Health Care Access Among Drug Users in Philadelphia

Author: H Zellman, E Addish, J Kostman, K Viner, D Kuncio, S B Trooskin

Theme: Epidemiology & Public Health Research Year: 2019

Background: Primary care is an important setting for hepatitis C virus (HCV) testing, treatment and cure,
and can be a critical resource in elimination strategies. Increasingly, insurance based treatment
restrictions that limit HCV care delivery in primary care settings are being removed. Expansion of HCV
treatment capacity to primary care providers must take into account the unique barriers faced by highrisk communities including people who use drugs (PWUD).
Methods: C Change is Philadelphia’s plan to eliminate HCV among PWUD, and partners with substance
use disorder (SUD) treatment centers and the city’s syringe exchange program. Enrollment in C Change
includes an interviewer-administered survey with questions on patient demographics, risk behavior, comorbid conditions and healthcare access and engagement. An interim analysis examining experiences
with healthcare was conducted on the first 917 participants.
Results: Among C Change enrollees (n=906), 804 (89%) self-reported current insurance coverage, 754
(93%) of whom were insured by Medicaid. Of those who were insured, 778 (97%) knew the name of
their insurance company. Seven hundred and fifty-five (94%) participants report previous HCV testing,
and 746 (93%) report previous HIV testing. Despite high rates of insurance coverage, only 515 (64%) of
insured participants report knowing their primary care provider (PCP); 302 (38%) of those individuals
had not seen their PCP within the last year.
Conclusions: While health insurance coverage is a key facilitator of health care access, many PWUD who
report insurance coverage are unaware of their PCP and engagement in primary care is limited. To
optimize the role of the primary care provider in HCV elimination, we must address the barriers that
exist in spite of high rates of insurance coverage. We must also consider co-location of HCV services
within SUD treatment programs and syringe services programs.
Disclosure of interest: none

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