HIV and HCV Screening, and Pre-Exposure Prophylaxis Among Managed Care Beneficiaries with Substance Use Disorders: A Cross-Sectional Study from a Single State.

PURPOSE: Screening for HIV and Hepatitis C (HCV) is critical in caring for individuals with substance use disorders (SUD). This is particularly relevant in identifying prescribing habits for Pre-Exposure Prophylaxis (PrEP). The objectives were to examine HIV and HCV screening rates, and PrEP prescription among managed care beneficiaries with SUD and without an HIV diagnosis and determine the factors associated with the screenings and PrEP prescriptions.

METHODS

We conducted a retrospective cross-sectional analysis (January-December 2021) of managed care claims for beneficiaries who visited either urban primary care clinics or emergency departments affiliated with an academic medical center. Sample included 2381 Medicaid and dually eligible for Medicare and Medicaid managed care beneficiaries with SUD, continuously enrolled for 12 months, 21 years or older, and without an HIV diagnosis. Substances included in the analysis were alcohol, opioid, cocaine, cannabis, and other psychoactive drugs. Univariate descriptive statistics and multivariable logistic models were used to address the objectives. Rates of HIV and HCV screening, and PrEP prescriptions were examined. Outcome variables for multivariable logistic regression were whether beneficiaries had HIV screening, HCV screening, and PrEP prescription. The predictors were age, gender, race, primary language, area of residence, insurance type, chronic conditions, tobacco use, polysubstance use, number of providers seen, primary care physician seen, emergency department visits, hospitalizations, and annual cost of care.

RESULTS

About 22% of beneficiaries had HIV or HCV screening; PrEP prescriptions were non-existent in this sample. About 83% visited their primary care physician (PCP). The predictors of HIV and HCV screenings include gender, area of residence, polysubstance use disorder, PCP visits, and hospitalizations.

CONCLUSION

Results indicate low HIV and HCV screening rates and no PrEP prescriptions among the managed care population with SUD. Specifically, beneficiaries with rural residence, females, and Medicaid beneficiaries need targeted interventions and missed opportunities exist at PCP offices.