Transcript Open slides - CTN Dissemination Library

HIV/AIDS-Related Services in
Substance Abuse Treatment
Settings: Preliminary Results
The NIDA Clinical Trials
Network
Lawrence S. Brown, Jr., MD, MPH, FASAM
Addiction Research and Treatment Corporation
Clinical Associate Professor of Public Health
Weill Medical College, Cornell University
Oral Presentation at the College on Problems of Drug Dependence
Scottsdale, Arizona - June 18, 2006
ACKNOWLEDGEMENTS
PATIENTS AND
STAFF OF THE
ADDICTION
RESEARCH AND
TREATMENT
CORPORATION, A
COMMUNITYBASED SUBSTANCE
ABUSE SERVICE
AGENCY
ACKNOWLEDGEMENTS
• Research Supported by National Institute on Drug
Abuse (NIDA) as part of a Cooperative
Agreement (1U10DA013046) with the NIDA CTN
and Protocol Team members consisting of:
– Steven Kritz, MD; John Rotrosen, MD; Jim Robinson,
MEd; Edmund Bini, MD, MPH; Jeff Goldsmith, MD;
Dennis McCarty, PhD; Donald Calsyn, PhD; Patrick
McAuliffe, MBA, LADC; Karen Reese, CAC-AD
– Shirley Irons; Sherryl Baker, PhD; Kathlene Tracy, PhD
GAME PLAN
• Rationale
• Main Study
Description
• Results & Next
Steps
Drug Abuse Treatment Clinical Trials Network
17 Nodes with 116 Community Treatment Agencies
Reaching into 26 States!
Seattle
Portland
Detroit
New York
City
Denver
Los Angeles
Philadelphia
Baltimore/Richmond
Cincinnati
San Francisco
(CA/AZ Node)
Raleigh/
Durham
Albuquerque
Charleston
Miami
CTN Sites
Boston
New Haven
Long Island
STUDY SITES
•
•
•
•
•
•
•
•
•
New York Node: New York University, New York, NY
South Carolina Node: Medical University of South Carolina, Charleston, SC
Florida Node: University of Miami, Coral Gables, FL
Great Lakes Node: Wayne State University, Detroit, MI
Ohio Valley Node: University of Cincinnati, Cincinnati, OH
Rocky Mountain Node: University of CO Health Sciences Center, Denver, CO
New England Node: Yale University, New Haven, CT
Delaware Valley Node: University of Pennsylvania, Philadelphia, PA
Mid-Atlantic Node: Johns Hopkins Univ., Baltimore, MD; Medical College
•
•
•
•
•
•
•
•
of Virginia, Richmond
Pacific Region Node: University of California at Los Angeles, CA
Oregon Node: Oregon Health Sciences University, Portland, OR
Washington Node: University of Washington, Seattle, WA
Long Island Node: NY State Psychiatric Institute, New York, NY
North Carolina Node: Duke University, Raleigh/Durham, NC
Southwest Node: University of New Mexico, Albuquerque, NM
Northern New England Node: McLean Hospital, Belmont, MA
California-Arizona Node: University of California at San Francisco, CA
MAIN STUDY RATIONALE
• HIV/HCV/STI: major causes of excess morbidity
and mortality in the US
• Substance abuse: a major vehicle for the
transmission of infection
• Substance abuse treatment= HIV prevention
• Scope of, and challenges to identifying,
counseling, and treating persons with these
infections in substance abuse treatment will
assist in developing effective interventions
MAIN STUDY: PRIMARY
OBJECTIVES
• TO DESCRIBE:
–
–
–
–
–
–
Range of Infection-Related Services Available
CTP Characteristics (funding, staffing)
Clinician Characteristics (training, knowledge, behavior)
Opinions
Perceived Barriers to Providing Infection-Related Services
State Regulatory Guidelines
• TO EXAMINE ASSOCIATIONS BETWEEN:
– CTPs’ Availability of Selected Infection Services
