Low Screening Rates for HIV and Hepatitis C in Patients Who Inject Drugs

Screening for HIV and hepatitis C virus in medical clinics or emergency departments is infrequent among patients with indicators for injection-drug use, according to a study published in The Journal of Infectious Diseases.

In 2015, roughly 1 in 7 people with HIV in the United States were unaware of their status, and 55.6% of people with hepatitis C virus were aware of their infection status during 2013–2016. Furthermore, an estimated 2.4 million people in the United States have a substance use disorder. Treating HIV and HCV infections among this high-risk population can help prevent transmission and result in a reduction in incidence.

The aim of this study was to assess the frequency of testing for HIV and hepatitis C virus in patients with indicators for injection-drug use. Investigators obtained the data from the 2010 to 2017 IBM Watson Health MarketScan®, which included diagnosis and procedure codes for inpatient and outpatient medical encounters from 21 commercial health insurance plans and 350 large company health insurance plans. They also retrieved data from the 2003 to 2017 Truven Health Analytics MarketScan® Commercial Claims and Encounters database, which included medical and prescription records.

The study population comprised 844,242 patients aged 15 to 49 years who had ≥1 clinical encounter that indicated injection-drug use between 2010 and 2016, and excluded patients who had a documented diagnosis of HIV or hepatitis C or were receiving antiretroviral therapy. The primary outcome was the frequency of HIV and hepatitis C testing within a year of a medical encounter with indicators for suspected injection-drug use.

Of the study cohort, 64.9% had an infection indicative of injection drug use and 31.9% had a diagnosis of substance abuse or dependence. Overall, 44% of the patients lived in the South, 85.7% lived in urban areas, and 46.2% received medical care at a general clinic.

HIV testing among patients with indicators for injection-drug use occurred in 8.6% of the study population. Results demonstrated that men being tested less frequently than women (adjusted odds ratio [aOR], 0.5; 95% CI, 0.49-0.50; P <.001), and individuals aged 20 to 29 years had a higher rate of HIV testing (13.7%). Patients who made > 3 visits to medical clinics were more frequently tested (aOR, 2.02; 95% CI, 1.97-2.08; P <.001); similarly, patients who were initially encountered via a rehabilitation inpatient treatment program, or a sexual/reproductive health clinic were more likely to receive HIV testing (aOR, 1.32; 95% CI, 1.28–1.35; P < .001) . Patients with skin or soft-tissue infections or endocarditis were less frequently tested than patients without infections (aOR, 0.91; 95% CI, 0.87-0.95; P <.001).

Hepatitis C testing among patients with indicators for injection drug use occurred in 7.7% of the study population, and a similar pattern for testing rates were observed. Men were less frequently tested than women (aOR, 0.66; 95% CI, 0.65-0.67; P <.001), and patients aged 20 to 29 years had higher rates (10.9%). Patients who made >3 visits to medical clinics were more frequently tested (aOR, 2.81; 95% CI, 2.73-2.89; P <.001); patients who were initially encountered via a rehabilitation inpatient treatment program, or a sexual/reproductive health clinic were more likely to receive HIV testing (aOR, 1.32; 95% CI, 1.28–1.35; P < .001). Patients with skin or soft-tissue infections or endocarditis were less frequently tested than patients without infections (aOR, 0.90; 95% CI, 0.86-0.95; P <.001).

Limitations of this study included not utilizing data from uninsured or Medicaid patients, the inability to assess if testing occurred outside of insurance coverage, using diagnostic codes that could lead to misclassification, and potential biases due to the stigma of drug use.

“HIV and [hepatitis C virus] testing of commercially insured persons with clinical indicators of [injection-drug use] or substance use disorder was performed infrequently at clinical encounters,” the researchers included.

Reference

Bull-Otterson L, Huang YA, Zhu W, King H, Edlin BR, Hoover KW. HIV and Hepatitis C Virus Infection Testing Among Commercially Insured Persons Who Inject Drugs, United States, 2010-2017 [published online January 30, 2020]. J Infect Dis. doi:10.1093/infdis/jiaa017