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National trends in testing for hepatitis C virus in licensed opioid treatment programs: Differences by facility ownership and state medicaid expansion status.

Authors
  • Pro, George1
  • Tompkins, D Andrew2
  • Azari, Soraya3
  • Zaller, Nickolas4
  • 1 Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W. Markham, Little Rock, AR 72205, USA; Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W. Markham, Little Rock, AR 72205, USA. Electronic address: [email protected]
  • 2 Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine, 1001 Potrero Ave., San Francisco, CA 94110, USA. Electronic address: [email protected]
  • 3 Department of Medicine, UCSF School of Medicine, 1001 Potrero Ave., San Francisco, CA 94110, USA. Electronic address: [email protected]
  • 4 Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W. Markham, Little Rock, AR 72205, USA; Southern Public Health and Criminal Justice Research Center, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W. Markham, Little Rock, AR 72205, USA. Electronic address: [email protected]
Type
Published Article
Journal
Drug and alcohol dependence
Publication Date
Sep 24, 2021
Volume
228
Pages
109092–109092
Identifiers
DOI: 10.1016/j.drugalcdep.2021.109092
PMID: 34571287
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The recent surge in hepatitis C virus (HCV) prevalence is primarily due to increased injection drug use. Opioid treatment programs (OTPs) are a major source of treatment for people at risk for HCV and are ideal settings for on-site HCV testing. The purpose of this national study was to identify state- and facility-level factors associated with HCV testing availability. We used the National Survey of Substance Abuse Treatment Services (2019) to identify OTPs in the US (n = 1679). We used multilevel logistic regression to test for an association between HCV testing and state Medicaid expansion status, and assessed whether the association depended on private or non-profit OTP ownership, adjusted for state racial/ethnic minority populations, poverty, Medicaid access to HCV treatment, and HCV, opioid use disorder, and overdose rates. Two-thirds of OTPs offered HCV testing. Medicaid expansion (versus non-expansion) was associated with a higher odds of HCV testing within OTPs owned by non-profits (adjusted odds ratio=1.99, 95% CI=1.02-3.91, p = 0.04). Nearly all non-profit OTPs that were in expansion states had predicted probabilities that were higher than the national average. HCV testing was highest in non-profit OTPs in expansion states. This is concerning given the increasing dominance of private OTPs in the marketplace. Payment structures and reimbursement are likely factors driving the low rate of HCV testing in private facilities and could be addressed with health policies aimed at eliminating HCV. Expanding support for non-profit OTPs also has the potential to strengthen testing rates and improve health. Copyright © 2021 Elsevier B.V. All rights reserved.

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