Transcript Open slide - CTN Dissemination Library

N = 1281
Arm 1 (offer of testing and counseling) N= 433
Arm 2 (information only and offer of testing) N= 419
Arm 3 (offer of referral for off site testing) N= 429
Adoption of HIV Counseling and Testing
Following Completion of Randomized Clinical Trial
Louise Haynes1, Beverly Holmes2 Camille Peay2, Lisa Metsch3
1Psychiatry and Behavioral Sciences, Medical University of South Carolina,
2Lexington Richland Alcohol and Drug Abuse Council, 3 University of Miami
Background
Substance abuse continues to be a major factor in the transmission of
HIV/AIDS, via injection and sexual risk behavior. Encouraging persons at
risk for HIV to be tested is one of the main HIV prevention strategies in
the United States. Previous studies have shown that many substance
abuse treatment programs do not offer on-site HIV testing .
Although the NIDA Clinical Trials Network was established to “bridge the
gap” between research and practice, dissemination of evidence based
practices studied in the CTN is challenging.
Methods
In 2010, the National Institute on Drug Abuse Clinical Trials Network (CTN)
completed a study designed to evaluate strategies for providing rapid HIV
testing in inpatient and outpatient substance use treatment
programs. This study demonstrated the value of on-site rapid HIV testing
in drug treatment centers but found no additional benefit from HIV sexual
risk-reduction counseling. LRADAC, a community-based treatment
program (CTP) in Columbia, SC and a participating CTP in the Southern
Consortium Node of the NIDA Clinical Trials Network (CTN), was one of
twelve sites. Staff to conduct HIV testing and HIV risk-reduction counseling
were recruited and hired prior to implementation of the clinical trial. The
staff were trained and certified to conduct testing and counseling as per
study protocol.
Participant Inclusion Criteria:
•Participating in substance abuse treatment service at the site
• Adult
•English speaking
•Willing to sign locator form
•HIV negative or unknown status
Eligible sites
•Not offering testing
•Inpatient and outpatient sites
•Methadone and psychosocial rehab
Study
N=1281
Arm 1 (offer of testing and counseling) N=433
Arm 2 (offer of testing and information) N= 419
Arm 3 (offer of referral for off site testing) N= 429
Clinical Implementation (Pilot)
Following completion of the study. LRADAC adopted (for clinical practice)
the counseling (RESPECT2) and testing procedures used in the trial. The
testing and counseling were piloted in the detoxification unit beginning
September 2009. Each new admission to detox was seen individually and
offered an appointment for confidential testing and counseling. Initially, the
counseling and testing were conducted by staff trained as part of CTN0032.
Subsequently, the research staff trained a program staff member to
conduct the testing and counseling. Agency-wide implementation to follow
in 2010.
State-Wide Implementation
•In Fiscal Year 2010, there were 12 local substance abuse treatment
agencies that were endorsed to conduct HIV testing.
•In Fiscal Year 2011, an additional 4 agencies were added.
•Figure #1 compares LRADAC to all of the additional state supported
substance abuse treatment providers who conducted HIV testing in
South Carolina from 7/1/2010 to 1/31/2011.
Clients Tested (LRADAC Detox Program)
September 8, 2009 to April 15, 2010
32% Female
49% Black
(consistent with patient population in detox)
319 Rapid Tests Offered
194 Accepted (61%)
LRADAC,
307
15
Substance
Abuse
Treatment
Agencies,
256
Reasons offered for not accepting test
69% Recently tested
10% (of those refusing test) reported being HIV positive
Other reasons: perceived no risk,
undecided about being tested, not interested
Figure #1: LRADAC compared to all of the additional state supported substance abuse treatment providers who
are conducting HIV tests in South Carolina.
Agency- Wide Implementation
Following the pilot LRADAC moved to full implementation, including both detox and
outpatient programs.
Clients Tested (Agency-Wide)
April 16, 2010 to May 31, 2011
490 Clients Tested
33% Acceptance Rate
40% Female
59% Black
Reasons offered for not accepting test
41% Recently tested
46% No Risk Factors
State-Wide Expansion of Project
•Well established collaborative relationship between Southern Consortium
Node (MUSC) and SC Single State Authority (DAODAS)
•DAODAS’ multi-year attempt to establish HIV testing programs in SC’s
substance abuse treatment system had progressed slowly
•Training required to certify substance abuse treatment staff was obtained
through the state health department (DHEC), and training requirements
were burdensome and not tailored for substance abuse providers
•Collaboration between Southern Consortium Node, LRADAC, DAODAS,
and DHEC resulted in development of certification course held at 2010 SC
School of Alcohol and Drug Studies. DAODAS offered scholarships to
substance abuse providers.
Conclusion
•Example of successful “science to practice”
•Participation in research can facilitate programmatic changes in
community treatment programs
•Substance abuse clients in detox were receptive to offer of HIV
testing and counseling
•Potential to reach beyond agency – state wide implementation
References
Brown, L S. ; Kritz, St ; Goldsmith, R. J ; Bini, E J. ; Rotrosen, J ; Baker, S ; Robinson, JA. ;
McAuliffe, P. Characteristics of Substance Abuse Treatment Programs Providing Services for
HIV/AIDS, Hepatitis C Virus Infection, and Sexually Transmitted Infections: The National Drug
Abuse Treatment Clinical Trials Network. Journal of Substance Abuse Treatment
2006;30:315-321. [doi: 1016/j.jsat.2006.02.006].
Haynes LF, Korte JE, Holmes BE, Gooden L, Matheson T, Feaster DJ, Leff JA, Wilson L,
Metsch LR, Schackman BR. HIV rapid testing in substance abuse treatment: Implementation
following a clinical trial. Eval Program Planning. 2011 Feb 28. [Epub ahead of print]