Transcript Open poster - 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, Anna Amberg2, Kathleen Brady1, 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 .
CTN0032 Client Characteristics
CTN 0032 Client Characteristics for all sites and LRADAC
-Well established collaborative relationship between Southern
Consortium Node (MUSC) and SC Single State Authority (DAODAS)
70.0%
60.0%
-DAODAS’ multi-year attempt to establish HIV testing programs in
SC’s substance abuse treatment system had had little success
50.0%
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.
40.0%
-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
30.0%
20.0%
Methods
10.0%
0.0%
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 that
participated in a randomized clinical trial (CTN 0032). The purpose of
CTN 0032 was to evaluate different strategies to increase the
acceptance of HIV testing and reduce HIV risk behaviors among patients
in substance abuse treatment. Staff to conduct HIV testing and HIV riskreduction 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.
Study 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
- Used rapid test – 20 minutes for results
- 3 arms: counseling and offer of testing, information and offer of testing,
off-site referral
- Which approach was more effective for getting tested and receiving
results?
- Ended 12-09
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
State-Wide Expansion of Project
Black
White
Mixed
All Sites (N=1281)
Native American
Hispanic
Females
LRADAC (N=115)
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 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 .
-Collaboration between Southern Consortium Node, LRADAC,
DAODAS, and DHEC resulted in development of certification course
to be held at 2010 SC School of Alcohol and Drug Studies. DAODAS
to offer scholarships to substance abuse providers. This two and a half
day course will be used as model for on-going training initiative in
state.
-Goal is to establish testing programs in all of the 33 contract CTPs.
Conclusions
- 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
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%)
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
- 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].