Transcript Open slides - CTN Dissemination Library

Adoption of HIV Counseling and Testing
Following Completion
of Randomized Clinical Trial
Addiction Health Services Research
Conference
Lexington, KY
Louise Haynes, MSW
“The Bridge”
NIDA Clinical Trials Network
2000-2010
Background
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Less than half of community substance abuse treatment
programs offer HIV testing
NIDA Clinical Trials Network recently completed a trial
(CTN0032) comparing strategies for providing testing in
community substance abuse treatment programs
Report of the experience of one community treatment
program that implemented on-site HIV rapid testing
following completion of NIDA clinical trial.
Focus on lessons learned
Community Programs: Challenges to
Conducting HIV Research and
Implementing HIV Services
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Culture change
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Particularly for psychosocial rehab programs (often 12
Step focused) - little past experience in HIV services
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Psychosocial rehab programs less likely to have medical
staff
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Specialty clinics staffed by counselors without specific
training in HIV risk reduction strategies. Counselor
discomfort with discussion of sexual issues with clients
The Setting
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Lexington Richland Alcohol and Drug Abuse
Council, Columbia South Carolina
Large publicly-funded, not-for-profit agency
Residential, outpatient, medical detox, DUI,
prevention services
Prior to clinical trial, not offering HIV testing
Despite SAMHSA initiative SC struggled to bring
HIV testing into substance abuse treatment
programs
3 Phases of Implementation:
Lessons learned in each phase of
implementation
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2.
3.
Clinical trial: enrollment Jan-May 2009
Pilot (detox program): Sept 2009-March
2010
Full implementation (detox and
outpatient): ongoing
Phase 1
CTN 0032
 Outpatient
 Oral
settings
swab
 RESPECT2 counseling
 LRADAC enrolled 115 participants
between Jan and May 2009
 Follow-up at 1 and 6 months
Phase 1
Lessons Learned
 Acceptability
of testing
 Value of integrating research practices
with established patient flow in agency
 Value of specialty counselors to provide
testing
Phase 2
Pilot in Detox
Agency decision to implement HIV
testing and counseling
Transition from research to practice
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1.
2.
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Adaptation of procedures: approach, finger
stick, timing of counseling
Training of staff
Support of agency management
Support by research infrastructure
Buy-in of front line staff
Pilot (Phase 2)
September 2009 through April 2010
 183
patients tested
 62% acceptance rate
 Most common reason for refusal: recently
tested
Phase 2
Lessons Learned
 Acceptability
of testing without
compensation
 Acceptability of finger stick
 Adaptation of research procedures
Phase 3
Full Implementation
 Increased
complexity of implementation
 Testing offered in detox and outpatient
 Decrease in availability of research staff
for testing
 Need for new source of funding
 Health Department grant received
 Train additional staff
Phase 3
May to Sept 2010
Detox:
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Outpatient:
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52% accepted
18% accepted
Total patients tested in Phase 3 (full
implementation): 191
Phase 3
Lesson Learned
 Need
for program specific strategy
 Need for Quality Assurance
 Need for clear chain of command
 Need for stable, adequate funding
 Training could be streamlined
Summary
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Phase 1: randomized clinical trial, enrolled 115,
two arms offered on-site testing, one arm TAU
Phase 2: pilot in detox, 62% acceptance, 183
tested
Phase 3: full implementation, detox and
outpatient, 52% acceptance in detox, 18% in
outpatient, 191 tested
Post RCT – 374 patients tested on site in 12
month period
Pre RCT – 0 patients tested on site
Summary
CLINICAL Implementation of
HIV Risk Reduction Intervention
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Process of change and acceptance - Agency
participated in multiple HIV risk reduction trials
RCT implementation was successful
Integrated into routine clinic practices
Philosophical changes
Acceptability to clients
Leadership support
Incentive to agency: peer recognition, financial
support
Champion
Participation in a clinical trial gives
a community treatment program:
 valuable
experience in conducting HIV
rapid tests
 using an HIV risk reduction intervention
 addresses
one of the challenges to
implementation
State Wide Implementation
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SC has a network of 33 substance abuse treatment
providers, contract with single state authority for block
grant funds
Since 2006, Goal of state-wide implementation of HIV
testing
Funding available, but little implementation
State Health Department had little knowledge of SA
treatment programs. Complex training requirements.
Following clinical trial, LRADAC recognized for having
experience and knowledge to promote implementation
Course developed for counselor certification in HIV
testing and counseling, offered at SC School of Alcohol
and Drug Studies at Furman University
For more information contact:
 Louise
Haynes: [email protected]
Thanks
– Beverly Holmes, Study
Coordinator; Leslie Wilson, Debbie Francis
 Lisa Metsch, Lauren Gooden, lead team of
CTN0032
 Kathleen Brady, PI, Southern Consortium
 LRADAC