Rev. 10-20-10 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.

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PREVIEW

1. HIV Testing is Changing

2. Strategies are needed to improve the uptake of HIV and HCV testing for persons in drug abuse treatment.

3. The Current Study: HIV Rapid Testing and Counseling

1. Methods

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BACKGROUND

• Changes in HIV Testing & Counseling– Technology

• Simplified collection of samples• Quicker results

– Policy

– Ethical and Practical Challenges

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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

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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

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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

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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

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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

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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

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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

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CTN STUDY

o The NIDA CTN is completing a protocol to study the impact ofo Providing rapid HIV testingo 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

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• Does offering on-site testing increase HIV testing Does offering on-site testing increase HIV testing rates?rates?

• What is the role of prevention counseling inWhat is the role of prevention counseling in

– Increasing acceptance of HIV testingIncreasing acceptance of HIV testing

– Reducing sexual risk behaviorsReducing sexual risk behaviors

CTN 0032 - HIV Rapid Testing & CounselingCTN 0032 - HIV Rapid Testing & CounselingPrimary Research QuestionsPrimary Research Questions

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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

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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?

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Recruitment and Enrollment

Brief Baseline

Assessment

Offer Rapid Testing

with brief participant-

tailored prevention Counseling

Random Assignment

Client post-intervention

data collection

Offer Rapid Testing with

Information Only

Offer Standard Referral for

Testing in Community

Funding: National Institute on Drug Abuse

(NIDA)

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Participating SitesParticipating Sites

CODA

La Frontera

Life Link

Gibson Recovery

MCCAWheeler

CPCDS

LRADACMorris Village

Glenwood

Chesterfield

Daymark

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Primary location of recruitmentPrimary location of recruitment Outpatient/intensive outpatient: 6Outpatient/intensive outpatient: 6 Residential: 3Residential: 3 Methadone program: 3Methadone program: 3 OwnershipOwnership Stand-alone private non-profit: 8Stand-alone private non-profit: 8 State or county: 2State or county: 2 Formerly county (recently privatized): 1Formerly county (recently privatized): 1 Academic medical center: 1Academic medical center: 1 Varying levels of integration between Varying levels of integration between

substance abuse and mental health services in substance abuse and mental health services in state agenciesstate agencies

Varying levels of experience with CLIA-waived Varying levels of experience with CLIA-waived on-site laboratory testing (e.g. urine toxicology on-site laboratory testing (e.g. urine toxicology testing)testing) LM slide

Diverse Site CharacteristicsDiverse Site Characteristics

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Study PopulationStudy Population

• 1281 1281 drug treatment clients enrolled at 12 CTPs drug treatment clients enrolled at 12 CTPs in the U.S. in less than 5 monthsin the U.S. in less than 5 months

• 12 sites randomized an average of 106 12 sites randomized an average of 106 participants (ranging from 59 to 126 per site)participants (ranging from 59 to 126 per site)

• Randomized participants were demographically Randomized participants were demographically similar (age, gender, race/ethnicity) to CTP similar (age, gender, race/ethnicity) to CTP demographicsdemographics

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Notable Inclusion CriteriaNotable Inclusion Criteria

Participant must: Participant must:

• Be seeking or currently receiving drug (inclusive Be seeking or currently receiving drug (inclusive of alcohol) abuse treatment services at the CTPof alcohol) abuse treatment services at the CTP

• Report being HIV-negative or HIV status Report being HIV-negative or HIV status unknownunknown

• Report no receipt of results from an HIV test Report no receipt of results from an HIV test performed in the prior 12 monthsperformed in the prior 12 months

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THANK YOU!

Contact information:

James.Sorensen@ucsf.edu

415-206-3969

ON TO DR. METSCH!