Only One-Third of Youth With Opioid Use Disorder Tested for HCV.
Study calls into question need for broader HCV screening.
SAN FRANCISCO — Only a little over a third of youth with documented opioid use disorder were tested for hepatitis C, and of those, one in ten were positive for exposure to HCV, according to research presented here.
Of adolescents with a diagnosed opioid use disorder, 35% were tested for hepatitis C, and 11% were seropositive for HCV. Moreover, only 11% of these adolescents had ever been tested for HIV, reported Rachel Epstein, MD, of Boston Medical Center.
These results were presented at the IDWeek annual meeting, with joint sponsorship by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society(PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).
At a press conference, Epstein said that little is known about what types of hepatitis C testing is occurring in the youth population.
The researchers examined data from around 270,000 individuals ages 13 to 21 with at least one visit to a federally-qualified health center across 19 states in the OCHIN electronic medical record. In all, there were 153 positive cases of HCV.
Overall, about 57% were girls, about 37% were white, and about a third were Hispanic. Median age at first HCV screening was about 19 years. Only 2.5% of the participants were tested for HCV. In addition to the 35% who were tested for hepatitis C with a diagnosed opioid use disorder, only 8.9% with any ICD-9 code for drug use were tested for HCV.
Demographic factors that were independently associated with HCV testing included:
- • Older age (age 19-21 versus 13-15 at study end, adjusted odds ratio [aOR] 5.64, 95% CI 5.13-6.19)
- • Black race (aOR 1.88, 95% CI 1.76-2.00)
And ICD-9 codes for substance use disorder:
- • Amphetamine (aOR 5.82, 95% CI 5.10-6.64)
- • Opioids (aOR 3.50, 95% CI 2.92-4.19)
- • Cocaine (aOR 2.90, 95% CI 2.43-3.47)
- • Cannabis (aOR 2.46, 95% CI 2.31-2.62)
Epstein said that given these numbers, this raised the question of whether more universal screening for hepatitis C in youth is needed. But when asked where the burden of that screening would fall, she said that prior research has modeled different approaches, and seemed to conclude that it would not necessarily fall to the provider.
“There is certainly evidence that by doing [screening] in a more universal way, you can have it as part of a battery of tests that the clinicians themselves do not perform, and that would be effective,” she told MedPage Today, adding that in a busy primary care practice, “time is always of the essence.”
Donna Futterman, MD, of Montefiore Medical Center in New York City, who moderated the press conference, but was not involved in the research, pointed out that no unique consent is required to test patients for hepatitis C, similar to syphilis, gonorrhea, and other sexually transmitted infections.
“Provider knowledge and comfort goes a long way, and there’s a tremendous amount of education we have to do to increase this. Not being aware of the risk was the number one reason clinicians used to not test for HIV,” she said. “This study helps us to understand the risk.”
Futterman said that there are no guidelines for testing for hepatitis C, even in the setting of substance use disorder. Current guidelines only recommend testing for HCV in those with “known injected drug use or other specific risk factors.”
She said the lack of testing in those with other risk factors reminded her of the early days of the HIV epidemic — where she characterized providers’ attitudes as “oh, you’re too pretty to have HIV, you can’t be high risk.” Specifically, she highlighted how only 11% of youth with a diagnosed opioid use disorder were ever tested for HIV.
“How can you test for HCV and not think HIV is part of it?” Futterman said. “What is that differentiator in a provider’s head that makes them focus on one thing, but not the other?”