Strengthening systems of care for people with or at risk for HIV, HCV and opioid use disorder: a call for enhanced data collection

Abstract

Background The syndemic between opioid use disorder (OUD), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) results in excessive burdens on the healthcare system. Integrating these siloed systems of care is critical to address all three conditions adequately. In this implementation project, we assessed the data capacity of the health system to measure a cascade of care (COC) across HIV, HCV and OUD services in five states to help guide public health planning. Materials and methods Data for this study were gathered from publicly available datasets and reports from government (SAMSHA, CMS, HRSA and CDC) sites. We created, where possible, COCs for HIV, HCV, and OUD spanning population estimate, diagnosis, treatment initiation, treatment retention, and patient outcomes for each of five states in the study. Results The process of data collection showed that baseline COCs examining the intersections of OUD, HIV, and HCV cannot be produced and that there are missing data in all states examined. Collection of specific data points is not consistent across all states. States are better at reporting HIV cascades due to federal requirements. Only gross estimates could be made for OUD cascades in all states because data are separated by payer source, leaving no central point of data collection from all sources. Data for HCV were not publicly available. Conclusion It is difficult to assess the strategies needed or the progress made towards increasing treatment access and decreasing the burden of disease without the ability to construct an accurate baseline. Using integrated COCs with relevant benchmarks can not only guide public health planning, but also provide meaningful targets for intervention. KEY MESSAGES While HIV COCs are available for most states at least annually, they are not disaggregated for populations with co-occurring OUD or HCV. Data to calculate HCV COC are not available and data to calculate OUD COC are partially available, but only for specific payers. States do not have systems in place to measure the scope of the syndemic or to identify targets for quality improvement activities.

Aligning an emergency department hepatitis C and human immunodeficiency virus testing quality improvement initiative with universal screening recommendations

“…A syndemic is the occurrence of 2 or more diseases overlapping with adverse social factors that reinforce poor outcomes. 1 Syndemic theory supports the notion that human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections cannot be addressed without also addressing the problem of substance use disorder (SUD), and vice versa, while considering disease interactions and the impact on personal and public health. 2 It is increasingly important to address the HCV, HIV, and SUD syndemic through integrated approaches as the problems are interdependent and lead to high health care use.…”

“… 2 It is increasingly important to address the HCV, HIV, and SUD syndemic through integrated approaches as the problems are interdependent and lead to high health care use. 1 Kentucky has long ranked in the top 10 states for new HCV infections and has 54 counties at high risk for rapid HIV and HCV transmission among people who inject drugs (PWID). 3 Emergency departments (EDs) serve as a stop gap for finding people at risk for worse health outcomes secondary to the syndemic through ED‐based screening, interventions, and linkage‐to‐care services.…”

“…Syndemic theory supports the notion that human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections cannot be addressed without also addressing the problem of substance use disorder (SUD), and vice versa, while considering disease interactions and the impact on personal and public health 2 . It is increasingly important to address the HCV, HIV, and SUD syndemic through integrated approaches as the problems are interdependent and lead to high health care use 1 . Kentucky has long ranked in the top 10 states for new HCV infections and has 54 counties at high risk for rapid HIV and HCV transmission among people who inject drugs (PWID) 3 .…”