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Abstract Details
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
Clin Infect Dis. 2023 May 24;76(10):1793-1801. doi: 10.1093/cid/ciac981.
1Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA.
2Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA.
3Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA.
4Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, West Virginia, USA.
5Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
6Health Behavior and Policy Department, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
7Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
8Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
9Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
10Government Resource Center, Ohio Colleges of Medicine, Ohio State University, Columbus, Ohio, USA.
11Hilltop Institute, University of Maryland Baltimore County, Baltimore, Maryland, USA.
12Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, Newark, Delaware, USA.
13College of Medicine, Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA.
14Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
15Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
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.