HIV/AIDS-Related Services in Substance Abuse Treatment Settings: Preliminary Results The NIDA Clinical Trials Network

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HIV/AIDS-Related Services in Substance Abuse
Treatment Settings Preliminary ResultsThe 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
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ACKNOWLEDGEMENTS

• PATIENTS AND STAFF OF THE ADDICTION RESEARCH AND
  TREATMENT CORPORATION, A COMMUNITY-BASED
  SUBSTANCE ABUSE SERVICE AGENCY

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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

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GAME PLAN

• Rationale
• Main Study Description
• Results Next Steps

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17 Nodes with 116 Community Treatment Agencies
Reaching into 26 States!
Drug Abuse Treatment Clinical Trials Network
Seattle
Portland
New York City
Detroit
Boston
New Haven
Denver
Long Island
Philadelphia
Cincinnati
San Francisco (CA/AZ Node)
Baltimore/Richmond
Raleigh/ Durham
Albuquerque
Los Angeles
Charleston
Miami
CTN Sites
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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

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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

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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

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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

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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

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ETHICAL, REGULATORY ADMINISTRATIVE
CONSIDERATIONS

• Expedited IRB Approval
• Waiver of Informed Consent
• Training for Node Protocol Managers

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STUDY PROCEDURES

• Node Protocol Managers
• Information Sheet In Lieu of Informed Consent
• Survey Administration
• Paper or Electronic
• Central data acquisition

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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)

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Characteristics of Treatment Programs
Characteristic Number of Surveys with Valid Responses Number () of Treatment Programs
Corporate structure Private not-for-profit Private for profit Government Other 268 212 (78.5) 15 (5.6) 36 (13.4) 6 (2.2)
Largest source of revenue County/local grants State funds Medicaid Federal grants VA Benefits Medicare Private contracts/insurance Self-pay Other Unknown 269 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
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Characteristics of Treatment Programs
Characteristic Number of Surveys with Valid Responses Number () of Treatment Programs
Patient census 500 500 1000 gt1000 250 145 (53.9) 52 (19.3) 53 (19.7)
Addiction Services Offered Inpatient or residential services Outpatient pharmacotherapy Other outpatient services Outreach support services
Addiction Services Offered Inpatient or residential services Outpatient pharmacotherapy Other outpatient services Outreach support services 256 242 257 259 148 (55.0) 89 (33.1) 206 (76.6) 227 (84.4)
Medical Staff 0 1 2-3 4-7 8 55 (20.4) 31 (11.5) 64 (23.8) 54 (20.1) 57 (21.2)
Non-Medical Staff 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
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PRELIMINARY RESULTS TREATMENT PROGRAM
CHARACTERISTICS BY AVAILABILITY OF HIV/AIDS
PROVIDER EDUCATION NIDA CTN
TREATMENT PROGRAM CHARACTERISTICS TREATMENT PROGRAM CHARACTERISTICS TREATMENT PROGRAM CHARACTERISTICS TREATMENT PROGRAM CHARACTERISTICS TREATMENT PROGRAM CHARACTERISTICS
For-Profit Non-Profit Residential Drug Free Opiate Agonist Rx
Offer Provider Education n () 15 (93) 146 (75) 59 (82) 105 (74) 61 (82)

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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

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HIV/AIDS-RELATED SERVICES IN SUBSTANCE ABUSE
TREATMENT PROGRAMS NIDA CTN ADMINISTRATOR
RESPONSES (N269)
Service Offered
Service Type 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)
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RELATIONSHIP BETWEEN STATE POLICIES, GUIDELINES,
REGULATIONS AND HIV/AIDS-RELATED SERVICES IN
SUBSTANCE ABUSE TREATMENT PROGRAMS
State Policies/Guidelines/Regs State Policies/Guidelines/Regs
Services 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)
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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)

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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)
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SERVICES TARGETED FOR SUBPOPULATIONS IN TREATMENT
PROGRAMS WITH HIV/AIDS-RELATED 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)
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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

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SUMMARY

• Most HIV/AIDS-related services are offered by
• a substantial proportion of private
  not-for-profit, 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.

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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

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NEXT STEPS

• Tests for significance
• Generate additional hypotheses for testing

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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, 200630 315-321
• CONTACTING STUDY PERSONNEL
• Dr. Brown, the Lead Investigator
  lbrown_at_artcny.org
• Steven Kritz, MD the Project Director
  skritz_at_artcny.org