Overview: HIV Testing and Counseling in Substance Abuse Treatment

1. Overview: HIV Testing and Counseling in Substance Abuse Treatment J L Sorensen1, G Colfax2, PT Korthuis3 L. Haynes4, D Feaster5, , S Tross6, R Mandler7 L Metsch5. October 2010 Affiliations:1Univ. of California, San Francisco, 2San Francisco City & County, 3Oregon Health and Science University, 4Morris Village Alcohol and Drug Treatment Center, 5University of Miami, 6Columbia University, 7National Institute on Drug Abuse. Addiction Health Services Research Conference, Lexington, KY (October 2010) Support (U10DA15815, R21DA020369DA14922, and P50DA09253. Rev. 10-20-10

2. PREVIEW • HIV Testing is Changing • Strategies are needed to improve the uptake of HIV and HCV testing for persons in drug abuse treatment. • The Current Study: HIV Rapid Testing and Counseling • Methods

3. BACKGROUND • Changes in HIV Testing & Counseling • Technology • Simplified collection of samples • Quicker results • Policy • Ethical and Practical Challenges

4. HIV RAPID TEST • FDA approved • Only requires blood from a finger stick or oral fluid from a swab • Results in 20 minutes • Does not require laboratory facilities and can be done by drug counselors LM slide

5. CHANGES IN POLICY • Changes in HIV Testing & Counseling • Technology • Finger Stick or Swab • Results in 20 minutes • Policy • Emphasis on benefits to public health • More routine testing • Less counseling and education • Ethical and Practical Challenges • Subgroups hard-hit and with less access to care • Fears, responsibilities, trust

6. BENEFITS OF WIDESPREAD HIV SCREENING • Decreases spread of HIV: An HIV diagnosis is associated with reduction in high risk sexual behaviors • Improves survival: Linkage to care and treatment • Reduces the stigma that is associated with testing based on risk LM slide

7. Policy Change: Offer Routine HIV Testing in Outpatient Health Care Settings CDC now recommends offering routine HIV testing to persons regardless of risk factors: • Emergency Departments • Sexually Transmitted Diseases (STD) Clinics • Labor and Delivery • Correctional Facilities • Offices of Primary Care Physicians • Substance Abuse Treatment Clinics LM slide

8. ETHICAL AND PRACTICAL ISSUES • Changes in HIV Testing & Counseling • Technology • Finger Stick or Swab • Results in 20 minutes • Policy • Emphasis on public health benefits • Broadened testing • Less counseling and education • Ethical and Practical Challenges • Subgroups hard-hit, with less access to care • Fears, responsibilities, trust • Feasibility of screening & treating

9. INFORMATION:Some Available, More Needed Desirable impact of HIV testing and counseling on sexual behavior Impact on drug-use risk behaviors is less well understood

10. NEED FOR RESEARCH • CDC and new guidelines are moving away from HIV counseling at the time of testing • Scientific study is needed to evaluate the effectiveness of offering HIV rapid testing + counseling in drug treatment programs • Effect on acceptability of HIV testing • Effect on risk behaviors LM slide

11. CTN STUDY • The NIDA CTN is completing a protocol to study the impact of • Providing rapid HIV testing • And counseling in drug abuse treatment programs. HIV Rapid Testing and Counseling in Drug Abuse Treatment Programs in the U.S. CTN 0032 • Led by: Lisa Metsch, Ph.D., Florida Node Alliance, University of Miami and • Grant Colfax, M.D., Western States Node and San Francisco Department of Public Health

12. CTN 0032 - HIV Rapid Testing & CounselingPrimary Research Questions LM slide Does offering on-site testing increase HIV testing rates? What is the role of prevention counseling in • Increasing acceptance of HIV testing • Reducing sexual risk behaviors

13. THREE INTERVENTIONS • Offer on-site HIV rapid testing with Project RESPECT counseling • Offer on-site HIV rapid testing with minimal counseling • Offer referral for HIV testing in the community LM slide

14. RESEARCH QUESTIONS Among persons who attend substance abuse treatment and report being HIV negative or not knowing their status… (1) What is the more effective testing strategy to ensure they get HIV tested and receive their results? (2) What is the more effective testing strategy to decrease their risk behaviors? LM slide

15. Funding: National Institute on Drug Abuse (NIDA) Recruitment and Enrollment Brief Baseline Assessment Random Assignment Offer Rapid Testing with brief participant- tailored prevention Counseling Offer Rapid Testing with Information Only Offer Standard Referral for Testing in Community Client post-intervention data collection LM slide

16. Participating Sites CODA MCCA Wheeler CPCDS Glenwood Gibson Recovery Chesterfield Life Link Daymark LRADAC Morris Village La Frontera LM slide

17. Diverse Site Characteristics • Primary location of recruitment • Outpatient/intensive outpatient: 6 • Residential: 3 • Methadone program: 3 • Ownership • Stand-alone private non-profit: 8 • State or county: 2 • Formerly county (recently privatized): 1 • Academic medical center: 1 • Varying levels of integration between substance abuse and mental health services in state agencies • Varying levels of experience with CLIA-waived on-site laboratory testing (e.g. urine toxicology testing) LM slide

18. Study Population LM slide 1281 drug treatment clients enrolled at 12 CTPs in the U.S. in less than 5 months 12 sites randomized an average of 106 participants (ranging from 59 to 126 per site) Randomized participants were demographically similar (age, gender, race/ethnicity) to CTP demographics

19. Notable Inclusion Criteria LM slide Participant must: Be seeking or currently receiving drug (inclusive of alcohol) abuse treatment services at the CTP Report being HIV-negative or HIV status unknown Report no receipt of results from an HIV test performed in the prior 12 months

20. THANK YOU! Contact information: James.Sorensen@ucsf.edu 415-206-3969 ON TO DR. METSCH!