Substance users are at substantially increased risk for HIV and HCV infection, as well as for HIV/HCV co- infection. Yet fewer than half of U.S. substance abuse treatment programs offer HIV testing to their clients on- site or through referral to outside agencies, and only about one third offer HCV testing. In contrast, most syringe exchange programs (SEPs) conduct on-site HIV and HCV testing. During the current funding period, we showed the clinical and economic value of on-site rapid HIV and HCV testing in substance abuse treatment programs, even where there is a low prevalence of undiagnosed HIV. On a practical level, however, lack of reimbursement for HIV and HCV testing has been a barrier to implementation in substance abuse treatment programs. Under the Affordable Care Act (ACA), HIV and HCV tests are now required to be reimbursed by health insurers without any copayment requirement. Results from a currently-funded nationally representative survey exploring the ACA's influence on substance abuse treatment program practices will provide a platform for a further in-depth study of testing reimbursement and budget impact. During the current funding period, we also conducted model-based analyses of the cost-effectiveness of hypothetical HCV linkage to care initiatives. We concluded that additional investments that address the limited linkage and care coordination infrastructure for HCV compared to HIV would be cost-effective. New effectiveness and cost data are now available from a recently completed randomized trial of HCV care coordination in substance abuse treatment programs. These data will allow us to estimate the cost-effectiveness of specific linkage and care coordination initiatives and their impact on program budgets. The economic value and budget impact of testing and linkage activities being conducted in syringe exchange programs has not been evaluated, and research is needed to collect data and conduct exploratory modeling studies.
Our specific aims i n the next funding period include: 1) determining the budget impact on substance abuse treatment programs of on-site HIV and HCV testing in the context of ACA and other reimbursement and organizational factors, 2) assessing the cost-effectiveness and budget impact of adding HCV care linkage and coordination services in substance abuse treatment programs, and 3) exploring the budget impact and cost-effectiveness of providing similar testing and care linkage services in SEPs.
These aims i nnovatively leverage NIH research investments in substance abuse treatment program surveys, a clinical trial of HCV care coordination, and a computer simulation model of HCV and HIV disease. The approach is innovative in that applies mixed methods to evaluating budget impact, extends clinical HCV care coordination trial results using a computer simulation model to project cost-effectiveness, and is the first study to explore the economic value and budget impact of HIV and HCV testing in SEPs. The results of this study will assist policy makers and program managers in addressing cost barriers and taking advantage of reimbursement opportunities to provide much needed HIV and HCV testing and care linkage services to their clients.

Public Health Relevance

Although substance users are at substantially increased risk for HIV and HCV infection, as well as for HIV/HCV co-infection, fewer than half of U.S. substance abuse treatment programs offer HIV testing to their clients on- site or through referral to outside agencies, and only about one third offer HCV testing. We have previously shown that conducting on-site HIV and HCV testing in substance abuse treatment programs is cost-effective; moreover, ACA implementation presents new opportunities for programs to obtain reimbursement. The results of this study will assist policy makers and program managers in addressing cost barriers and taking advantage of reimbursement opportunities by determining the budget impact on substance abuse treatment programs of on-site HIV and HCV testing, assessing the cost-effectiveness and budget impact on these programs of adding HCV care linkage and coordination services, and exploring the budget impact and cost-effectiveness of providing similar testing and care linkage services in syringe exchange programs.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA027379-05
Application #
9013463
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Duffy, Sarah Q
Project Start
2009-09-01
Project End
2018-01-31
Budget Start
2016-02-01
Budget End
2017-01-31
Support Year
5
Fiscal Year
2016
Total Cost
$485,416
Indirect Cost
$101,310
Name
Weill Medical College of Cornell University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Traynor, Sharleen M; Rosen-Metsch, Lisa; Feaster, Daniel J (2018) Missed Opportunities for HIV Testing Among STD Clinic Patients. J Community Health 43:1128-1136
Schackman, Bruce R; Gutkind, Sarah; Morgan, Jake R et al. (2018) Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs. Drug Alcohol Depend 185:411-420
Behrends, Czarina N; Nugent, Ann V; Des Jarlais, Don C et al. (2018) Availability of HIV and HCV On-Site Testing and Treatment at Syringe Service Programs in the United States. J Acquir Immune Defic Syndr 79:e76-e78
Feaster, Daniel J; Parish, Carrigan L; Gooden, Lauren et al. (2016) Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug Alcohol Depend 169:171-179
Perlman, David C; Jordan, Ashly E; Uuskula, Anneli et al. (2015) An international perspective on using opioid substitution treatment to improve hepatitis C prevention and care for people who inject drugs: Structural barriers and public health potential. Int J Drug Policy 26:1056-63
Schackman, Bruce R; Leff, Jared A; Barter, Devra M et al. (2015) Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction 110:129-43
Linas, Benjamin P; Barter, Devra M; Morgan, Jake R et al. (2015) The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection. Ann Intern Med 162:619-29
Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A et al. (2014) The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States. Sex Transm Dis 41:545-50
Linas, Benjamin P; Barter, Devra M; Leff, Jared A et al. (2014) The cost-effectiveness of improved hepatitis C virus therapies in HIV/hepatitis C virus coinfected patients. AIDS 28:365-76
Linas, Benjamin P; Barter, Devra M; Leff, Jared A et al. (2014) The hepatitis C cascade of care: identifying priorities to improve clinical outcomes. PLoS One 9:e97317

Showing the most recent 10 out of 16 publications