion. 33,38,39 Prisons have instituted opt-out HCV testing at intake. [40][41][42] Another option is POC testing at mobile clinics, shelters, and street medicine providers.…”

Screening for hepatitis C as part of an opioid stewardship quality improvement initiative: Identifying infected patients and analyzing linkage to care

“…Recent studies have highlighted the efficacy of hepatitis C screening in these settings. [17][18][19][20][21][22][23] Socioeconomic barriers prevalent in the OUD population often contribute to poor treatment adherence. Successful linkage to care strategies that use tools to overcome these barriers is imperative for good patient outcomes.…”

“…Given this lack of engagement with primary care, it is imperative that HCV screening efforts and subsequent referral for treatment be maximized in venues such as emergency departments, medication-assisted therapy (MAT) clinics, homeless shelters, needle exchange programs, prison clinics, federally qualified health centers, and acute care hospitals. Recent studies have highlighted the efficacy of hepatitis C screening in these settings 17–23 . Socioeconomic barriers prevalent in the OUD population often contribute to poor treatment adherence.…”