Relationships Between HIV Disease Knowledge, Opinions, Training, Experience; and Service Availability at Substance Abuse

1. Relationships Between HIV Disease Knowledge, Opinions, Training, Experience; and Service Availability at Substance Abuse Treatment Programs Authors & Affiliations Steven Kritz, MD; Roberto Zavala, MD; Lawrence S. Brown, Jr., MD, MPH; Melissa Lin, MS Addiction Research and Treatment Corporation, Brooklyn, NY

2. Background • In HIV care, evidence exists of relationships between clinical outcomes and provider experience and knowledge • However, relationships between clinician characteristics and availability of infection-related services have not been reported

3. Objectives • To provide empirical evidence of an association between clinician knowledge and a) clinician opinions and b) clinician experience pertaining to HIV-related health • To determine the association between the availability of infection-related health services in addiction treatment programs and the opinions of the administrators of these programs • To determine the association between the availability of infection-related health services in addiction treatment programs and ongoing staff training pertaining to infection-related health

4. Methods • Study Design • Cross sectional survey • Descriptive exploratory • Study Population • Administrators and clinicians at substance abuse treatment programs within the NIDA Clinical Trials Network

5. Methods • Data Source: Survey instrument • Surveys captured infection-related knowledge, opinions, training and experience • Opinions were assessed using 5-point Likert scale, while the knowledge component contained 20 closed-end questions • Approved via expedited review and waiver of informed consent by Institutional Review Boards with jurisdiction over the participating treatment programs.

6. The Administrator Survey Consisted of 112 questions divided into 8 sections: • Structure and Service Setting (6) • Patient Characteristics (3) • Staff Characteristics (10) • Reimbursement Issues (24) • Practices (30) • Program Guidelines (8) • Barriers (27) • Opinions (4)

7. The Clinician Survey • Consisted of 90 questions divided into 5 sections: • Practices (31) • Program Guidelines (8) • Knowledge (20) • Barriers (27) • Opinion (4) • Survey was given to medical & non-medical personnel, who were further categorized as expert & non expert by program administrators

8. Results • The data derives from surveys submitted by administrators from 269 (84%) of 319 treatment programs within the CTN located in 26 states & DC • Also 1716 (78%) of 2210 clinicians from the 269 CTN treatment programs participated • No portion of the country or the CTN was over-represented among the 50 non-responding programs

9. Results • For 366 medical clinicians, mean percent correct responses to knowledge questions was 65% • Among 1350 non-medical clinicians, mean percent correct responses to knowledge questions was 59% • For 772 expert and 944 non-expert clinicians, mean percent correct responses to knowledge questions was 64% and 57%, respectively • For 251 medical expert and 115 medical non-expert clinicians, mean percent correct responses to knowledge questions 68% and 60%, respectively

10. Results • Mean percent correct responses (knowledge) was significantly associated with clinician opinions (p<.01) and experience (p<.01) • Knowledge was also associated with HIV testing (p<.05), but not counseling availability • In 84% of cases, HIV counseling and testing was associated with ongoing staff training and experience (p<.05)

11. Results • Comfort discussing intimate sexual relationships with women having sex with women was endorsed by 71% of medical staff compared to 79% of non-medical staff • 97% of medical staff viewed substance abuse prevention as important compared to 95% of non-medical staff • 33% of program administrators (but not clinicians) believe full abstinence is necessary for successful HIV-related interventions

12. Discussion • This investigation highlighted five major findings: • Knowledge score between medical and non-medical personnel was very similar • Mean percent correct responses (knowledge) was significantly associated with opinions and experience of clinicians, and HIV testing, but not counseling availability • Both medical and non-medical personnel view substance abuse prevention as an important tool • HIV counseling and testing was associated with ongoing staff training and experience • Program administrators felt that full abstinence from substance use is needed for successful HIV interventions

13. Limitations • This investigation did not include information about the costs, effectiveness or utilization of HIV-related services or patient satisfaction • Lack of random selection may impact generalizablility of the findings • Definitions and categorizations for the expert/non-expert groups may not have been optimal, since they were decided by the programs administrators

14. Conclusions This study provided empirical support for relationships between knowledge, opinions, ongoing training, and experience; and availability of HIV-related services at substance abuse treatment programs

15. Drug Abuse Treatment Clinical Trials Network 17 Nodes with 116 Community Treatment Programs Reaching into 26 States & DC Seattle Portland Detroit New York City Boston New Haven Denver Long Island Philadelphia Cincinnati San Francisco Baltimore/Richmond Raleigh/ Durham Albuquerque Los Angeles Charleston Miami CTN Sites (2003-2005)

16. Acknowledgements Research supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreement with the NIDA Clinical Trials Network (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 were: 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

17. Disclosures There are no financial interests or other disclosures to report for any of the authors involved in this project

18. Clinical Trials Network ∙ Dissemination Library NationalDrugAbuseTreatment A copy of this presentation will be available electronically after the meeting from the: CTN Dissemination Library http://ctndisseminationlibrary.org