– Other Constructs Listed Above
IMPORTANT TERMS
• Treatment Program vs. NIDA CTN CTP
• Services Assessed
– Provider Education
– Patient Education
– Patient Risk Assessment
– Patient Counseling
– Patient Medical History & Physical Exam
– Patient Biological Testing
– Patient Treatment
– Patient Monitoring
• Medical vs. Non-Medical Clinical Staff
• ‘Expert’ Clinical Staff
MAIN STUDY: DESIGN AND
POPULATION
• STUDY DESIGN
– 3 Cross-sectional Surveys
– Descriptive & Exploratory
• STUDY POPULATION
– CTP Administrators
– CTP Clinicians
– Administrators of State Health Departments
and State Substance Abuse Agencies
ETHICAL, REGULATORY
& ADMINISTRATIVE
CONSIDERATIONS
• Expedited IRB Approval
• Waiver of Informed Consent
• Training for Node Protocol Managers
STUDY PROCEDURES
• Node Protocol Managers
• Information Sheet In Lieu of Informed
Consent
• Survey Administration
– Paper or Electronic
– Central data acquisition
RESULTS
• 269 administrators responded (84%) out
of 319 substance abuse program
administrators surveyed, from 95 CTPs in
the NIDA CTN, covering 26 states & DC
• 1723 clinicians of 2210 targeted (78%)
• At least one substance abuse or health
department administrator from 48 states
and the District of Columbia (96%)
Characteristics of Treatment Programs
Characteristic
Number of Surveys with
Valid Responses
Corporate structure
Private not-for-profit
Private for profit
Government
Other
268
Largest source of revenue
County/local grants
State funds
Medicaid
Federal grants
VA Benefits
Medicare
Private contracts/insurance
Self-pay
Other
Unknown
269
Number (%) of
Treatment Programs*
212 (78.5)
15 (5.6)
36 (13.4)
6 (2.2)
45 (16.7)
103 (38.1)
46 (17.0)
33 (12.2)
5 (1.9)
4 (1.5)
9 (3.3)
15 (5.6)
3 (1.1)
7 (2.6)
*Percentages do not total 100% due to rounding and non-respondents
Characteristics of Treatment Programs
Characteristic
Number of Surveys with
Valid Responses
Patient census
≤500
500 – 1000
>1000
Number (%) of
Treatment
Programs*
250
145 (53.9)
52 (19.3)
53 (19.7)
Addiction Services Offered #
256
242
257
259
Inpatient or residential services
Outpatient pharmacotherapy
Other outpatient services
Outreach & support services
Medical Staff
Non-Medical Staff
148 (55.0)
89 (33.1)
206 (76.6)
227 (84.4)
0
1
2-3
4-7
8+
55 (20.4)
31 (11.5)
64 (23.8)
54 (20.1)
57 (21.2)
0-7
8-11
12-17
18+
79 (29.4)
59 (21.9)
59 (21.9)
64 (23.8)
*Percentages do not total 100% due to rounding and non-respondents
# Responses were not mutually exclusive for this item
PRELIMINARY RESULTS: TREATMENT
PROGRAM CHARACTERISTICS BY
AVAILABILITY OF HIV/AIDS PROVIDER
EDUCATION: NIDA CTN
TREATMENT PROGRAM CHARACTERISTICS
Offer
Provider
Education
n (%)
ForProfit
NonProfit
Residential
Drug
Free
Opiate
Agonist
Rx
15 (93)
146 (75)
59 (82)
105 (74)
61 (82)
PRELIMINARY RESULTS: Relationship
Between State Policy & Treatment
Program (TP) Provision of HIV
Provider Education
• State Administrator Respondents
– 67% Reported Guidelines/Regulations/Policies
• TP Administrator Respondents
– In States With Guidelines/Regulations/Policies:
77% Provide the Service
– In States Without Guidelines/Regulations/Policies:
65% Provide the Service
HIV/AIDS-RELATED SERVICES IN SUBSTANCE
ABUSE TREATMENT PROGRAMS: NIDA CTN
ADMINISTRATOR RESPONSES (N=269)
