Identifying Safety-Net Resources at Health Centers to Prevent Infectious Disease Transmission Resulting from the Opioid Epidemic

by Joshua Breslau, Ryan K. McBain, Molly Simmons

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Research Questions

  1. What factors affect Community Health Centers' (CHCs') care for people with opioid use disorder (OUD)? For preventing human immunodeficiency virus (HIV) and hepatitis C (HCV) transmission among people who inject drugs?
  2. What strategies and innovations do CHCs use to care for people with OUD? What strategies are used to contain HIV and HCV transmission among people who inject drugs?
  3. How do CHCs integrate substance use disorder services with mental health services and primary care? What challenges have they faced and how have they addressed them?
  4. What information do CHCs have about HCV and HIV treatment uptake? How is it used?

The Assistant Secretary for Planning and Evaluation for the U.S. Department of Health and Human Services asked the RAND Corporation to conduct an exploratory study examining the factors that affect the ability of Community Health Centers (CHCs) to reduce transmission of infectious diseases related to the opioid epidemic. The emphasis is on rural areas, which have suffered disproportionately from the opioid epidemic and lack resources to address the complex social and medical issues related to opioid use, opioid use disorder, and risk for infectious diseases. Discussions were held with staff from eight CHCs, selected from the 102 CHCs in counties that prior research has identified as being at high risk for opioid-use related transmission of infectious diseases. The content of these discussions was summarized to identify the major challenges that CHCs face in preventing and treating infectious diseases and the strategies that they employ to overcome these strategies.

Key Findings

Staff shortages, politics, and confusion about costs all hamper care

  • CHC staff were concerned about the costs of treating HCV and about staying informed regarding best HCV treatment practices. HCV treatment guidelines were seen as overrestricted.
  • CHCs had limited access to staff, especially behavioral health staff.
  • Health information exchanges help CHCs track patients with opioid use disorder or infectious diseases.
  • Local community-based organizations, both governmental and nongovernmental, play important cooperative roles with CHCs, but these relationships are largely ad hoc.
  • Access to sterile syringes can help prevent disease transmission, but political pressure hampers syringe services programs.
  • Many CHCs are involved with justice-involved populations.

Table of Contents

  • Chapter One

    Background

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Conclusions: CHC Concerns About Opioids and Infectious Disease Transmission

Research conducted by

This research was funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and conducted by Payment, Cost, and Coverage program within RAND Health Care.

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