This report summarized findings from a series of eight semi-structured discussions with health centers in counties deemed by researchers at CDC as being at high risk of infectious disease outbreaks from injection drug use to better understand how these providers care for individuals with opioid use disorder and attempt to prevent related infectious disease transmission. These health centers reported being active in pursuing collaborations with community-based organizations and local governments to provide prevention and treatment services. Many of the CHCs reported using telehealth technologies to collaborate with specialists in behavioral health and to address other opioid use and infectious disease issues. They also reported a variety of challenges such as acquiring sufficient resources to treat hepatitis C; recruiting behavioral health staff and integrating primary care with behavioral health; stigma (both internal and external) attached to drug use, drug use treatment, and infectious diseases; gaps in state and county systems for monitoring prescription drugs; as well as other issues related to delivering services.
Results provided in this research brief indicated that expanding HCV screening in the IHS service population to include all women of reproductive age or universal screening for all individuals ages 15–64 would be cost-beneficial in the long term at a seroprevalence of 0.20 percent or above, although this depended on the utilization of certain higher- and lower-cost medications. Studies estimate seroprevalence in AI/AN populations to be higher than 0.20 percent, ranging from 0.82 percent to 11.5 percent. Given the range of seroprevalence estimates for AI/AN populations, this report found that it is likely that expanded screening would be cost-beneficial even if more expensive drugs are used, but expanded screening is unlikely to be cost-beneficial if the majority of HCV-positive patients receive the most expensive drug regimens currently available.
According to surveillance data from the Centers for Disease Control and Prevention, AI/AN populations have the highest incidence of acute hepatitis C virus (HCV) and the highest rate of HCV-related mortality relative to other racial and ethnic groups. Understanding the seroprevalence of HCV and the costs associated with prevention and treatment of HCV can help inform decisions about expanding HCV screening in the population IHS serves.
This report summarized findings from a small qualitative study of six health centers that were pursuing a diverse range of approaches to facilitating specialty care for patients. Approaches varied by specialty, patient insurance status, and community opportunities and constraints. Key approaches included hospital affiliation, providing specialty care at primary care sites and remote visits and consultations using telehealth technology. All study sites provided mental health services and are working to integrate these services with primary care: two covering a full range, four focusing on services most linked to primary care. Only two provided substance use disorder services. A per member per month payment for case management appears to have a direct positive impact on access to specialty care.
This study described the diverse arrangements health centers have in place to assure provision of specialty services for their patients and described how telehealth and tele-consult are among the approaches for providing this care.