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. 2023 May 24;76(10):1793-1801.
doi: 10.1093/cid/ciac981.

Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016-2019

Katherine Ahrens  1 , Michael Sharbaugh  2 , Marian P Jarlenski  2 , Lu Tang  3 , Lindsay Allen  4 , Anna E Austin  5 , Andrew J Barnes  6 , Marguerite E Burns  7 , Sarah Clark  8 , Kara Zivin  9 , Aimee Mack  10 , Gilbert Liu  10 , Shamis Mohamoud  11 , Mary Joan McDuffie  12 , Lindsey Hammerslag  13 , Adam J Gordon  14   15 , Julie M Donohue  2 ; Writing Committee for Medicaid Outcomes Distributed Research Network
Collaborators, Affiliations

Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016-2019

Katherine Ahrens et al. Clin Infect Dis. .

Abstract

Background: Limited information exists about testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among Medicaid enrollees after starting medication for opioid use disorder (MOUD), despite guidelines recommending such testing. Our objectives were to estimate testing prevalence and trends for HIV, HBV, and HCV among Medicaid enrollees initiating MOUD and examine enrollee characteristics associated with testing.

Methods: We conducted a serial cross-sectional study of 505 440 initiations of MOUD from 2016 to 2019 among 361 537 Medicaid enrollees in 11 states. Measures of MOUD initiation; HIV, HBV, and HCV testing; comorbidities; and demographics were based on enrollment and claims data. Each state used Poisson regression to estimate associations between enrollee characteristics and testing prevalence within 90 days of MOUD initiation. We pooled state-level estimates to generate global estimates using random effects meta-analyses.

Results: From 2016 to 2019, testing increased from 20% to 25% for HIV, from 22% to 25% for HBV, from 24% to 27% for HCV, and from 15% to 19% for all 3 conditions. Adjusted rates of testing for all 3 conditions were lower among enrollees who were male (vs nonpregnant females), living in a rural area (vs urban area), and initiating methadone or naltrexone (vs buprenorphine). Associations between enrollee characteristics and testing varied across states.

Conclusions: Among Medicaid enrollees in 11 US states who initiated medications for opioid use disorder, testing for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and all 3 conditions increased between 2016 and 2019 but the majority were not tested.

Keywords: HIV; Medicaid; hepatitis; opioid use disorder; testing.

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Figures

Figure 1.
Figure 1.
Unadjusted changes in prevalence of testing for HIV, HBV, HCV, and all 3 conditions within 90 days among Medicaid enrollees with medication for opioid use disorder (MOUD) initiation episode in 11 states, 2016–2019. States are represented with letters to prevent identification. Denominators for testing prevalence include enrollees diagnosed with OUD who initiated MOUD (with buprenorphine, methadone, or naltrexone) and had at least 3 months of continuous enrollment in Medicaid after their index claim for MOUD and had no previous diagnosis of the viral infection being examined. State-level prevalence (data points) and prevalence differences are displayed (error bars). Random effects meta-analyses were used to estimate global prevalence differences for each measure across the 11 states, along with 95% CIs (diamond) and 90% prediction intervals (error bars). Prediction intervals denote the range within which prevalence differences would fall for 90% of US states if a different set of states were to be drawn. Abbreviations: CI, confidence interval; HBV, hepatitis B virus; HCV, hepatitis C virus. HIV, human immunodeficiency virus.
Figure 2.
Figure 2.
Random effects meta-analysis adjusted risk ratios for prevalence of testing for all 3 conditions (human immunodeficiency virus, hepatitis B virus, and hepatitis C virus) within 90 days of medication for opioid use disorder (OUD) initiation among 297 079 Medicaid enrollees in 11 states, 2016–2019. Adjusted prevalence ratios (log scale) were estimated from random effects meta-analysis. Data points and error bars represent the global prevalence ratios and 95% confidence intervals of the global prevalence ratios across states. The lightly shaded bars represent 90% prediction intervals, which denote the range within which prevalence ratios would fall for 90% of states if a different set of states were to be drawn. Other race/ethnicity includes Hispanic, Native Hawaiian, Pacific Islander, American Indian, Alaska Native, and Asian. SUD includes non-OUD and non-nicotine substance use disorders such as alcohol-related disorders; cannabis-related disorders; sedative,- hypnotic-, or anxiolytic-related disorders; cocaine-related disorders; other stimulant–related disorders; hallucinogen-related disorders; inhalant-related disorders; other psychoactive–related disorders; and abuse of nonpsychoactive substances. Abbreviations: MOUD, medication for opioid use disorder; SUD, substance use disorder.
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References

    1. American Society of Addiction Medicine . The ASAM national practice guideline for the treatment of opioid use disorder 2020 focused update. Rockville, MD: American Society of Addiction Medicine,2020. Accessed 6 January 2023.
    1. Department of Veterans Affairs, Department of Defense . Clinical practice guideline for the management of substance use disorders, version 3.0. Available at: https://www.healthquality.va.gov/guidelines/MH/sud/VADODSUDCPGRevised222.... Accessed 26 January 2022.
    1. Substance Abuse and Mental Health Services Administration . Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.
    1. Taylor JL, Johnson S, Cruz R, Gray JR, Schiff D, Bagley SM. Integrating harm reduction into outpatient opioid use disorder treatment settings: harm reduction in outpatient addiction treatment. J Gen Intern Med 2021; 36:3810–9. - PMC - PubMed
    1. National Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide (third edition). Available at: https://nida.nih.gov/publications/principles-drug-addiction-treatment-re.... Accessed 6 January 2023.

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