HCV screening common but follow-up lacking in young opioid users

Young adult opioid users infected with the hepatitis C virus (HCV) do not receive adequate screening support or referral to care, according to a new study.

The results suggest that HCV screening is common, but follow-up measures needed to stop the spread of the virus fall short.

Primary care physicians can be enlisted to ensure adequate follow-up after referral to care. “Primary care physicians who care for young people who use opioids should be sure to screen patients for HCV and provide referrals to treatment services where appropriate,” Brandon Marshall, PhD, associate professor of epidemiology in the Brown University School of Public Health, told Medical Economics.

Most studies have focused on young people who are injecting opioids, and found that HCV prevalence varies between 30 percent and 40 percent. “We found that, among persons reporting a prior history of HCV screening, 12 percent reported a positive test. The lower prevalence in our study could be due to a number of factors, including that only one-third reported ever injecting. Nonetheless, these young people are at high risk of HCV, particularly those who have recently started injecting,” said Marshall. “Many young people who are at risk for hepatitis C may acquire the infection and then not know it, and then through drug injection practices may transmit it to others.”

The researchers published their results January 2018 Journal of Adolescent Health.

Marshall and colleagues recruited 196 young adults, ages 18 to 29 years, who used prescription opioids recreationally, not for medical reasons in Rhode Island. Of those, 154 (78.6%) opioid users reported receiving HCV screening. The prevalence of screening was much higher among those ages 24 to 29 (89.5%) than among those ages 18 to 23 (59.7%).

“We were surprised that over three-quarters of young people in our study had reported a lifetime HCV test. This speaks to the good work of free HCV screening programs operating across the state. However, the youngest people in the study were least likely to report a history of HCV testing. These results show that we need to work on improving access to HCV testing programs for people who have recently initiated illicit opioid use,” said Marshall.

Among those who were screened, 18 young adults said they tested positive for HCV, which was 30% of the 59 participants who said they have injected drugs. Of the 18 young adults who tested positive, 13 received a confirmatory follow-up test, 12 were referred for specialty care, only 10 received information about how not to transmit the virus to others, and 9 received education about living with HCV.

“We need to address financial and other barriers to care for youth who test positive and are in need of additional resources and hepatitis C care. Further studies are needed to identify effective mechanisms to link youth who have screened positive with HCV treatment and care,” said Marshall.

Better strategies are needed to encourage young opioid users to receive earlier HCV screening and testing. “HCV screening and testing can be integrated into overdose prevention programs, including syringe access programs and community-based naloxone distribution,” he said.