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Addressing Viral Hepatitis in People with Substance Use Disorders in Arizona

Viral Hepatitis

Viral hepatitis is a silent epidemic that significantly impacts individuals with substance use disorders (SUDs) in Arizona and across the United States. Hepatitis C virus (HCV) infection, in particular, is highly prevalent among people who inject drugs, with rates up to 70-90%. Integrating viral hepatitis prevention, screening, and treatment services into SUD treatment programs is a critical public health strategy to reduce the burden of hepatitis and improve long-term outcomes for people in recovery.

In Arizona, the state’s warm climate and rural expanses create unique challenges for delivering hepatitis services to people with SUDs. However, by implementing the comprehensive recommendations, Arizona SUD treatment providers have an opportunity to lead the way in reducing hepatitis transmission and promoting health equity.

Understanding the Intersection of Viral Hepatitis and Substance Use Disorders

Most common types of Viral Hepatitis

To effectively address viral hepatitis among people with SUDs, it’s essential to understand the complex interplay between these conditions. The most common types of viral hepatitis in Arizona are hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV).

Substance Use Disorders as a Risk Factor for Viral Hepatitis

Non-injection drug use is associated with HCV risk
  • According to a report by CDC, injection drug use is the primary mode of HCV transmission in the U.S., accounting for over 60% of infections.
  • Sharing injection equipment, such as syringes, cookers, and cottons, can transmit HCV and HBV.
  • Non-injection drug use, such as sharing straws or pipes to snort or smoke drugs like heroin, cocaine, crack, or methamphetamine, is also associated with hepatitis C risk.

The Impact of Viral Hepatitis on People with SUDs

  • Chronic HCV infection can lead to severe liver damage, cirrhosis, and liver cancer, especially among people with untreated SUDs.
  • People with SUDs face significant barriers to hepatitis testing and treatment, including stigma, lack of access to healthcare, and competing priorities.
  • Co-infection with viral hepatitis and HIV is common among people with SUDs, leading to increased morbidity and mortality.

Screening for Viral Hepatitis in Arizona SUD Treatment Programs

Early detection through routine screening is the first step in preventing the negative health consequences of viral hepatitis. All SUD treatment programs implement universal hepatitis screening for clients.

Implementing Hepatitis Screening Protocols

  • Programs should establish policies and procedures for offering hepatitis A, B, and C screening to all new clients.
  • Screening can be done through on-site rapid HCV antibody testing or through referral to a healthcare provider.
  • Programs should have protocols linking clients with positive screening results to confirmatory testing and medical care. Below is an example (an image) showcasing the screening process for Hepatitis C.
HCV Screening Process

The Role of Counselors in the Screening Process

  • Counselors play a critical role in educating clients about the importance of hepatitis screening and prevention.
  • Counselors should be trained to provide pre-and post-test counseling, including assessing clients’ readiness for screening and explaining test results.
  • Motivational interviewing techniques can be used to encourage clients to engage in screening and risk-reduction behaviors.

Preventing Viral Hepatitis Transmission in Arizona Communities

Preventing new infections is a key component of addressing viral hepatitis among people with SUDs. Arizona SUD treatment programs can implement a range of evidence-based prevention strategies to reduce hepatitis transmission risk.

Harm Reduction Strategies

  • Expanding access to sterile injection equipment through syringe services programs (SSPs) is an effective way to reduce HCV and HBV transmission among people who inject drugs.
  • SUD treatment programs can partner with local SSPs to provide education on safer injection practices and linkage to harm reduction resources.

Hepatitis A and B Vaccination

  • Hepatitis A and B are vaccine-preventable diseases, and all people with SUDs should be offered vaccination.
  • In Phoenix, the adult immunization program provides vaccination at no cost regardless of insurance status for hepatitis A and B vaccines for uninsured or underinsured adults at risk for infection.
  • SUD treatment programs can collaborate with local health departments to offer on-site hepatitis vaccinations or refer patients to community vaccination providers.

