West Virginia University researcher Judith Feinberg has partnered with colleagues at Yale University to integrate services for opioid use disorder, the hepatitis C virus and HIV in 20 primary care clinics across West Virginia. The National Institute on Drug Abuse expects to award over $6.6 million during the five-year project.
West Virginia has the highest overdose rate in the country, and the state has experienced numerous outbreaks of both HIV and hepatitis C in recent years. Because drug and alcohol use are known to place people at a higher risk for getting hepatitis C and HIV, these health conditions are deeply intertwined with the opioid crisis.
“The goal of this grant is to integrate care for substance use disorder, infectious diseases and other medical needs that people have—at the same time, in the same place—so that we don’t have key aspects of people’s medical care being handled in a disconnected manner,” said Feinberg, the WVU Department of Medicine’s vice chair for research. “It’s efficient and appropriate because, first of all, it’s all part of the greater health issue for people who use drugs. You can’t deal with one effectively without dealing with the other. And second of all, there is such a paucity of specialist care here in West Virginia that we can’t be sending patients hither and yon to get appropriate care.”
People who live in West Virginia’s more rural areas may have an exceptionally difficult time accessing the specialized care they need. For instance, if someone with a chronic case of hepatitis C lives in Pocahontas County (population: 7,869) but has to see a WVU Medicine specialist in Monongalia County (population: 105,822), that’s a six-hour round-trip drive.
The injection drug epidemic in West Virginia occurs mostly in rural settings, where primary care providers are uniquely positioned to reduce the harms of drug misuse, especially the increased risk of HIV and hepatitis C when drugs are being injected.
“This research has great potential to effectively address the intertwined opioid and HIV epidemics in a state that is most profoundly impacted by both conditions,” said Rick Altice, one of the principal investigators on the research and a professor at Yale.
Feinberg, Altice and Lynn Madden—a Yale assistant professor who is also a principal investigator—will use a number of tools to empower physicians, physician assistants and nurse practitioners at 20 federally qualified health centers to evaluate and treat patients for substance use disorder, HIV and hepatitis C.
These tools will include automated screening processes and a clinical monitoring dashboard within the electronic medical record.
Using Project ECHO—a medical education program funded by the West Virginia Clinical and Translational Science Institute—the researchers will also provide ongoing clinical education and support to primary care providers who may not feel expert in treating what others may call specialty conditions.
“The research is especially crucial since people with substance use or psychiatric disorders die, on average, 10 to 25 years earlier than those without them and mostly from chronic conditions that are diagnosed and treated in primary care settings,” Altice said.
Working alongside the West Virginia Primary Care Association and the West Virginia Practice-Based Research Network, the researchers will collect data to quantify the project’s impact. They’ll consider, for example, rates of diagnoses of HIV, hepatitis B and C and endocarditis, and they’ll determine whether the 20 participating health centers identify these conditions in patients more often than their non-participant counterparts do.
The researchers will also characterize the obstacles they encounter as they roll out the program and how they overcome them.
They hope that what they learn may influence primary care not only in West Virginia but in other communities aiming to address the co-occurrence of substance use disorders with HIV or hepatitis C.
Although West Virginia has among the highest rates of opioid-involved overdose deaths in the United States, fatal overdoses aren’t confined to the state. In 2019 alone, 70,630 Americans died from overdoses. That’s the equivalent of nearly 200 daily deaths.
“If a jet filled with 200 people crashed every day, don’t you think that there would be more urgency in addressing this problem?” Madden said.
And according to the World Health Organization, half a million deaths worldwide are attributable to drug use. That’s the same as seven Boeing 737 crashes each day.
“In the resource-rich world—the United States, Europe, Canada, Australia and New Zealand—almost all hepatitis C exists as a function of injection drug use because it’s very contagious in blood,” Feinberg said.
Although hepatitis C can cause serious complications in people who don’t receive treatment for it, oral medication—taken once daily, for eight to 12 weeks—can cure it.
And while there’s no cure yet for HIV, it’s become an extremely manageable condition. The Centers for Disease Control and Prevention reports that a person who is diagnosed with HIV at age 20 and who takes current HIV medication will live, on average, to be 71 years old. Without that medication, the average lifespan shrinks to 32 years. (The average person without HIV lives to be 79.)
There’s even a once-daily pill that can prevent someone from contracting HIV if they’re at risk for it.
“One pill, once a day—very few side effects,” Feinberg said. “This is in the wheelhouse of a primary care provider.”