Service Type
Service Offered
n (%)
Risk Assessment
224 (89)
Patient Education
226 (84)
Patient Counseling
178 (66)
History & Physical Examination
150 (56)
Biological Assessments
131 (49)
Pharmacotherapies Administered/
Prescribed
103 (38)
Clinical Monitoring
117 (43)
RELATIONSHIP BETWEEN STATE POLICIES,
GUIDELINES, & REGULATIONS AND HIV/AIDSRELATED SERVICES IN SUBSTANCE ABUSE
TREATMENT PROGRAMS
Services
State Policies/Guidelines/Regs
YES
NO
Patient Education
218 (90)
7 (88)
Risk Assessment
180 (91)
42 (79)
Counseling
137 (72)
39 (71)
History & Physical
Examination
67 (59)
60 (59)
Biological Testing
65 (52)
66 (54)
Treatment
66 (59)
37 (27)
Monitoring
44 (72)
72 (39)
SUBSTANCE ABUSE TREATMENT PROGRAMS
OFFERING SERVICES SPECIFICALLY FOR
WOMEN AND MINORITIES:
Women
Children
Teens
Minorities
(all)
n (%)
n (%)
n (%)
n (%)
191 (71)
62 (23)
89 (33)
127 (47)
Blacks
Indian/
Eskimo
Hispanic
Asian
Hawaiian/
Pacific Isle
n (%)
n (%)
n (%)
n (%)
n (%)
91 (34)
46 (17)
106 (39)
44 (16)
37 (14)
HIV/AIDS-RELATED SERVICES IN
PROGRAMS WITH SERVICES TARGETED
FOR SUBPOPULATIONS: NIDA CTN
Women
Blacks
Hispanics
Service
n (%)
n (%)
n (%)
Provider Education
130(73)
74(86)
86(85)
Patient Education
164(92)
82(95)
95(94)
Risk Assessment
161(90)
79(92)
92(91)
Counseling
132(75)
74(86)
80(82)
History & Physical
Examination
110(62)
61(72)
65(66)
Biological Testing
95(54)
50(60)
55(57)
Treatment
79(45)
54(64)
57(58)
Monitoring
92(53)
56(67)
61(63)
SERVICES TARGETED FOR SUBPOPULATIONS IN
TREATMENT PROGRAMS WITH HIV/AIDSRELATED SERVICES: NIDA CTN
Women
Blacks
Hispanics
Service
n (%)
n (%)
n (%)
Provider Education
130(73)
74(44)
86(50)
Patient Education
164(75)
82(39)
95(45)
Risk Assessment
161(74)
79(38)
92(44)
Counseling
132(76)
74(45)
80(48)
History & Physical
Examination
110(75)
61(44)
65(46)
Biological Testing
95(74)
50(42)
55(45)
Treatment
79(79)
54(56)
57(58)
Monitoring
92(80)
56(51)
61(54)
STUDY LIMITATIONS
• Generalizability of Results
– Consistent with 2 previous publications
• Lack of detailed description of services
tailored for women and minorities
• Does not include utilization, cost, efficiency,
or effectiveness of HCV-related services
– Hypothesis generating
SUMMARY
• Most HIV/AIDS-related services are
offered by:
– a substantial proportion of private not-forprofit, for-profit, and public agencies
– a substantial proportion of substance abuse
treatment programs of all sizes
• A significant number of programs offer no
HIV-related services.
SUMMARY
• Availability of HIV/AIDS-related services
appears to be related to:
– State Guidelines, Policies, or Regulation
– Availability of substance abuse treatment
services for women & minorities
• A number of hypotheses & opportunities
remain to be proposed, pursued, and
answered
• These are preliminary results of a larger
study
NEXT STEPS
• Tests for significance
• Generate additional hypotheses for
testing
FOR MORE INFORMATION
ABOUT THIS STUDY
• AT THIS MEETING
– Symposium III- Disparities in Substance Abuse
Treatment- Salon HI- 6/19 -1-3 PM
• PEER-REVIEWED PUBLICATIONS
– Brown LS. et. al., Journal of Substance Abuse
Treatment, 2006;30: 315-321
• CONTACTING STUDY PERSONNEL
– Dr. Brown, the Lead Investigator:
[email protected]
– Steven Kritz, MD – the Project Director:
[email protected]