HIV, HCV Testing Availability Stagnates Despite Growing Number of Substance Use Treatment Facilities

Despite the opening of 3107 new substance use disorder treatment facilities offering medication for opioid use disorder between 2017 and 2020, the proportions of facilities offering HIV and hepatitis C virus (HCV) testing hardly changed, according to a research letter published in JAMA.

These new facilities include 437 more Opioid Treatment Programs (OTPs) and 2670 more non-OTPs, with the number of OTPs increasing from 1317 to 1754 and non-OTPs increasing from 3826 to 6496 between 2017 and 2020.

Federally recognized OTPs are required by the Substance Abuse and Mental Health Services Administration to provide HIV prevention counseling and may provide methadone, whereas non-OTPs are not required to provide such counseling. Despite this, data collected from the 2017-2020 National Survey of Substance Abuse Treatment Services showed higher proportions of offering both HIV and HCV treatment among non-OTPs compared with OTPs.

According to the authors of the research letter, HIV outbreaks and a resurgence of HCV cases are a result of the US opioid crisis.

“The National Strategic Plan to End the HIV Epidemic recommends integrating programs to address HIV, viral hepatitis, and substance use disorders,” the authors explained. “Facilities that offer medication for opioid use disorder treatment—ie, methadone, buprenorphine, and/or naltrexone—are ideal settings to co-locate HIV/HCV services because they serve a high-risk population and medication for opioid use disorder is associated with improved HIV/HCV treatment outcomes.”

The Substance Abuse and Mental Health Services Administration also recommends that OTPs screen high-risk patients for HIV and HCV. However, between 2017 and 2020, the proportion of OTPs offering HIV testing did not improve, slightly dropping from 59.7% in 2017 to 59.0% in 2020 (95% CI, −0.4% to 2.8%).

On the other hand, the proportion of non-OTPs offering testing increased by 4.4 percentage points in the same time frame, from 42.2% to 46.6% (95% CI, 2.4%-6.3%).

The authors noted that similar trends were observed for HCV testing availability.

Between OTPs and non-OTPs combined, HIV testing availability increased by only 2.5% and HCV testing availability increased by only 1.1%, despite the opening of 3107 facilities.

“Despite an increasing number of substance use disorder treatment facilities that offered medication for opioid use disorder, the proportion of facilities that also offered HIV and HCV testing did not change between 2017 and 2020,” the authors said, noting that only half of the total substance use disorder treatment facilities offered testing in 2020. “The stagnant trends, including among OTPs, are troubling, as a prior study found declines in HIV testing availability among OTPs between 2000 and 2011.”

Trends in HIV and HCV treatment were only available for 2019 and 2020 in this national survey. Overall, the number of facilities offering HIV treatment increased by 147 in that time frame, from 1172 to 1319, with most (126) being non-OTPs.

Slightly more facilities offered HCV treatment, with 225 more OTP and non-OTP facilities making this treatment available in 2020 vs 2019. Again, there was a higher increase in the number of non-OTPs offering treatment (204) compared with OTPs (21). As of 2020, there are 1522 facilities offering HCV treatment, including 1334 non-OTPs and 188 OTPs.

The National Strategic Plan to End the HIV Epidemic identified high-priority rural states in 2020. Of 117 OTPs in these areas, 54 (46.2%) offered HIV testing and only 5 (4.3%) offered HIV treatment.

“Limitations of the study include that the findings may not be generalizable to clinicians who prescribe medication to treat opioid use disorder outside of the specialty treatment system,” the authors noted. “While integration of medication for opioid use disorder into primary care and infectious disease clinics remains important, these data highlight that increased efforts are needed to better integrate HIV and HCV testing and treatment in the specialty treatment system.”

Reference

Patel EU, Genberg BL, Zhu X, et al. HIV and hepatitis C virus testing and treatment services in specialty treatment facilities that offer medication for opioid use disorder in the US. JAMA. 2022;327(8):776-778. doi:10.1001/jama.2022.0293