Viral hepatitis screening policies and practices in methadone maintenance centers

Users of injected drugs (IDUs) are at high risk for hepatitis A exposure (66%) and chronic hepatitis B (6%), and hepatitis C (50-93%). Federal guidelines for medically-assisted treatment programs (MATs) include hepatitis screening.

In 2009 we interviewed directors from 10 of 12 Philadelphia-supported MATs (serving 3,700 of the 4,000 annual clients) to identify policies and practices for hepatitis-related testing and results communication.

Most policies mentioned HCV, 50% mentioned HBV and one mentioned HAV testing. Most considered timing and criteria for testing and half considered re-testing. Few policies mentioned results communication. Practices varied and frequently did not adhere to policy. Hepatitis tests occurred within one week of intake. All tested for anti-HCV antibodies. Sixty-percent tested for HBVsAg, 30% for anti-HBVsAb and none tested for anti-HAVAbs. Seventy-percent tested all clients, a few did risk-based testing or did not test transfer clients. Retesting was conducted in half of programs. A few re-tested all clients annually. Some retested upon request or under specific circumstances. Test results were communicated by staff with varied training and knowledge. One program could not identify who was responsible for communication and another communicated test results only if clients asked.

Inadequate policies and practices limit the ability of MATs to test appropriately, determine prevalence and vaccination needs, accurately inform clients of infection, and protect clients and communities from viral hepatitis. We propose recommendations to improve and reduce costs for hepatitis testing in MATs. Learning if you have a potentially life-threatening infection shouldn't depend on which MAT you enter.