Dear Colleague:

On December 9, 2024, the Assistant Secretary for Mental Health and Substance Use and leader of the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Director of the Centers for Disease Control and Prevention (CDC), urge public health and substance use disorder (SUD) treatment communities to increase the number of people with SUD who are tested and treated for HIV and viral hepatitis.

In the United States, an estimated 2.4 million people have Hep C, 1.2 million people have HIV, and 660,000 people have Hep B. Roughly 2 percent of those with HIV also have Hep B. Injection drug use is a risk factor for all three infections and is the most commonly reported risk factor for new Hep C and Hep B infections. Further, one in four people with HIV who inject drugs also have Hep C. One in seven people with HIV, one in three people with Hep C infection, and one in two people with Hep B do not know they have it. According to the National Substance Use and Mental Health Services Survey, only a third of our nation’s 15,000 substance use disorder treatment facilities offer HIV, Hep C, or Hep B testing. This represents thousands of missed opportunities to ensure everyone knows their HIV, Hep C, and Hep B status and to link individuals to lifesaving treatment.

To increase the identification and treatment of all people with HIV and viral hepatitis, CDC recommends that all adults receive HIV, Hep B and Hep C testing at least once in their lifetime.

Other CDC HIV, Hep C and Hep B Recommendations

  • HIV testing at least once a year for people who share needles, syringes, or other drug injection equipment (for example, cookers) or exchange sex for drugs or money
  • Routine periodic Hep C testing for people with ongoing risk factors, including
    people who currently inject drugs and share needles, syringes, or other drug preparation equipment
  • Routine periodic Hep B testing for people who inject drugs
  • Clients without Hep B immunity, including adults age 19–59 and adults 60 and older with risk factors, should be vaccinated

Testing is the first step to accessing lifesaving treatment. For example, Hep C treatment with oral direct-acting antivirals is curative in >95% of cases, prolongs life, is very well tolerated, and confers cost savings to the healthcare system by preventing Hep C-related complications. Yet too few people are diagnosed, and only one-third of people with diagnosed Hep C have been treated or have naturally cleared the virus. At the end of June 2024, the FDA cleared a fingerstick point-of-care (POC) Hep C RNA test for use in Clinical Laboratory Improvement Amendments (CLIA)-waived settings. This new POC test has the potential to revolutionize provider workflows and significantly reduce barriers to Hep C testing and treatment. Prior POC tests for the Hep C antibody have only been able to diagnose previous exposure and not current infection, requiring multiple visits to test and connect people to treatment. Since the test takes 60 minutes or less to run, the new POC Hep C RNA test can facilitate same-day diagnosis and rapid treatment initiation for Hep C. CDC recommends direct Hep C RNA testing for people who might have been exposed to Hep C within the past six months. Co-located Hep C treatment or highly accessible treatment through telehealth, mobile units, or warm handoffs to Hep C treatment providers is essential to actualize the benefit of POC Hep C RNA testing. POC Hep C RNA testing has the potential to significantly improve Hep C testing and treatment rates in settings where people with SUD seek care.

People with SUD are at increased risk for HIV, and SUD treatment improves both HIV and SUD-related health outcomes. There are several FDA-approved POC tests for HIV that can be run on fingerstick whole blood or oral fluids in CLIA-waived settings. We reiterate an earlier appeal to increase POC HIV testing in SUD treatment programs. Linking people with HIV to treatment is essential to prolong their lives and prevent HIV transmission, and those who test negative may benefit further from being connected with HIV pre-exposure prophylaxis (PrEP) and syringe service programs.

Integrating HIV and viral hepatitis testing in SUD treatment settings improves treatment initiation, especially when treatment is co-located, and is in line with SAMHSA’s 2023–2026 Strategic Plan, which prioritizes the integration of behavioral and physical healthcare. SAMHSA and CDC encourage SUD treatment facilities to integrate HIV and viral hepatitis testing, including POC HIV and Hep C tests, into the services they offer their clients. Those who test positive should be connected to HIV or Hep C treatment or offered on site when feasible. Information on integrating HIV and Hep C into SUD treatment is available. Hep C POC testing may be an allowable expense for SAMHSA grant recipients—reach out to your SAMHSA Government Project Officer to assess feasibility; a budget revision may be necessary.

More than one million Americans are on medications for opioid use disorder, and millions more receive SUD treatment each year. It is our collective responsibility to ensure that they access screening and lifesaving treatment for HIV and viral hepatitis. Advancements in diagnostics are the first step to increasing testing, but we need your help to implement and use these new tools. Please consider integrating these POC diagnostics into your practice. With your help, we can increase HIV and viral hepatitis screening to ensure that no more families and communities have to lose loved ones to these preventable and treatable diseases.

Sincerely,
Miriam E. Delphin-Rittmon, PhD
Assistant Secretary
Mental Health and Substance Use

Mandy K. Cohen, MD, MPH
Director
Centers for Disease Control and Prevention

View Dear Colleague Letter here

Last Updated on January 16, 2025 by HepFree NYC

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