Infectious Disease Screening in Substance Use Treatment Programs Effective, Study Finds

New research is shedding light on the potential benefits of embedding infectious disease (ID) screening within inpatient substance use disorder (SUD) programs, highlighting increases in testing uptake and low-barrier delivery of preventive and therapeutic treatment.1

The effectiveness study evaluated a comprehensive ID screening, prevention, and treatment intervention embedded within an inpatient withdrawal management and substance use recovery program at Penn Presbyterian Medical Center and found that embedding ID services in this setting significantly increased completion of hepatitis A virus (HAV), hepatitis B virus (HBV), and latent tuberculosis (LTBI) screening.1

In response to the intersecting challenge of SUDs and IDs and seeking to capitalize on opportunities for screening in various health care settings, guidelines have called for regular screening for ID among people with SUD. For example, in 2021, the Substance Abuse and Mental Health Services Administration released guidelines encouraging medical staff members at substance use treatment programs to have a primary role in screening for hepatitis and HIV for all patients presenting to care.1,2

“Despite this guidance and the success of integrated screening interventions in other settings, the potential for inpatient SUD programs to serve as platforms for comprehensive ID screening, treatment, and prevention has not been fully explored,” Kelly Dyer, MD an infectious disease fellow at the University of Pennsylvania, and colleagues wrote.1

To address this gap in research and assess the impact of co-locating ID screening services within inpatient SUD treatment programs, investigators conducted an effectiveness study within an 18-bed inpatient SUD program at an affiliate hospital of the University of Pennsylvania Health System. Patients were included in the study if they were admitted to the inpatient withdrawal management and substance use treatment program during the study periods.1

Patients admitted during the intervention period, defined as September 2022 through June 2023, who were seen by the ID-trained nurse navigator were included in the intervention group to assess the effectiveness of the intervention, which encouraged completion of screening for HIV, viral hepatitis, LTBI, and sexually transmitted infections (STI). The intervention period was compared with a “usual care” period from September 2021 through June 2022, during which ID screening was completed at the discretion of the admitting psychiatrist.1

Of 515 unique patients admitted to the substance use treatment unit, 261 (50.7%) were admitted during the usual care period and 254 (49.3%) during the intervention period. Of the 254 patients admitted during the intervention period, 207 were approached by the nurse navigator and included in the effectiveness analysis.1

Results showed completion of any ID screening tests and identification of treatment or prevention needs were significantly higher during the intervention period. Specifically, any ID screening was completed for 60.2% and 90.8% of patients in the usual care and intervention groups, respectively (P < .001), with the greatest increases in HAV (6.1% vs 90.3%; P <.001), HBV (8.8% vs 91.3%; P <.001), and LTBI (1.9% vs 67.8%; P <.001). The prevalence of any identified treatment or prevention needs significantly increased from 28.7% to 79.3% in the intervention group (P < .001).1

Investigators noted HAV and HBV vaccinations increased from 0% to 58% and 71%, respectively. HCV viremia was identified in 15 usual care and 19 intervention patients, of whom 0% and 36.8% initiated direct-acting antiviral therapy within 2 weeks of testing.1

Further analysis revealed screening for STIs increased significantly for gonorrhea, chlamydia, syphilis, and trichomonas in the intervention period, with STIs identified in 9.2% and 13.5% (P = .09) of the patients in the usual care and intervention groups.1

“Embedding ID screening, treatment, and prevention services into inpatient substance use treatment results in timely identification of ID and facilitates prompt delivery of preventive services, treatment of infections, and linkage to care,” investigators concluded.1 “This comprehensive approach can serve as an opportunity for engagement and care in a patient population that experiences stigma and other barriers to care.”

References

1. Dyer KE, Russell R, Nafiz R, et al. Effectiveness of an Embedded Infectious Disease Screening, Treatment, and Prevention Intervention Within an Inpatient Substance Use Treatment Program. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofaf403

2. Substance Abuse and Mental Health Services Administration. SCREENING AND TREATMENT OF VIRAL HEPATITIS IN PEOPLE WITH SUBSTANCE USE DISORDERS. 2021. Accessed August 7, 2025. https://library.samhsa.gov/sites/default/files/pep20-06-04-004.pdf