Counseling on Risk Reduction Behaviors

  • Counselors should incorporate education on hepatitis transmission risks and prevention strategies into individual and group counseling sessions.
  • Clients should be provided with clear, accurate information on how to reduce their risk of contracting or transmitting viral hepatitis, such as avoiding sharing drug use equipment and practicing safer sex.
  • Counselors can use role-play scenarios and other interactive techniques to help clients build skills for engaging in risk reduction behaviors.

Linking Arizona Clients to Hepatitis Treatment and Care

For individuals with SUDs who test positive for viral hepatitis, timely linkage to medical care and treatment is essential for preventing disease progression and improving quality of life. Arizona SUD treatment programs can play a vital role in connecting clients to hepatitis care services.

Building Referral Networks for Hepatitis Care

  • Programs should establish relationships with local healthcare providers with experience treating viral hepatitis in people with SUDs.
  • The Arizona Department of Health Services maintains a list of providers offering hepatitis C care in the state, which can be a starting point for building referral networks.
  • Memoranda of understanding (MOUs) can formalize referral processes and ensure continuity of care between SUD treatment and hepatitis care providers.

Providing Support for Hepatitis Treatment Adherence

  • Adherence to antiviral medication regimens is critical for achieving sustained viral response (SVR) in people with chronic HCV.
  • SUD treatment programs can support adherence by educating on the importance of treatment completion, monitoring side effects, and offering incentives for medication adherence.
  • Peer support specialists can be valuable resources for helping clients navigate the challenges of hepatitis treatment and sharing their own experiences with achieving SVR.

Ongoing Care Coordination and Case Management

  • Effective care coordination between SUD treatment providers, hepatitis care providers, and other support services is essential for ensuring optimal outcomes for clients with viral hepatitis.
  • Programs should assign dedicated case managers to help clients navigate the complex healthcare system, assist with appointment scheduling, and provide ongoing support throughout the treatment.
  • Regular communication and data sharing between providers (with client consent) can facilitate a team-based approach to addressing clients’ comprehensive health needs.

Strengthening Arizona's Response to Viral Hepatitis and Substance Use Disorders

Addressing viral hepatitis among people with SUDs in Arizona requires a coordinated, collaborative approach that involves SUD treatment providers, healthcare systems, public health agencies, and community organizations. Several recommendations for enhancing state and local response efforts are offered, for instance:

  • Develop statewide policies and funding mechanisms to support integrating viral hepatitis services into SUD treatment programs.
  • Provide staff training and technical assistance to help SUD treatment providers implement evidence-based hepatitis screening, prevention, and linkage to care interventions.
Staff Training for Hepatitis in Substance Abuse Treatment
  • Provide staff training and technical assistance to help SUD treatment providers implement evidence-based hepatitis screening, prevention, and linkage to care interventions.
  • Expand harm reduction services, including SSPs and naloxone distribution programs, to reduce the negative consequences of substance use and promote engagement in care.
  • Conduct public awareness campaigns to reduce stigma around viral hepatitis and SUDs and encourage testing and treatment.
  • Support research to inform the development of tailored interventions for specific populations disproportionately impacted by viral hepatitis and SUDs, such as tribal communities and individuals involved in the criminal justice system.


Viral hepatitis is a critical health concern for people with substance use disorders in Arizona. However, there are evidence-based strategies that SUD treatment providers can implement to reduce the burden of this epidemic. By integrating hepatitis screening, prevention, and linkage to care services into SUD treatment programs, providers can significantly improve the health outcomes of their clients and communities. The recommendations outlined in SAMHSA’s TIP provide a comprehensive roadmap for addressing viral hepatitis among people with SUDs. Arizona has the opportunity to be a leader in implementing these best practices. Through collaboration, innovation, and a commitment to health equity, we can work towards the elimination of viral hepatitis in the state while supporting the recovery and wellness of all Arizonans affected by substance use disorders.

Furthermore, if you want to delve deeper into the minute details of how viral hepatitis can be addressed in individuals with SUD, check out the pdf attached below. It has all the necessary details so you don’t miss any information. 

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