In 2015, an unfolding crisis in rural Scott County, Indiana, ground zero of the worst HIV outbreak in the state’s history, seized national headlines. All told, more than 200 people would test positive for HIV.
Most had a common story. They injected opioids and shared needles with others. In fact, the transmission rate for these individuals was 80 percent, according to Dr. William Cooke, the sole physician in heavily impacted Austin, Indiana. Notably, 90 percent of those who tested positive for HIV were co-infected with hepatitis C (HCV).
Writing for the Health Affairs blog, amfAR Policy Associate Austin Jones and colleagues set out to study how the substance abuse treatment system is addressing the overlap of the opioid epidemic and recent outbreaks of HIV and HCV, conducting a new analysis to assess the availability of HIV and HCV testing in substance abuse clinics nationwide.
In the study, Jones and colleagues write, “Substance abuse facilities that offer HIV and hepatitis C (HCV) testing can play a key role in identifying and interrupting transmission, and help serve as sentinel surveillance for prospective outbreaks.” Given the connection between opioid use and infectious diseases, increased access to testing means more effective prevention.
“At this point in the opioid epidemic, infectious disease testing is a basic need for people who inject drugs.” —Austin JonesThe authors report sobering statistics: in 2017, only 28.1 percent of substance abuse facilities reported offering HIV testing and 27.5 percent reported offering HCV screening. Numbers vary widely by state, from 8.1 percent in North Dakota to 62.5 percent in the District of Columbia.
Particularly concerning is that several states with large numbers of vulnerable counties had low rates of testing.
The Scott County HIV outbreak was a wakeup call, and a recent outbreak in the northern Massachusetts cities of Lawrence and Lowell—not considered vulnerable by the CDC—shows this can happen anywhere without robust preventive services. Jones and colleagues report that only two of seven substance abuse facilities in Lawrence offer HIV testing, and none of the three facilities in Lowell offer HIV testing.
“At this point in the opioid epidemic, infectious disease testing is a basic need for people who inject drugs,” said Jones. “All parts of the health system should be prepared to meet this need, including substance abuse facilities.”