Departments of Population Health Sciences (Drs Behrends, Schackman, and Kapadia) and Medicine (Dr Kapadia), Weill Cornell Medical College, New York, New York; and Carey Business School, John Hopkins University, Baltimore, Maryland (Dr Frimpong).
J Public Health Manag Pract. 2021;27(4):393-402. doi: 10.1097/PHH.0000000000001262.
Few substance use disorder (SUD) treatment programs provide on-site human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV) testing, despite evidence that these tests are cost-effective.
To understand how methadone maintenance treatment (MMT) programs that offer on-site HIV/HCV testing have integrated testing services, and the challenges related to offering on-site HIV/HCV testing.
We used the 2014 National Drug Abuse Treatment System Survey to identify outpatient SUD treatment programs that reported offering on-site HIV/HCV testing to 75% or more of their clients. We stratified the sample to identify programs based on combinations of funding source, type of drug treatment offered, and Medicaid-managed care arrangements. We conducted semi-structured qualitative interviews with leadership and staff in 2017-2018 using a directed content analysis approach to identify dominant themes.
Seven MMT programs located in 6 states in the United States.
Fifteen leadership and staff from 7 MMT programs with on-site HIV/HCV testing.
Themes related to integration of on-site HIV/HCV testing.
Methadone maintenance treatment programs identified 3 domains related to the integration of HIV/HCV testing on-site at MMT programs: (1) payment and billing, (2) internal and external stakeholders, and (3) medical and SUD treatment coordination. Programs identified the absence of state policies that facilitate medical billing and inconsistent grant funding as major barriers. Testing availability was limited by the frequency at which external organizations could provide services on-site, the reliability of those external relationships, and MMT staffing. Poor electronic health record systems and privacy policies that prevent medical information sharing between medical and SUD treatment providers also limited effective care coordination.
Effective and sustainable integration of on-site HIV/HCV testing by MMT programs in the United States will require more consistent funding, improved billing options, technical assistance, electronic health record system enhancement and coordination, and policy changes related to privacy.
尽管有证据表明这些检测具有成本效益，但很少有物质使用障碍（SUD）治疗项目提供现场人类免疫缺陷病毒（HIV）和/或丙型肝炎病毒（HCV）检测。
了解提供现场 HIV/HCV 检测的美沙酮维持治疗（MMT）项目如何整合检测服务，以及与提供现场 HIV/HCV 检测相关的挑战。
我们使用 2014 年全国药物滥用治疗系统调查，确定了报告为 75%或以上患者提供现场 HIV/HCV 检测的门诊 SUD 治疗项目。我们对样本进行分层，根据资金来源、提供的药物治疗类型和医疗补助管理式医疗安排的组合来确定项目。我们在 2017-2018 年使用定向内容分析方法对领导层和工作人员进行了半结构化定性访谈，以确定主导主题。
美国 6 个州的 7 个 MMT 项目。
7 个有现场 HIV/HCV 检测的 MMT 项目中有 15 名领导层和工作人员。
与现场 HIV/HCV 检测整合相关的主题。
美沙酮维持治疗项目确定了与现场 MMT 项目整合 HIV/HCV 检测相关的 3 个领域：（1）支付和计费，（2）内部和外部利益相关者，（3）医疗和 SUD 治疗协调。项目确定缺乏促进医疗计费的州政策和不一致的赠款资金是主要障碍。测试可用性受到外部组织提供现场服务的频率、这些外部关系的可靠性以及 MMT 人员配备的限制。电子健康记录系统不完善以及防止医疗和 SUD 治疗提供者之间医疗信息共享的隐私政策也限制了有效的护理协调。
美国 MMT 项目要有效和可持续地整合现场 HIV/HCV 检测，需要更一致的资金、改进的计费选项、技术援助、电子健康记录系统增强和协调，以及与隐私相关的政策变化。
