Communicable Diseases
Screening
Requirements
(As required in HFS 75)
Hepatitis C Hepatitis B Syphilis Gonorrhea
Herpes HIV TB Contacts
Rationale HFS75 Home
On August 1, 2000, the Department of Health Services,
Division of Supportive Living, HFS 75, Community Substance Abuse Service
Standards, was promulgated.
Rationale behind
requirement:
Using drugs is an important risk factor for disease. Drug use is
associated with such risk behaviors as the sharing of contaminated needles
and other drug paraphernalia, and unsafe sexual practices that contribute
to the transmission of certain infectious or communicable diseases.
There has been a steady increase in the incidence of hepatitis B,
despite the availability of a vaccine. The prevalence of hepatitis C in
drug users, and in injection drug users specifically, is also high. The
association between syphilis and drug use has been substantiated by
retrospective studies and is particularly strong among cocaine users.
Many drug users are reluctant to become involved with traditional
medical providers because of previous poor treatment and insensitive care.
As a result, they may not seek testing for and treatment of
infectious/communicable diseases. Further, lack of access to health care,
either due to financial or other socioeconomic reasons, may mean that drug
users may have had minimal or no medical care before entering a treatment
service.
Substance abuse services are the ideal beginning to provide
infectious/communicable disease screening. Service staff have a good
understanding of the lifestyles of individuals who use drugs and are
sensitive to and knowledgeable about their concerns and needs.
Screening for infectious/communicable diseases in patients may be
especially important to their recovery effort, may result in improved
health and improved treatment compliance, and may prevent the spread of
debilitating and life-threatening infectious/communicable diseases.
Integration of drug treatment and infectious/communicable disease
screening offers an important therapeutic intervention for patients, their
families, and the broader community.
This is a new administrative rule for alcohol and other drug abuse (AODA)
outpatient treatment services that receive certification under HFS 75.
AODA outpatient treatment services are required to conduct a risk
assessment for sexually transmitted diseases (STDs), human
immunodeficiency virus (HIV), hepatitis B and C, and tuberculosis (TB).
The evaluation/ assessment must be conducted by the AODA outpatient
treatment service and may include on-site testing, performed by trained
medical personnel. Those patients testing positive must be referred to the
local public health agency for appropriate follow-up.
Basic prevention messages for persons with high-risk drug or sexual
practices include:
- Stop using and/or injecting drugs.
- Complete substance abuse treatment.
- The surest way to prevent the spread of human immunodeficiency virus
infection and other sexually transmitted diseases is to have sex with
only one uninfected partner or not to have sex at all.
- Use latex condoms correctly and every time to protect themselves and
their partners from diseases spread through sexual activity.
- Get vaccinated against hepatitis B, and if appropriate, hepatitis A.
Persons who should be tested routinely (referred to local public health
agency or private physician) for hepatitis C
virus (HCV) infection are:
- Persons who ever injected illegal drugs, including those who
injected once or a few times many years ago and do not consider
themselves as drug users.
- Persons who received a transfusion of blood or blood components
before July 1992.
- Children born to HCV-positive women.
- HIV+ persons.
Persons who should be tested routinely (referred to local public health
agency or private physician) for hepatitis B (HBV)
infection are:
- Persons who have injected illegal drugs.
- Persons entering methadone treatment programs. If there is no
serologic evidence of prior HBV infection, hepatitis B vaccine should
be administered.
Persons who should be tested routinely (referred to public STD clinic
or private physician) for syphilis infection are:
- Persons entering drug treatment programs. Screening should be
repeated every year if at-risk behavior continues, or earlier if signs
and symptoms suggestive of syphilis infection occur.
Persons who should be tested routinely (referred to public STD clinic
or private physician) for gonorrhea infection are:
- Persons with indications of infection or for those who have had
sexual contact with infected individuals.
Persons who should be tested routinely (referred to public STD clinic
or private physician) for herpes infection are:
- Persons with genital, rectal, or oral ulcers.
Persons who should be tested routinely (referred to public STD clinic
or private physician) for HIV infection are:
- Persons entering drug treatment programs. Persons who are
HIV-negative, should receive follow-up screening and risk-reduction
counseling.
Persons who should be tested routinely (referred to public STD clinic
or private physician) for TB infection are:
- Persons entering drug treatment programs.
Persons who use illegal drugs or have high-risk sexual practices should
be provided with information regarding how to reduce their risk for
acquiring bloodborne and sexually transmitted infections or of potentially
transmitting infectious agents to others.
The objectives of conducting surveillance for hepatitis C are to:
- Identify new cases and determine disease incidence and trends.
- Determine risk factors for infection and disease transmission
patterns.
- Estimate disease burden.
- Identify infected persons who can be counseled and referred for
medical follow-up.
What if someone refuses testing?
Patients have the right to refuse to be tested for
infectious/communicable diseases and should not be denied treatment
services based solely on that refusal, except where there is a potential
public health threat to other patients or service staff. Treatment
providers must evaluate the potential exposure risk for other patients and
treatment staff, particularly for potential exposure to infectious
tuberculosis (TB). In all instances, patients should be educated about the
benefits to themselves and others from proper and early diagnosis and
treatment for infectious/ communicable diseases.
Where to obtain further information:
The Center for Substance Abuse Treatment (CSAT) has developed Treatment
Improvement Protocols (TIPs) # 6 (BKD131 & BKD131C) on Screening for
Infectious Diseases Among Substance Abusers, and TIP # 11(BKD143 &
BKD143C) Simple Screening Instruments for Outreach for Alcohol and Other
Drug Abuse and Infectious Diseases. Both of these publications are
available on the web http://www.samhsa.gov/csat/csat.htm
or by calling 800-729-6686; TDD (hearing impaired) 800-487-4889.
The web-site for the Centers for Disease Prevention and Control has a
vast amount of information available on all communicable diseases. The
address is www.cdc.gov.
Last Revised: July 18, 2008 |
