Hepatitis C Virus Services Offered by Substance Abuse Treatment Programs in the U.S. E. J. Bini, MD, MPH; S. Kritz MD; L.S. Brown, MD, MPH; J. Robinson, MEd; D. Alderson, MS; P. McAuliffe, MBA, LADC; C. Smith, MD; J. Rotrosen, MD; and the NIDA Clinical Trials Network Infections Study (CTN-0012) Team NYU School of Medicine and VA Hospital, NY, NY; Addiction Research & Treatment Corp, Brooklyn, NY; Nathan Kline Institute, Orangeburg, NY; NYS Psychiatric Institute, NY, NY; Connecticut Renaissance, Inc., Norwalk, CT; Mount Sinai School of Medicine, NY, NY
ABSTRACT Background: Although substance abuse treatment programs are an important point of contact to provide health services to diagnose, treat, and prevent transmission of hepatitis C (HCV) viral infection, little is known about the availability of these services in substance abuse programs. This study evaluated the prevalence and spectrum of HCV services offered by drug treatment programs in the U.S. Methods: We conducted a questionnaire-based survey of drug treatment programs within the National Drug Abuse Treatment Clinical Trials Network. Completed questionnaires were received from 269 (84.3%) of the 319 program administrators. Results: Although 78.7% of programs reported that they offered ongoing hepatitis training for clinical staff, only a minority of programs offered testing for HCV antibodies (52.9%), HCV qualitative PCR (10.1%), HCV quantitative PCR (8.9%), and HCV genotyping (11.6%). Hepatitis A and B vaccinations were offered by 68.3% of programs, either on site (19.3%) or via referral (49.1%). Programs having clear guidelines for hepatitis testing were significantly more likely to offer each of the hepatitis tests as compared with those that did not have clear guidelines. Only 28.9% of programs offered HCV treatment either on-site or via referral. Conclusions: Despite the importance of substance abuse in sustaining the hepatitis epidemic in the U.S., many substance abuse treatment programs do not offer comprehensive HCV and hepatitis vaccination services. Public health interventions to improve access to hepatitis testing, treatment, and prevention for substance abusers are needed.
ACKNOWLEDGEMENTS • Research Supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreement (1U10DA013046) with the NIDA CTN; and other Protocol Team members consisting of: • Randy Seewald, MD; Frank McCorry, PhD; Dennis McCarty, PhD; Donald Calsyn, PhD; Leonard Handelsman, MD; Steve Kipnis, MD • Al Hassen, MSW; Karen Reese, CAC-AD; Sherryl Baker, PhD • Shirley Irons; Kathlene Tracy, PhD
Drug Abuse Treatment Clinical Trials Network 17 Nodes with 116 Community Treatment Agencies Reaching into 26 States! Seattle Portland New York City Detroit Boston New Haven Denver Long Island Philadelphia Cincinnati San Francisco (CA/AZ Node) Baltimore/Richmond Raleigh/ Durham Albuquerque Los Angeles Charleston Miami CTN Sites
STUDYSITES • New York Node:New York University, New York, NY • South Carolina Node:Medical University of South Carolina, Charleston, SC • Florida Node:University of Miami, Coral Gables, FL • Great Lakes Node:Wayne State University, Detroit, MI • Ohio Valley Node:University of Cincinnati, Cincinnati, OH • Rocky Mountain Node:University of CO Health Sciences Center, Denver, CO • New England Node:Yale University, New Haven, CT • Delaware Valley Node:University of Pennsylvania, Philadelphia, PA • Mid-Atlantic Node:Johns Hopkins Univ., Baltimore, MD; Medical College of Virginia, Richmond • Pacific Region Node:University of California at Los Angeles, CA • Oregon Node:Oregon Health Sciences University, Portland, OR • Washington Node:University of Washington, Seattle, WA • Long Island Node:NY State Psychiatric Institute, New York, NY • North Carolina Node:Duke University, Raleigh/Durham, NC • Southwest Node:University of New Mexico, Albuquerque, NM • Northern New England Node:McLean Hospital, Belmont, MA • California-Arizona Node:University of California at San Francisco, CA
STUDY RATIONALE • HCV is a major cause of morbidity and mortality in the U.S. • Substance abusers are disproportionally affected by HCV, and these individuals are largely responsible for sustaining the HCV epidemic in the U.S. • Despite the potential role of substance abuse treatment programs in reducing transmission of viral hepatitis, surprisingly little is known about HCV health services offered by drug treatment programs in the U.S.
PRIMARY OBJECTIVES • TO DESCRIBE THE: • Range of HCV-related services offered by substance abuse treatment programs • Specific types of HCV testing available • Availability of HCV treatment • TO DETERMINE WHETHER HCV-RELATED HEALTH SERVICES DIFFER BETWEEN: • Programs that do and do not have clear guidelines for hepatitis testing • Methadone and non-methadone programs
DESIGN AND POPULATION • STUDY DESIGN • Cross-sectional survey • Descriptive & exploratory • STUDY POPULATION • Treatment program administrators of drug treatment programs in the U.S.
ETHICAL, REGULATORY & ADMINISTRATIVE CONSIDERATIONS • Expedited IRB Approval • Waiver of Informed Consent • Training for Node Protocol Managers
STUDY PROCEDURES • Node Protocol Managers • Information Sheet In Lieu of Informed Consent • Survey Administration • Paper or Electronic • Central data acquisition
Administrator Surveys Administrator completes survey online or mails to Data Center; Administrator enters contact information for Clinicians Contact CTP Directors for Treatment Program and Administrator contact information Ensure IRB approval Survey materials mailed to Administrators Data Center contacts Administrators that have not completed the survey or Clinician contact information within 30 days Node Protocol Manager contacts Administrators that have not responded within two weeks Data Center contacts Administrators to resolve any data queries After four weekly attempts, Administrators flagged as non-responders by the Data Center Node Protocol Managers contact non-responder Administrators weekly For Administrators that refuse to participate or still have not responded after two additional weeks, the Node Protocol Manager alerts the Node Principal Investigator
RESULTS • 319 treatment program administrators surveyed • 269 individuals (84.3%) from geographically diverse locations in the U.S. returned completed questionnaires
CHARACTERISTICS OF THE SUBSTANCE ABUSE TREATMENT PROGRAMS SURVEYED *Responses were not mutually exclusive for this item
CHARACTERISTICS OF THE SUBSTANCE ABUSE TREATMENT PROGRAMS SURVEYED
HCV TRAINING OF MEDICAL AND NON-MEDICAL STAFF IN SUBSTANCE ABUSE TREATMENT PROGRAMS
HCV TESTING AND HEPATITIS A AND B VIRUS VACCINATIONS OFFERED BY DRUG TREATMENT PROGRAMS
PROPORTION OF SUBSTANCE ABUSEPROGRAMS THAT OFFERED HCV TESTING AND HEPATITIS VACCINATION SERVICES ACCORDING TO THE PRESENCE OR ABSENCE OF CLEAR OR SOMEWHAT CLEAR GUIDELINES
HCV SERVICES OFFERED BY METHADONE AND NON-METHADONE SUBSTANCE ABUSE TREATMENT PROGRAMS P <0.01 for all comparisons between methadone and non-methadone programs
CONCLUSIONS • Despite the importance of substance abuse in sustaining the HCV epidemic in the U.S., many substance abuse treatment programs do not offer comprehensive • HCV-related health services • HCV testing • HCV treatment • Hepatitis vaccination services • Public health interventions to improve access to hepatitis testing, treatment and prevention for substance abusers are needed.