Relationships Between the Availability of InfectionRelated Services

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Relationships Between the Availability of
Infection-Related Services Availability of
Services Tailored for Subpopulations in Substance
Abuse Treatment Programs The 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
• Disparities Secondary Analysis

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BOTTOM LINE

• Treatment programs of various descriptions offer
  an array of infection-related services some do
  not.
• Substance abuse treatment programs that offer
  services tailored for Women Minorities were
  more likely to also offer infection-related
  services.
• A number of hypotheses opportunities remain to
  be proposed, pursued, and answered
• These are preliminary results of a larger study

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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
• 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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IMPORTANT ABREVIATIONS

• HIV Human Immunodeficiency Virus
• AIDS Acquired Immunodeficiency Syndrome
• HCV Hepatitis C Virus
• STI Sexually Transmitted Infections
• CTP Community Treatment Program
• CTN Clinical Trials Network
• SOP Standard Operating Procedures
• IRB Institutional (Human Subject) Review Board

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IMPORTANT DEFINITIONS

• 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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IMPORTANT DEFINITIONS
Service A
Service A
Service A
Service B
Service C
Service E
Service D
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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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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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Administrator Surveys
Administrator completes survey online or mails to
Data Center Administrator enters contact
information for Clinicians
Contact CTP Directors for Treatment Program and
Administrator contact information
Ensure IRB approval
Survey materials mailed to Administrators
Data Center contacts Administrators that have not
completed the survey or Clinician contact
information within 30 days

Node Protocol Manager contacts Administrators
that have not responded within two weeks
Data Center contacts Administrators to resolve
any data queries
After four weekly attempts, Administrators
flagged as non-responders by the Data Center

Node Protocol Managers contact non-responder Admin
istrators weekly
For Administrators that refuse to participate or
still have not responded after two additional
weeks, the Node Protocol Manager alerts the Node
Principal Investigator

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MEASUREMENTS ANALYTICAL METHODS

• SAMPLING METHODOLOGYAt Each CTP
• All Expert Clinicians Designated by the CTP
• 10 randomly sampled Non-Expert Clinicians,
• in a ratio of MedicalNon-Medical reflecting
  that of
• the CTPs clinical staff
• ANALYTIC METHODOLOGIES
• Experts will be analyzed separately
• Clinicians may decline next randomly
• selected person will be asked to participate

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STATISTICAL ELEMENTS

• Sample Size and Precision of the Estimated Mean
• Analytic Plan
• Descriptive stats for survey variables
• Principal Component or Cluster or Factor Analysis
  to group and reduce the number of variables
• Structural Equation Models to test for
  associations

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SURVEY RETURNS

• 269 administrators responded (84) out of 319
  substance abuse program administrators surveyed
  from 95 CTPs in the NIDA CTN, covering 26 states
  DC
• 1719 clinicians of 2207 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
Percentages do not total 100 due to rounding
and non-respondents
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Characteristics of Treatment Programs
Percentages do not total 100 due to rounding
and non-respondents Responses were not mutually
exclusive for this item
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SECONDARY ANALYSIS

• LIMITED TO RESPONSES FROM ADMINISTRATOR SURVEYS
• TO REPORT THE AVAILABILITY OF SUBSTANCE ABUSE
  TREATMENT SERVICES SPECIFICALLY DESIGNED FOR
• Women
• Children
• Teens
• Minorities (Black/African American,
  Hispanic/Latino, Indian/Eskimo, Asian,
  Hawaiian/Pacific Islanders)

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SECONDARY ANALYSIS (CONTD)

• TO REPORT THE AVAILABILITY OF SERVICES
  SPECIFICALLY DESIGNED WOMEN MINORITIES IN
  TREATMENT PROGRAMS OFFERING INFECTION-RELATED
  SERVICES
• TO REPORT THE AVAILABILITY OF INFECTION RELATED
  SERVICES IN TREATMENT PROGRAMS WITH SERVICES
  TAILORED FOR WOMEN MINORITIES

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SUBSTANCE ABUSE TREATMENT PROGRAMS OFFERING
SERVICES SPECIFICALLY FOR WOMEN AND MINORITIES
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ARE SERVICES FOR POPULATIONS SUFFERING FROM
DISPARATIES MORE PREVALENT IN TREATMENT PROGRAMS
WITH INFECTION-RELATED SERVICES?
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SERVICES TARGETED FOR SUBPOPULATIONS IN TREATMENT
PROGRAMS WITH HIV/AIDS-RELATED SERVICES NIDA CTN
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SERVICES TARGETED FOR SUBPOPULATIONS IN TREATMENT
PROGRAMS WITH HCV-RELATED SERVICES NIDA CTN
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SERVICES TARGETED FOR SUBPOPULATIONS IN TREATMENT
PROGRAMS WITH STI-RELATED SERVICES NIDA CTN
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ARE INFECTION-RELATED MORE PREVALENT IN TREATMENT
PROGRAMS OFFERING SERVICES FOR POPULATIONS
SUFFERING FROM DISPARATIES ?
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HIV/AIDS-RELATED SERVICES IN PROGRAMS WITH
SERVICES TARGETED FOR SUBPOPULATIONS NIDA CTN
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HCV-RELATED SERVICES IN PROGRAMS WITH SERVICES
TARGETED FOR SUBPOPULATIONS NIDA CTN
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STI-RELATED SERVICES IN PROGRAMS WITH SERVICES
TARGETED FOR SUBPOPULATIONS NIDA CTN
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LIMITATIONS

• Innate drawbacks of secondary analysis
• Lack of detailed description of services tailored
  for women and minorities
• No date on utilization, cost, efficiency, or
  effectiveness of subpopulation-tailored services
  or infection-related services.

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SUMMARY

• Substance Abuse Treatment Services Tailored for
  Women were Available in
• 75 or more in substance abuse treatment programs
  offering any infection-related service.
• Substance Abuse Treatment Services Tailored for
  African Americans and Hispanics were Available
  in
• more than 50 of substance abuse treatment
  programs offering treatment or monitoring
  infection-related services

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SUMMARY

• Of Treatment Programs with services tailored for
  women and minorities
• Infection-related services more prevalent in
  programs with services tailored for AA
  Hispanics than women
• Non-medical infection services more prevalent
  than medical infection services
• HIV-related services more prevalent than HCV or
  STI-related services

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NEXT STEPS

• Tests for significance
• Generate additional hypotheses for testing

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FOR MORE INFORMATION ABOUT THIS STUDY

• 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