People with substance use disorder (SUD), particularly those who inject drugs, face a significantly higher risk of contracting HIV, hepatitis B (HBV), and hepatitis C (HCV) 1-3. Together, these infections, combined with the ongoing opioid crisis, create a dangerous syndemic that continues to threaten lives and strain treatment systems. Yet, despite this elevated risk, many people who use drugs (PWUD) are not adequately screened or treated. 4-6
Preventive measures such as HBV vaccination and HIV preexposure prophylaxis (PrEP) remain underutilized, leaving critical gaps in care 7,8. Substance use disorder treatment centers are uniquely positioned to help close those gaps by implementing panviral screening, a one-stop approach to testing for HIV, HBV, and HCV, and connecting patients to appropriate treatment or prevention services.
However, for many providers, questions remain about how to make panviral screening financially feasible and operationally sustainable. In a recent interview with Integritas Communications, Stacey Trooskin, MD, PhD, MPH, Chief Medical Officer of the Mazzoni Center in Philadelphia, shares practical guidance on integrating panviral testing into SUD care settings while addressing both logistical and financial considerations.
Integritas Communications (IC): What are the benefits of panviral screening for SUD centers?
Stacey Trooskin, MD, PhD, MPH (ST): Clinical benefits should be the driver behind implementation of panviral screening. Integrating that testing to where the patients already access services will maximize uptake and benefit both the individual’s health and the public’s health, because knowing one’s status is the first step to being treated. Patients who test negative to one or both can still have infection prevented through HBV vaccination or PrEP to prevent HIV, or even learning about harm reduction for HCV and hepatitis A virus (HAV) transmission.
We also should acknowledge the risk of not screening. Imagine if somebody in your care went undiagnosed when there’s treatment or prevention available. This level of risk is easily avoidable if you make a diagnosis or provide somebody with prevention, particularly if they’re not immune to HBV. It is now the Centers for Disease Control and Prevention (CDC)’s recommendation that we do a triple screen for HBV: HBV surface antibody, core antibody, and surface antigen.6 We should be doing that for everyone aged 18 years and older and for each pregnant person during their pregnancy. And if you’re at increased risk, you should be tested more frequently than that and then vaccinated if not already immune.6 The same thing applies for HCV testing.5 HIV testing recommendations are for people aged 13 and older.4 Individuals at greater risk for HCV and HIV should be tested more frequently.
Panviral screening increases many opportunities for patient care. There’s a growing interest among payers and departments of public health for integration of panviral screening into SUD centers, which may benefit the testing site. The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend that SUD treatment programs provide HCV testing.9
There’s a vested interest among payers to reimburse testing up front so that you can introduce HAV or HBV vaccines and other prevention opportunities, as well as early treatment or cure. SUD treatment programs may be primarily contracted with behavioral health payers but should explore credentialing providers with physical health payers as well. The type of payers a site is credentialed with will often dictate what testing services are reimbursed, who’s going to be paying for those long-term, more-costly interventions, and if there is a financial benefit to providing testing up front.
IC: What is the financial burden of panviral screening, including up-front costs?
ST: There is a burden in navigating the very siloed reimbursement structure that we have in the United States, where individuals will often be covered with physical health payer benefits, behavioral health payer benefits, and then, separate from that, pharmacy benefits. If you are a site that primarily contracts with behavioral health payer companies, getting that panviral testing covered if you’re not recognized as a physical health site may be challenging. Working with payers to ensure that testing is included in reimbursed services is a critical step so that you’re not at risk of losing money by providing this essential screening for the patient population that you’re serving.
I think the up-front costs are usually personnel related. Having trained staff that does phlebotomy is part of testing. If you’re not going to be working through a reference lab, there are some point-of-care (POC) tests that are available that don’t require phlebotomy training. POC HIV and HCV testing are available.4,10 Right now, there isn’t a POC HBV test that is approved in the US. There are some POC tests that are, in fact, covered by payers, though they may not cover the entirety of the cost. It’s important to keep in mind that a lot of POC tests, with the exception of the HCV RNA test that’s available, require some type of confirmatory testing.4,10,11 For the most part, you’re going to want to confirm a positive HIV POC test through a fourth-generation test.4 POC tests, particularly the HCV RNA test, may have some up-front costs that will need to be budgeted for, though there are many POC HIV and HCV antibody tests available that do not require additional equipment. Costs can be identified by working with a laboratory or testing kit representative.
