In the Journals

Only 30% of youths with identified substance use tested for HCV

Rachel L. Epstein, MD, MScE
Rachel L. Epstein

According to study results published in JAMA, during a nearly 6-year period, only 30% of 13- to 21-year-olds with identified opioid, cocaine or amphetamine use who accessed U.S. federally qualified health centers in 19 states were tested for hepatitis C virus, suggesting a need to improve screening.

Current guidelines recommend testing all children and adults with identified risk factors for HCV, including injection drug use, the authors noted. In their study, they used opioid, cocaine or amphetamine use — “shown to have 80% sensitivity and 81% specificity for reported injection drug use” — as a proxy for HCV risk, noting that this method could potentially overestimate the at-risk population. “Given underdiagnosis of substance use, however, it is likely that fewer individuals with any injectable substance use were HCV tested than the observed 30% with documented use,” they wrote.

“We need to appropriately test for HCV in order to identify cases and link those with chronic infection to treatment to both improve care for individuals and decrease transmission, as most new HCV infections occur in individuals under age 30 who inject drugs,” Rachel L. Epstein, MD, MScE, a post-doctoral research fellow in the section of infectious diseases at Boston Medical Center, told Healio.

Epstein and colleagues included 269,124 youths aged 13 to 21 years who visited an Oregon Community Health Information Network-affiliated federally qualified health center at least once from January 2012 to September 2017. They excluded those with HCV diagnosed by ICD-9 or ICD-10 code before testing. Among those included in the study, 0.3% were diagnosed with opioid use, 54.7% were female and 62.5% were nonwhite.

They found that 6,812 (2.5%) of those included in the study were tested for HCV, of whom 122 (1.8%) were anti-HCV positive. The average age at first HCV test was 18.5 years, with an average age of 19.1 years at first positive result.

Of the 2,573 (1%) participants with documented cocaine, opioid or amphetamine use, 761 (29.6%) were tested for HCV. Of this group, 54 (7.1%) tested HCV positive. One individual with identified chronic HCV infection was treated, the researchers noted.

Direct-acting antivirals have now been approved in children 3 to 17 years old, with multiple regimens available for 12- to 17-year-olds,” Epstein said. “We need to improve linkage to care and treatment in this population, particularly now that these treatments are available.”

Epstein noted that the study was limited to data from 19 states and investigators could not analyze differences in regional testing practices.

“Future studies that address state or regional differences could be helpful for tailoring program implementation in different areas to improve screening rates,” Epstein said. “Additionally, universal HCV-testing programs or prospective cohort studies would be needed to evaluate the true burden of disease in this population.” – by Eamon Dreisbach

Disclosures: Epstein reports receiving grants from the National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse and National Center for Advancing Translational Sciences through the Boston University Clinical and Translational Sciences Institute during the conduct of this study. Please see the study for all other authors’ relevant financial disclosures.

Rachel L. Epstein, MD, MScE
Rachel L. Epstein

According to study results published in JAMA, during a nearly 6-year period, only 30% of 13- to 21-year-olds with identified opioid, cocaine or amphetamine use who accessed U.S. federally qualified health centers in 19 states were tested for hepatitis C virus, suggesting a need to improve screening.

Current guidelines recommend testing all children and adults with identified risk factors for HCV, including injection drug use, the authors noted. In their study, they used opioid, cocaine or amphetamine use — “shown to have 80% sensitivity and 81% specificity for reported injection drug use” — as a proxy for HCV risk, noting that this method could potentially overestimate the at-risk population. “Given underdiagnosis of substance use, however, it is likely that fewer individuals with any injectable substance use were HCV tested than the observed 30% with documented use,” they wrote.

“We need to appropriately test for HCV in order to identify cases and link those with chronic infection to treatment to both improve care for individuals and decrease transmission, as most new HCV infections occur in individuals under age 30 who inject drugs,” Rachel L. Epstein, MD, MScE, a post-doctoral research fellow in the section of infectious diseases at Boston Medical Center, told Healio.

Epstein and colleagues included 269,124 youths aged 13 to 21 years who visited an Oregon Community Health Information Network-affiliated federally qualified health center at least once from January 2012 to September 2017. They excluded those with HCV diagnosed by ICD-9 or ICD-10 code before testing. Among those included in the study, 0.3% were diagnosed with opioid use, 54.7% were female and 62.5% were nonwhite.

They found that 6,812 (2.5%) of those included in the study were tested for HCV, of whom 122 (1.8%) were anti-HCV positive. The average age at first HCV test was 18.5 years, with an average age of 19.1 years at first positive result.

Of the 2,573 (1%) participants with documented cocaine, opioid or amphetamine use, 761 (29.6%) were tested for HCV. Of this group, 54 (7.1%) tested HCV positive. One individual with identified chronic HCV infection was treated, the researchers noted.

Direct-acting antivirals have now been approved in children 3 to 17 years old, with multiple regimens available for 12- to 17-year-olds,” Epstein said. “We need to improve linkage to care and treatment in this population, particularly now that these treatments are available.”

Epstein noted that the study was limited to data from 19 states and investigators could not analyze differences in regional testing practices.

“Future studies that address state or regional differences could be helpful for tailoring program implementation in different areas to improve screening rates,” Epstein said. “Additionally, universal HCV-testing programs or prospective cohort studies would be needed to evaluate the true burden of disease in this population.” – by Eamon Dreisbach

Disclosures: Epstein reports receiving grants from the National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse and National Center for Advancing Translational Sciences through the Boston University Clinical and Translational Sciences Institute during the conduct of this study. Please see the study for all other authors’ relevant financial disclosures.