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.
Department of Psychiatry and Behavioral Sciences, UCSF School of Medicine, 1001 Potrero Ave., San Francisco, CA 94110, USA.
Drug Alcohol Depend. 2021 Nov 1;228:109092. doi: 10.1016/j.drugalcdep.2021.109092. Epub 2021 Sep 24.
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.
丙型肝炎病毒（HCV）感染率的近期上升主要归因于注射毒品使用的增加。阿片类药物治疗项目（OTP）是感染 HCV 风险人群的主要治疗来源，也是现场 HCV 检测的理想场所。本项全国性研究的目的是确定与 HCV 检测可用性相关的州和机构级别因素。
我们使用国家药物滥用治疗服务调查（2019 年）识别美国的 OTP（n=1679）。我们使用多水平逻辑回归来检验 HCV 检测与州医疗补助计划扩张状态之间的关联，并评估了这种关联是否取决于 OTP 的私人或非营利性所有权，调整了州内种族/族裔少数人群、贫困、医疗补助获得 HCV 治疗的机会以及 HCV、阿片类药物使用障碍和过量率。
三分之二的 OTP 提供 HCV 检测。与非扩张州相比，医疗补助计划扩张（versus 非扩张）与非营利性 OTP 内 HCV 检测的几率更高（调整后的优势比=1.99，95%置信区间=1.02-3.91，p=0.04）。几乎所有位于扩张州的非营利性 OTP 的预测概率均高于全国平均水平。
在扩张州的非营利性 OTP 中 HCV 检测率最高。考虑到私人 OTP 在市场中的主导地位不断增强，这令人担忧。支付结构和报销可能是导致私人设施 HCV 检测率低的因素，可通过旨在消除 HCV 的卫生政策来解决。扩大对非营利性 OTP 的支持也有可能提高检测率并改善健康状况。