If you have a contract with reference labs, they often provide you with phlebotomy supplies as part of the laboratory contracts. You may be able to get tourniquets and butterfly needles as well, but it really depends on what your contract looks like. You will have to budget for those things if they’re not included in the contract.
IC: You mentioned behavioral health vs physical health payers. How can SUD centers best work with payers to obtain coverage for panviral testing?
ST: Many behavioral health programs include some amount of viral testing, but perhaps not the whole panel or perhaps not the confirmatory testing. The first step would be to reach out to somebody you commonly work with in that behavioral health payer to see if you could expand coverage. If that doesn’t happen, or if there are additional barriers, then getting credentialed with a physical health payer often works. That’s easy to do if you have clinicians outside of psychiatry working at the SUD center, like family medicine providers or internists.
We know that treatment for HCV is cost-effective, so we want to be able to lean into that. Some state Medicaid programs have gotten excited about HCV elimination and want to pay for treatment before somebody ends up with end-stage liver disease and needs a transplant. They have been incentivizing Medicaid managed care programs to help their member sites implement testing and treatment services. Drug prices to treat HCV have come down considerably. Similarly, it’s much less expensive to prevent HIV or to treat it early in the infection than it is to have somebody hospitalized for AIDS, opportunistic infections, and other complications.
I would encourage sites to engage behavioral health payers and physical health payers about the possibility of panviral testing and integrated care. It’s not a bad idea to reach out and to point out that panviral testing is of interest to them because it will save them money in the long run. There has been a shift, at least where I live, around payers’ approach to this, and there is a real desire to make sure folks know their status.
IC: How can SUD centers utilize and benefit from the 340B drug pricing program?
ST: There are examples of SUD centers that have become a 340B-eligible entity. The 340B Drug Pricing Program requires drug manufacturers to sell outpatient drugs at a significant discount to eligible safety-net providers.12 The entities eligible for 340B pricing generally include certain federally funded grantees, FQHCs and look-alikes, and safety net hospitals.13 The most common path I have seen for SUD treatment programs applying to become a 340B-eligible entity is to become a site for treatment of sexually transmitted infections (STIs) and to partner with their local department of health to receive federal dollars, usually as a pass-through from the city or state. STI clinics leverage the 340B revenue to help them stretch scarce resources and provide care to more patients. There is a methadone program in Philadelphia that has become a grantee for STI treatment and has, as a result, been able to leverage the 340B program to reinvest in their services, and it dispenses HCV treatment alongside methadone.13 SUD centers can use 340B revenue to support adherence and to support prior authorization if one is still required.
IC: How would implementing panviral testing affect SUD center licensing?
ST: Depending on what kind of test you’re doing, whether it’s phlebotomy and laboratory-based testing or whether you’re using POC testing, you will need to look at your state’s regulations and figure out what you need: Do you need a Clinical Laboratory Improvement Amendments (CLIA) license? Will you be doing CLIA-waived testing? What does that look like for your center? Oftentimes you will need some form of a laboratory license if you’re not already providing on-site testing or phlebotomy. Each state has slightly different rules around what is required, but you may need to add a particular test to your license.
IC: What are some metrics of successful implementation of a panviral screening program?
ST: I think it depends on where you are along the care cascade. One of the first things you can look at is how many people are coming through your door; that’s going to be your denominator. Success can be the percentage of those folks you were able to screen and deliver test results for. The next metric is what you did with that test result. If somebody is negative for HIV, did you offer them PrEP so that they can stay negative? Did you offer somebody who is negative for HBV the opportunity to be vaccinated? And did you offer education about strategies to avoid infection to somebody who was negative for HCV?
