OBJECTIVES: The United States Preventive Services Task Force and Centers for Disease Control and Prevention recommend screening for hepatitis C virus (HCV) infection periodically for persons at high risk for infection, including those with substance use disorders (SUD). Little is known about HCV testing rate among patients with SUD in real-world clinical practice over time. This study aimed to examine the HCV testing rate and to identify characteristics associated with non-receipt of HCV testing among Medicaid beneficiaries with SUD.

METHODS: A retrospective cohort study included Florida Medicaid Data from 2012-2018. We identified patients aged 18-64 years with a SUD diagnosis or medications for the treatment of SUD. Patients were excluded if they had HCV diagnosis or HCV treatments one year before the date of first SUD diagnosis. Annual crude HCV testing rate was calculated as the number of patients with SUD who received the first HCV testing divided by the total follow-up person-time. A multivariable logistic model with generalized estimating equation, using a binomial distribution and a logit link, was used to examine the trend of HCV testing and to identify factors associated with non-receipt of HCV testing.

RESULTS: Among 159,126 eligible Florida Medicaid beneficiaries with SUD(mean age=39±14 year;males=40%; white=51%) from 2012-2018, the overall HCV testing rate was estimated at 10.9 per 100 person-years. No significant change exists in the annual HCV testing rate(P_trend=0.06) over time. Factors associated with a decreased odds of receiving HCV testing among Florida Medicaid beneficiaries included white(odds ratio[OR]=0.68, 95% confidence interval(95%CI)=0.66-0.70), male(OR=0.70, 95%CI=0.68-0.72]), younger age(18 ≤age≤35 years compared to 51≤age≤64 years)(OR=0.71, 95%CI=0.69-0.74), and having opioid use disorder(OR=0.86, 95%CI=0.82–0.90).

CONCLUSIONS: HCV testing rates among Florida Medicaid beneficiaries with SUD remained very low from 2012 to 2018, despite the national recommendations for screening. Our findings underscore the need to identify the barriers to HCV testing, especially among Medicaid beneficiaries with SUD.