Transcript The Spectrum of HIV/AIDS-Related Services in Substance Abuse

HIV/AIDS-Related Health Services
in Substance Abuse Treatment
Programs
Authors & Affiliations
Lawrence S. Brown, Jr, MD, MPH, Steven Kritz, MD, Edmund J.
Bini, MD, MPH, Ben Louie, BA, Jim Robinson, MEd, Donald
Alderson, MS, John Rotrosen, MD
Addiction Research and Treatment Corporation, Brooklyn, NY
New York University School of Medicine / VA New York Harbor
Healthcare System, New York, NY
Nathan Kline Institute, Orangeburg, NY
Disclosures
There are no financial interests or other
disclosures to report for any of the
authors involved in this project
Drug Abuse Treatment Clinical Trials Network
17 Nodes with 116 Community Treatment Programs
Reaching into 26 States & DC
Seattle
Portland
Detroit
New York
City
Denver
Long Island
Philadelphia
Baltimore/Richmond
Cincinnati
San Francisco
Los Angeles
Boston
New Haven
Albuquerque
Raleigh/
Durham
Charleston
Miami
CTN Sites (2003-2005)
Study Sites
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Northern New England Node: McLean Hospital, Belmont, MA
New England Node: Yale University, New Haven CT
New York Node: New York University, New York, NY
Long Island Node: NY State Psychiatric Institute, New York, NY
Delaware Valley Node: University of Pennsylvania, Philadelphia, PA
Mid-Atlantic Node: Johns Hopkins University, Baltimore, MD
Medical College of Virginia, Richmond, VA
South Carolina Node: Medical University of South Carolina, Charleston, SC
North Carolina Node: Duke University, Raleigh/Durham, NC
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
Southwest Node: University of New Mexico, Albuquerque, NM
Pacific Region Node: University of California at Los Angeles, Los Angeles, CA
California-Arizona Node: University of California at San Francisco, San Francisco, CA
Oregon Node: Oregon Health Sciences University, Portland, OR
Washington Node: University of Washington, Seattle, WA
Background
• HIV disease -- a major cause of morbidity &
mortality, substantially associated with substance
abuse.
• Substance abuse treatment – recommended to reduce
substance abuse-related HIV infection.
• Little is known about how drug treatment programs
reduce substance abuse-related HIV infection.
Objectives
To describe:
1. Characteristics of the substance abuse treatment
programs
2. Characteristics of the patients served
3. Range of HIV-related services offered:
• All patients
• New admissions
• HIV+ patients
Methods
• Study Design
Cross sectional survey
Descriptive exploratory
• Study Population
Administrators at substance abuse treatment
programs within the NIDA Clinical Trials Network
Methods
• Data Source: Survey instrument
• Approved waiver of informed consent by
Institutional Review Boards with jurisdiction
over the participating treatment programs.
The Survey
Consisted of 112 questions divided into 8 sections:
1.
2.
3.
4.
5.
6.
7.
8.
Structure and Service Setting (6)
Patient Characteristics (3)
Staff Characteristics (10)
Reimbursement Issues (24)
Practices (30)
Program Guidelines (8)
Barriers (27)
Opinions (4)
…more on the survey
• Drug treatment program administrators were advised
to describe:
Main clinical setting
Types of addiction services
Types of HIV-related services
• They also were asked about:
Estimated HIV infection prevalence
Risk behaviors
Results
• The data derives from surveys submitted
by administrators from 269 (84%) of 319
treatment programs within the CTN
located in 26 states & DC
• No portion of the country or the CTN was
over-represented among the 50 nonresponding programs
About the treatment programs
Approximately 80% of the treatment programs
were private not-for-profit agencies
The program types were:
 61%: free-standing facilities
14%: hospitals, medical schools or universities
13%: co-located in mental health, family health or
child health centers
12%: other types of healthcare facilities
…more about the treatment programs
• Most treatment programs offered two or more
addiction treatment services
• 88% offered outreach and support services
• 80% had other outpatient services: detox, intensive
outpatient, housing or aftercare
• 55% offered inpatient detox or residential services
• 37% provided outpatient pharmacotherapy services,
such as methadone
HIV-Related Treatment Services at Substance
Abuse Treatment Programs
HIV-Related Treatment Services at Substance
Abuse Treatment Programs
Mean Number of HIV-Related Treatment Services By Program and
Patient Characteristics of Substance Abuse Treatment Programs
Mean Number of HIV-Related Treatment Services By Program and
Patient Characteristics of Substance Abuse Treatment Programs
...And… THERE IS MORE DATA
Discussion
• The results of this study provide a plausible mechanism of
how substance abuse treatment reduces HIV transmission via
the availability of:
 HIV-related prevention services
 HIV-related medical services
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This provides the basis for:
 future hypothesis-testing
 health service studies examining the utilization,
effectiveness, and cost-effectiveness of HIV-related health
services provided by substance abuse treatment programs
Discussion
• This investigation highlighted four major findings:
 Rates for HIV-related education, behavioral risk assessment
and HIV testing are lower than authoritative guidelines
 Hospital and university-based programs offered the most
services
 HIV-related services are higher in programs with higher
HIV infection and risk behavior rates
 A previous publication from this study showed that greater
service availability can be achieved by drafting state
guidelines and providing information on funding sources
directly to the programs
Limitations
• This investigation did not include information about the costs,
effectiveness or utilization of HIV-related services or patient
satisfaction
• It did not include data validating the information provided by
treatment program administrators
• Lack of random selection may impact generalizablility of the
findings
Conclusions
Given the public health significance of
HIV disease and the role of substance
use in its transmission, further studies
to examine the reasons for the wide
variability of HIV-related service
availability are warranted
Acknowledgements
Research supported by the National Institute on Drug Abuse
(NIDA) as part of a Cooperative Agreement with the NIDA
CTN (2U10DA013046). Its contents are solely the
responsibility of the authors and do not necessarily
represent the official views of the NIH or NIDA CTN
Other protocol team members are:
Randy Seewald MD, Frank McCorry PhD, Dennis McCarty PhD,
Donald Calsyn PhD, Leonard Handelsman MD, Steven Kipnis MD,
Al Hasson MSW, Karen Reese CAC-AD, Sherryl Baker PhD,
Cheryl Smith PhD, Shirley Irons, Kathlene Tracy PhD,
Pat McAuliffe MBA, LADC