How much prevention did you deliver on-site? Maybe you provided that HBV vaccine on-site. Maybe you were able to prescribe that person PrEP. If you’re not able to do those things within the SUD treatment program, did you successfully refer individuals out? It’s more than just handing them the referral. You need to look at how many of those patients successfully landed with a provider that could prescribe PrEP for them to remain HIV negative. How many of them were able to get to their local pharmacy for an HBV vaccine? Similarly, if somebody does test positive for any of those viruses, were you, as a provider, able to treat them or did you successfully link them to care somewhere else?
Part of the challenge is having a system in place that allows you to monitor the impact of your efforts. You want to ensure people are getting their test result. You want to ensure they’re receiving education. If you’re just handing folks a referral and they’re not making it to a provider, maybe that’s the moment where you consider using a patient navigator or attempt to colocate services. Even if you are not the ones to do the prescribing, maybe you want to partner with somebody from the community to do it. One mark of a successful program is being able to measure those things and make necessary changes once you know the impact.
IC: How can a site champion help initiate panviral testing at a SUD center?
ST: I think the importance of a site champion cannot be emphasized enough. It really is a necessity. You need somebody who can take the ball and run with it and help troubleshoot problems, help oversee and smooth out any challenges that arise, and work with your data quality or oversight team. A foundational role of the site champion is to keep an eye on the metrics; they need to keep an eye on the number of tests performed, your positive results, your negative results, and then what you do with those individuals.
A lot of places can’t afford one full-time individual to lead the charge. I have worked with SUD treatment programs that grow their programs sufficiently and are able to make it sustainable to the point where they can hire somebody to oversee that work, but for the most part, it starts off with somebody internally that really feels a lot of passion about the cause. Sometimes it’s a physician, sometimes it’s a nurse, sometimes it’s a certified peer specialist who is really excited about this work. It may be somebody who has lived experience and wants to make sure that other people benefit from either prevention or treatment.
IC: Can providing panviral screening make a SUD center more competitive?
ST: Incorporating panviral screening and linkage to care into your center’s services can set your center apart. These days, patients and referral sources increasingly seek out facilities that provide whole-person care, so offering on-site panviral testing can serve as a key differentiator. It signals your center’s commitment to evidence-based care and can put you in a better position to compete for referrals from hospitals, courts, and public health agencies. It’s also important to consider whether providing panviral testing may help improve patient trust and engagement at the same time it’s increasing your eligibility for funding, partnerships, or value-based contracts. Integrating panviral testing is helpful not only for your patients, but also for your market value and for the community.
Want more information on panviral screening?
For additional information on panviral screening guidance, available tests, interpretation of tests, and patient counseling and referral recommendations, please watch “Pan-Viral ACTIONS Initiative: A Call to Implement One-Stop Screening” on Integritas Communications’ free website.
References
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3. Centers for Disease Control and Prevention. Hepatitis B surveillance guidance. Accessed August 26, 2025. https://www.cdc.gov/hepatitis/statistics/surveillanceguidance/HepatitisB.htm
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9. Bhattacharya D, Aronsohn A, Price J, et al. Hepatitis C guidance 2023 update: American Association for the Study of Liver Diseases – Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Clin Infect Dis. 2023:ciad319.
10. Centers for Disease Control and Prevention. Testing for hepatitis C. Accessed August 26, 2025. https://www.cdc.gov/hepatitis-c/testing/index.html#cdc_testing_type_test-testing-methods
11. FDA permits marketing of first point-of-care hepatitis C RNA test. News release. US Food and Drug Administration. June 27, 2024. Accessed August 26, 2025. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-point-care-hepatitis-c-rna-test
12. National Coalition of STD Directors. The 340B drug pricing program: frequently asked questions (FAQs). Accessed August 26, 2025. https://www.ncsddc.org/wp-content/uploads/2021/10/340B-Medicaid-Drug-Pricing-FAQs.pdf
13. Health Resources & Services Administration. 340B drug pricing program. Accessed August 26, 2025. https://www.hrsa.gov/opa
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