STI Testing

In spite of government recommendations for more widespread screening, the percentage of for-profit opioid treatment programs offering on-site testing for HIV, the hepatitis C virus, and other sexually transmitted infections (STIs) has dropped over the past decade.

This decrease in screening may unnecessarily delay the diagnosis and treatment of people enrolled in these programs and increase the chances that they will pass on infectious diseases to others.

“Opioid dependence—addiction to heroin, prescription painkillers, or both—is a very well-known risk factor for HIV, hepatitis C virus, and sexually transmitted infections,” says Marcus A. Bachhuber, M.D., of Albert Einstein College of Medicine, co-author of a Dec. 25 letter on STI testing at treatment centers in the journal JAMA.

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Drop in Screening for Infectious Diseases

Using data from an annual survey sent to the directors of drug treatment facilities in the U.S., the researchers found stark differences among the levels of screening offered at public, nonprofit, and for-profit opioid treatment centers.

While more than 75 percent of public programs offered on-site testing for HIV, hepatitis C, and STIs during the 11 year study period, the percentage of for-profit programs screening for these infections declined during that time.

From 2000 to 2011, on-site screening for HIV dropped by 20 percent in for-profit programs, while screening for hepatitis C declined by 13 percent and STIs by 23 percent.

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Rise in Number of For-Profit Programs

Opioid treatment programs “were among the first venues to offer HIV testing,” the study authors write, “and are more likely to offer HIV, STI, and HCV [hepatitis C virus] testing than other drug treatment programs.”

These strengths, however, are offset by the failure of many for-profit programs to offer on-site screening for potentially deadly infectious diseases, coupled with a rise in the number of these programs nationwide. 

Of the more than 1,000 opioid treatment programs in the U.S.—which provide treatment to more than 300,000 people each year—54 percent were for-profit in 2011, up from 43 percent in 2000.

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Opt-Out Screening Has Little Effect

In 2006, the Centers for Disease Control and Prevention revised its stance on HIV screening to include opt-out testing for patients in all healthcare settings, including drug treatment programs.

Bachhuber and his colleague expected that the government’s new recommendation—HIV screening unless a patient specifically declines—would lead to more widespread testing for HIV in opioid treatment programs.

The survey showed that this was not the case, though it did not provide enough information to explain why the opposite trend occurred. 

“While it's not entirely clear why for-profit treatment programs are less likely to offer testing, it may help their bottom line,” says Bachhuber. “Offering testing is not required by federal and most state regulations, and may not be reimbursed for many patients (for example, those who do not have insurance or have poor coverage). For-profit programs may therefore cut costs and increase profits by not offering testing.”

The survey also didn’t look at whether patients were referred for off-site screening. However, this would likely have had little impact on the overall testing rate for HIV. In a 2012 study in the American Journal of Public Health, researchers found that only 18 percent of people in drug treatment programs who were referred off-site for HIV screening received their results, compared to more than 80 percent who underwent on-site testing.

With rapid gains now being made in HIV and hepatitis C research and treatments, policy officials must determine how to reverse the decline in these lifesaving screenings in drug treatment programs.

“We are planning a follow-up study,” says Bachhuber, “to get at the specific reasons why more treatment programs don't offer testing.”

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