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Substance abuse treatment programs are ideal settings for testing for diseases that occur more commonly in people with opioid dependence, such as HIV and hepatitis C virus (HCV) infections, as well as sexually transmitted infections (STIs). To determine the proportion of opioid treatment programs that offer on-site testing for these diseases, investigators analyzed the results of surveys sent to the directors of all U.S. drug treatment facilities from 2000 to 2011.
During this period, the number of opioid treatment programs increased markedly, from 849 to 1175. There was a shift from public and nonprofit programs, which accounted for 57% of centers in 2000, to for-profit businesses, which accounted for 54% of programs in 2011. Among public programs, >75% offered on-site testing for HIV, HCV, and STIs; this proportion did not change significantly over the decade. Among for-profit programs, however, the proportion offering on-site testing for these infections declined during the study period (see ). In 2011, <50% of for-profit programs offered on-site HIV testing.
Bachhuber MA and Cunningham CO.Changes in testing for human immunodeficiency virus, sexually transmitted infections, and hepatitis C virus in opioid treatment programs. JAMA 2013 Dec 25; 310:2671. (http://dx.doi.org/10.1001/jama.2013.278456)
Comment
Drug treatment centers — for-profit businesses as well as nonprofit and public programs — should be required to offer on-site testing for HIV, hepatitis C virus, and sexually transmitted infections. Decreasing missed opportunities for testing for potentially treatable or manageable conditions is good not only for individuals but also for public health. With the Affordable Care Act increasing the number of Americans with health insurance, lack of reimbursement as a barrier to testing should decline — and just in time.
Too many infected Americans (nearly 1 in 6 of those with HIV infection and up to 3 of 4 with HCV infection) are still unaware of their status. Now that highly effective therapy is available for all of these infections, including HCV, it's incumbent upon us to increase testing rates and to engage all infected individuals in care.