Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV.
Hepatitis C (HCV) and HIV are associated with opioid use disorders (OUD) and injection drug use. Medications for OUD can prevent the spread of HCV and HIV. This study aimed to describe the prevalence of documented OUD, as well as receipt of office-based medication treatment, among primary care patients with HCV or HIV, using data collected from Phase 1 of the PRimary care Opioid Use Disorders (PROUD) Study (CTN-0074), a pragmatic trial testing whether a collaborative care model increases OUD medication treatment in primary care. Electronic health record and insurance data for adults 18 or older with 2 or more visits to primary care during the study were analyzed. The primary outcome was the diagnosis of OUD; the secondary outcome was OUT treatment with buprenorphine or oral/injectable naltrexone. Prevalence of OUD and OUD treatment was calculated across four groups: HCV only, HIV only, HCV and HIV, and neither HCV nor HIV. In addition, adjusted odds ratios (AOR) of OUD treatment associated with HCV and HIV (separately) were estimated, adjusting for age, gender, race/ethnicity, and site.
The sample included 1,368,604 people, of whom 10,042 had HCV, 5,821 HIV, and 422 both. The prevalence of diagnosed OUD varied across groups: 11.9% for those with HCV, 1.6% for those with HIV, 8.8% for those with both, and 0.92% for those with neither. Among those with diagnosed OUD, the prevalence of OUD medication treatment was 20.9%, 16%, 10.8%, and 22.3% for those with HCV, HIV, both, and neither, respectively. HCV was not associated with OUD treatment, whereas patients with HIV had a lower probability of OUD treatment.
Conclusions: Among patients receiving primary care, those diagnosed with HCV and HIV were more likely to have documented OUD than those without, with the highest prevalence (11.9%) occurring among patients with HCV. Receipt of medication treatment for OUD was uniformly low for all patients, including those with HCV and HIV, with only up to 1/5 of patients with OUD receiving buprenorphine or naltrexone. The finding that patients with HIV who had OUD were less likely to received medication treatment for OUD compared to uninfected patients was unexpected and merits further investigation. These results highlight the need for improved access to medications for OUD, particularly from providers caring for patients living with HCV/HIV. Providing effective treatment for OUD is critical for maximizing the health of people living with HIV and HCV, as well as preventing transmission of these diseases.
Related protocols: CTN-0074