DHHR nixes proposed audit of Cabell-Huntington harm reduction program

HUNTINGTON — A proposed audit of the Cabell-Huntington Health Department’s Harm Reduction Program — which operates the county’s syringe exchange — will not happen, the West Virginia Department of Health and Human Resources has confirmed.

Cabell County Commissioner Kelli Sobonya had requested an audit for the Cabell-Huntington Health Department similar to what DHHR had compiled for the Kanawha-Charleston Health Department’s now-defunct syringe exchange, which revealed a number of red flags in how that program operated. Sobonya, who made the request as an individual and not on behalf of the commission, contends that not only is an audit necessary, but also that the state should pay for it.

An audit would shed light on the type of people the syringe exchange serves, with Sobonya arguing the program, in part, attracts a transient population to Huntington in conjunction with other homeless services around the city.

The decision against the audit comes after senior DHHR leadership met in Charleston two weeks ago to discuss the audit with Sobonya at her request. That group included Secretary Bill Crouch, State Health Officer Dr. Cathy Slemp and Bob Hansen, director of the Office of Drug Control Policy. Delegates John Mandt Jr., R-Cabell; Matthew Rohrbach, R-Cabell; and Chad Lovejoy, D-Cabell, also attended.

While the result of the closed-door meeting is certain — that there will be no state audit of the Cabell-Huntington Health Department’s syringe exchange — how the decision was reached was told in slightly different stories.

According to DHHR, the decision to not continue an audit was made by a “consensus” of those involved after the meeting, said Allison Adler, DHHR communications director, in an email last week.

Slemp added in a follow-up email statement that “with greater mutual understanding, it became clear that an audit of the (Harm Reduction Program) would be of little benefit in addressing the concerns expressed.” She added that program audits typically focus on fiscal accountability and quality improvement.

Sobonya, however, contends that an audit is still necessary, and said DHHR was simply unwilling to pay for it. The state department had set a precedent after it funded an audit of Kanawha-Charleston’s syringe exchange, and she felt it was unfair DHHR would not do the same for Cabell-Huntington.

“I just want an audit,” Sobonya said in a call Thursday. “I have not publicly asked for this program to end; I just want to know that it’s working.”

An audit would bring to light several points of data Sobonya says could be indicative of how the syringe exchange is operating. Those include how many clients have tested positive for HIV, how many of those who have tested positive are native to Cabell County, and how many transient individuals have established Cabell County residency through a homeless shelter — effectively making them Cabell County residents and able to use the program.

The question of a residency requirement — and how residency is established — is the driving argument for an audit, all parties agreed.

Cabell-Huntington’s syringe exchange began in 2015 by serving everyone regardless of county of residence, but last summer limited the program to Cabell County residents only. The health department has, however, allowed homeless individuals to use the syringe exchange if they can be confirmed as residents of one of the city’s shelters.

The Cabell County Commission, which in part funds the Cabell-Huntington Health Department but does not govern it, is not in a position to fund an audit, said Sobonya, who is the only one of three commissioners expressing interest in an audit. The health department is also funded and monitored by DHHR and guided by an independent Board of Health.

Dr. Michael Kilkenny, physician director at the Cabell-Huntington Health Department, said he would support any decision from the state to review the program.

The goal of a syringe exchange is to provide one clean syringe for every intravenous injection of drugs. Syringe exchanges have been used for more than 30 years in hundreds of locations nationwide — including nearly 20 in West Virginia — to discourage the use of sharing dirty needles leading to the spread of bloodborne illnesses like HIV and hepatitis.

It’s particularly necessary to control Cabell County’s HIV cluster, Kilkenny said, which has more than 50 confirmed cases. These cases have been diagnosed entirely among local intravenous drug users.

“Harm reduction programs are very potent tools in controlling the spread of this serious disease, and communities need every tool in their toolboxes to stop the spread of HIV,” Kilkenny wrote in an email Friday.

These programs have nearly universal support from public health officials, state and federal, as an effective, inexpensive means to controlling disease. Syringe exchanges also encourage an otherwise hard-to-reach population of intravenous drug users to visit a clinical setting — where they receive their syringes at the health department — which then can become a talking point to referring them to treatment.

Between 2018 and May 2019, more than 900 harm reduction clients in West Virginia were referred to treatment in West Virginia — around 300 of those from Cabell-Huntington’s program alone, Slemp said.

Cabell-Huntington’s syringe exchange serves an estimated 600 individuals with varying regularity — some weekly, others with months between visits.

Sobonya reiterated she does not oppose the concept of a syringe exchange, but only if it is done correctly and in a clinical setting. She contrasted the Kanawha-Charleston program, which an audit found had been overwhelmed, with a syringe exchange still operating in Charleston by nearby West Virginia Health Right, an independent clinic. Sobonya says Health Right’s model is more clinical-based than the Kanawha-Charleston program, including mandatory HIV screenings and barcoded syringes for easy identification.

DHHR recommended Kanawha-Charleston suspend its syringe exchange last year after their audit discovered several inconsistencies, including missing data, which made it difficult to fully track how the program was operating. The KCHD Board of Health, which oversees the department, contends the audit was hastily conducted and inconclusive.

With an audit of Cabell-Huntington’s program seemingly out of the picture, Sobonya said “doing our due diligence” is the next step. That includes finding out why Kanawha-Charleston’s program failed and what other harm reduction programs, like Health Right, are doing differently.

Any changes would need to be pursued through the state Legislature with bills that would ideally create uniformity among state-funded harm reduction programs and require it be offered in a clinical setting, said Sobonya, a former delegate.

While she no longer serves in the House of Delegates, Sobonya said these are issues discussed by her and Mandt, who has been a vocal critic of the syringe exchange. Mandt was not available for comment Friday due to travel.


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