Addiction Disorders

Efficacy of Bundled HIV, HCV Testing for People With Substance Abuse Disorders Examined

Bradley van Paridon
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The Denver City Council recently passed an ordinance to allow the nation’s first supervised injection site. The Colorado General Assembly must also render an approval. A bipartisan bill to allow the site narrowly failed in a Republican-controlled Senate in 2018, but party control will change in 2019, making its passage more likely.3 Meanwhile, cities including San Francisco and Philadelphia are moving forward with their own site plans, despite warnings from the US Justice Department. Whether in Denver, San Francisco, Philadelphia, or elsewhere, expect the first supervised injection site in the United States to open in the near future, and for a legal battle to follow.
The Denver City Council recently passed an ordinance to allow the nation’s first supervised injection site. The Colorado General Assembly must also render an approval. A bipartisan bill to allow the site narrowly failed in a Republican-controlled Senate in 2018, but party control will change in 2019, making its passage more likely.3 Meanwhile, cities including San Francisco and Philadelphia are moving forward with their own site plans, despite warnings from the US Justice Department. Whether in Denver, San Francisco, Philadelphia, or elsewhere, expect the first supervised injection site in the United States to open in the near future, and for a legal battle to follow.
By providing bundled HIV and HCV testing, substance use disorder treatment programs may create increased awareness of infection status among people with substance abuse disorders.

Providing bundled, rapid testing for HIV and hepatitis C virus (HCV) infection at substance use disorder treatment programs may increase awareness of infection status among people with substance abuse disorders, according to the results of a study published in Medical Care.

The current HIV and HCV epidemics overlap and disproportionally affect people with substance abuse disorders. Offering on-site, bundled, rapid HIV and HCV testing is a potential strategy that may increase the receipt of both test results for this patient population. To test the efficacy of this strategy, investigators conducted a 2-armed, randomized controlled trial within a substance use disorder treatment program in New York City.

In total, 162 participants with unknown HIV and HCV statuses were randomly assigned to either the treatment or control arm of the study. Patients in the treatment group were offered bundled rapid HIV and HCV tests with immediate results provided onsite (n=65) while the control group were offered the current standard of care: referral to onsite or off-site laboratory-based HIV and HCV testing with delayed results (n=69).

Approximately half of the participants (51.2%) were Hispanic, 25.3% were non-Hispanic Black, and 17.9% were non-Hispanic White; two-thirds were men. More than 54% of participants reported injection as their method of drug use (54.9%). Among the eligible participants, 82.7% completed the 1-month follow-up assessment. At 1 month, participants in the treatment arm were more likely to report having received both test results compared with those in the control arm (69% vs 19%, P <.001). In the treatment arm, 7 participants received a new HCV diagnosis compared with 1 participant in the control arm (P =.029).

The study was subject to several limitations, including that participants were enrolled from 2 substance use disorder treatment programs and most had previously been tested for HIV or HCV, although not within the past 6 months. This potentially makes the findings ungeneralizable to other settings or populations. Another limitation was the loss of nearly 17% of participants to follow-up. Dependence on self-reporting test receipt was also a limitation, and the evaluation of bundling rapid HIV/HCV tests may be affected by misreporting.

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The investigators also noted higher reported rates of unprotected intercourse among those in the treatment arm, which may be associated with increased acceptance to test and receive results.

“Our findings suggest that this strategy may be an efficacious approach to increasing awareness of infection status for at-risk groups,” the researchers concluded. They also noted that a bundled testing strategy is likely to be cost-effective as well, and that further studies are now needed “to develop multilevel strategies to promote and sustain the use of this testing approach in [substance use disorder treatment program] facilities.” Ultimately, this approach may also improve linkages to care for patients in substance use disorder treatment programs and increase early initiation of treatment.

Reference

Frimpong JA, Shiu-Yee K, Tross S, et al. Bundling rapid human immunodeficiency virus and hepatitis C virus testing to increase receipt of test results: A randomized trial. Med Care. 2020;58:445-452.

This article originally appeared on Infectious Disease Advisor