Opioid Crisis Inflaming Hep C, HIV in Hard-Hit Communities

Nancy A. Melville

November 08, 2017

DALLAS — The areas of the United States hardest hit by the opioid epidemic are also seeing increases in hepatitis C and HIV transmission, new state-by-state data show, but funding shortcomings are translating into treatment gaps in areas of the country most devastated by the crisis.

"These three public health emergencies are very much connected," said Alana Sharp, MPH, from the Foundation for AIDS Research, a private foundation in Washington, DC that focuses on research that produced the database. "We can develop a strong public health response by responding to the crises together, and we believe that we can do that best by having good data."

The web-based Opioid & Health Indicator Database pulls together, for each state, trends over time in opioid use and related infectious disease mortality, as well as state-by-state levels of federal funding.

Sharp presented results from some of the first database analyses on the accessibility of addiction treatment facilities here at the Association of Nurses in AIDS Care (ANAC) 2017.

Rates of drug abstinence are at least doubled when treatment for opioid addiction involves medications approved by the US Food and Drug Administration — such as methadone, buprenorphine, and naltrexone — and psychosocial therapy, she reported.

Treatment Programs

From 2005 to 2017, the percentage of treatment facilities that offer such treatment increased from less than 10% to about 40%, which is still exceptionally low, considering the soaring rates of drug overdoses in the country. Drug overdose deaths increased 250% from 1999 to 2015, according to the Centers for Disease Control and Prevention (CDC).

"What this tells us is that, right now, more than half the facilities in this country are not offering what many consider to be the gold standard of addiction treatment," Sharp pointed out.

And although 62% of treatment facilities accept Medicaid, which is often essential in the opioid-addicted population, only 41% offer medication-assisted treatment. Of the medication-assisted treatment facilities, only 28% accept Medicaid.

An analysis of each county showed that the average distance to travel to an outpatient facility that offers at least one form of medication-assisted treatment is considerable.

In the 220 counties identified by the CDC as being most vulnerable to outbreaks of HIV and hepatitis C, 93% have no needle-exchange programs at all.

Needle Exchanges

"We clearly have poor overlap in syringe-exchange programs and vulnerable counties, and there are serious gaps suggesting that we are not doing a good job in responding to treatment needs in vulnerable counties," Sharp said.

The rate of hepatitis C infection has tripled in the past 5 years in the United States — largely driven by injection drug use, which leads to needle sharing and the transmission of bloodborne infections — so access to needle-exchange programs is critical, she emphasized.

Strikingly, the number of deaths associated with hepatitis C surpassed deaths from all other infectious diseases in the country, including HIV, in 2015, according to the CDC.

The database also specifies the federal funding each state receives from various sources.

For example, in Indiana, which had a recent dramatic spike in HIV infections caused by drug injection and needle sharing, funding from the 21st Century Cures Act will be nearly $11 million in 2017. Funding from the HRSA–Ryan White HIV/AIDS Program was about $18.3 million in 2016, and Housing Opportunities for Persons With AIDS funding was about $2.2 million. CDC funding for HIV and AIDS was approximately $3.8 million in 2016, when funding for viral hepatitis was only about $74,000.

"The amount of money we see for states for viral hepatitis is extremely low," Sharp said.

This database analysis underscores the ongoing challenges associated with the opioid crisis, said ANAC President Jeffrey Kwong, DNP, associate professor of nursing at the Columbia University Medical Center in New York City.

"There remains significant work to do with regard to addressing the HIV, hepatitis C, and opioid crises in the United States, and ANAC is committed to helping address this epidemic," he told Medscape Medical News.

"As HIV providers, we are familiar with the issue of stigma that plays a major role in terms of treatment access, policy, and support for the hepatitis epidemic," Dr Kwong said.

"Ongoing efforts to address disparities, specifically in substance-using communities and other vulnerable populations, are needed, and ANAC continues to identify ways that our organization can help reduce these disparities," he added.

Ms Sharp is a policy associate at the Foundation for AIDS Research. Dr Kwong is on the speakers bureau for Gilead Sciences.

Association of Nurses in AIDS Care (ANAC) 2017. Presented November 3, 2017.

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