Coordinated Approach Needed to Increase Follow-Up Care After Rapid HIV, HCV Testing
Successfully implementing HIV and hepatitis C testing at drug detoxification centers could help identify and link patients to care, but would require that the test results are available to nearby health care facilities.
Only a small number of those tested for HIV and hepatitis C virus (HCV) scheduled a follow up visit for clinical care, according to new research. The findings demonstrate a need for more coordinated approaches to help patients access testing and treatment.
The ongoing opioid epidemic and coronavirus disease 2019 (COVID-19) pandemic are both likely to cause an increase in HIV and HCV infections, according to a press release from study authors at Boston Medical Center. Drug detoxification centers may offer a much-needed option, as researchers found they have a distinct advantage over laboratory testing among hard-to-reach populations.
Investigators conducted a single-site randomized trial comparing test results delivery between laboratory-based and rapid testing for HIV and HCV at a short-term inpatient drug and alcohol detoxification center in Boston. The study included 200 participants with a history of self-reported drug use who accessed detoxification services between November 2016 and July 2017.
Among the participants, 48% tested positive for HCV and 0.5% received new positive diagnoses for HIV. During follow-up, investigators found that only 6% with positive tests were successfully linked to care, attending an HIV- or HCV-related visit within 4 months of testing.
The investigators noted that half of US state health departments and territories are prioritizing identification of acute HIV cases and are moving away from rapid testing in community-based settings. At sites such as drug detoxification centers, laboratory-based testing may see fewer diagnoses due to a lack of follow-up before result delivery, according to the study. In contrast to the 3 days required by laboratory-based testing, results for point-of-care rapid testing are available within 30 minutes.
“We currently have a cure for HCV and effective treatment for HIV,” said researcher Sabrina Assoumou, MD, MPH, in a press release. “Successfully identifying and linking patients to care at drug detoxification centers during the opioid epidemic could help decrease transmission and improve outcomes for these 2 infections.”
According to the study findings, 41 of the individuals with no record of HCV-related follow-up used other health care services. These averaged 3 visits within 4 months, of which 61% were in an emergency department.
The study authors noted that although successfully implementing HIV and HCV testing at drug detoxification centers could help identify and link patients to care, doing so would require that the test results are available to nearby health care facilities.
“We hope that these findings will encourage changes in local and national HIV and HCV testing practices and policy at non-hospital-based settings caring for populations at-risk during the opioid epidemic,” Assoumou said in the release.
She concluded that further research should investigate interventions to improve linkages to care and treatment initiation after testing in community-based settings.
Rapid HIV, HCV Testing at Drug Detoxification Centers Associated with Higher Rate of Test Result Delivery [news release]. Boston Medical Center; September 2, 2020. https://www.bmc.org/news/press-releases/2020/09/02/rapid-hiv-hcv-testing-drug-detoxification-centers-associated-higher. Accessed September 10, 2020.