STATE POLICIES

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STATE POLICIES AVAILABILITY OF
INFECTION-RELATED SERVICES IN SUSTANCE ABUSE
TREATMENT PROGRAMS CONNECTED AT THE HIP?

• The NIDA Clinical Trials Network Infections Study
  (CTN-0012)

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• Lawrence S. Brown, Jr., MD, MPH, FASAM Steven
  Kritz, MD John Rotrosen, MD Jeff Goldsmith, MD
  Edmund Bini, MD, MPH Jim Robinson, MEd
• Addiction Research Treatment Corp, Brooklyn,
  NY NYU School of Medicine and VA Hospital, NY,
  NY University of Cincinnati Medical Center,
  Cincinnati, OH Nathan Kline Institute,
  Orangeburg, NY

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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 other
  Protocol Team members consisting of
• Randy Seewald, MD Cheryl Smith, MD Frank
  McCorry, PhD Dennis McCarty, PhD Donald Calsyn,
  PhD Leonard Handelsman, MD Steve Kipnis, MD
• Patrick McAuliffe, MBA, LADC Al Hassen, MSW
  Karen Reese, CAC-AD Sherryl Baker, PhD
• Shirley Irons Kathlene Tracy, PhD

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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 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

• AIDS Acquired Immunodeficiency Syndrome
• HIV Human Immunodeficiency Virus
• 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 TERMS

• Treatment Program vs. NIDA CTN CTP
• Services Assessed
• Provider Education
• Patient Education
• Patient Risk Assessment
• Patient Medical History Physical Exam
• Patient Biological Testing
• Patient Counseling
• Patient Treatment
• Patient Monitoring

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PRIMARY OBJECTIVES

• TO DESCRIBE
• Range of Infection-Related Services Available
• CTP Characteristics (funding, staffing)
• 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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DESIGN AND POPULATION

• STUDY DESIGN
• 2 Cross-sectional Surveys
• Descriptive Exploratory
• STUDY POPULATION
• CTP Administrators
• Administrators of State Health Departments and
  Substance Abuse Agencies

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ETHICAL, REGULATORY AND ADMINISTRATIVE
CONSIDERATIONS

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

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Administrator Surveys
Contact CTP Directors for Treatment Program and
Administrator contact information
Administrator completes survey online or mails to
Data Center Administrator enters contact
information for Clinicians
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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State Surveys
Project Manager enters State Administrator
contact information into the Data Center system
Data Center mails survey material to State
Administrators
State Administrator completes the survey online
or mails to Data Center
Project Manager contacts State Administrators that
have not completed survey within 30 days
After four weekly attempts to contact State
Administrators, the Project Manager flags them as
non-responders
Data Center reviews data and communicates any
issues to Project Manager
Project Manager contacts State Administrators to
resolve data queries
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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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RESULTS

• 269 out of 319 (84) substance abuse program
  administrators responded administrators.
• At least one health department or substance abuse
  agency administrator from 48 states and the
  District of Columbia (96) responded

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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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HIV/AIDS, HCV STI-RELATED SERVICES PROVIDED IN
SUBSTANCE ABUSE TREATMENT PROGRAMS WHEN STATE
MANDATED
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RELATIONSHIP BETWEEN STATE MANDATES PERCENT OF
SUBSTANCE ABUSE TREATMENT PROGRAMS PROVIDING
HIV/AIDS, HCV STI-RELATED BEHAVIORAL SERVICES
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HIV/AIDS, HCV STI-RELATED SERVICES PROVIDED IN
SUBSTANCE ABUSE TREATMENT PROGRAMS WHEN NOT STATE
MANDATED
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RELATIONSHIP BETWEEN STATE MANDATES PERCENT OF
SUBSTANCE ABUSE TREATMENT PROGRAMS PROVIDING
HIV/AIDS, HCV STI-RELATED MEDICAL SERVICES
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SUMMARY

• Most HIV/AIDS, HCV STI-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
• Staffing patterns (medical and non-medical) are
  quite varied

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SUMMARY

• Six of eight targeted services were provided by a
  similar of programs, regardless of state
  mandates
• Two services (treatment and monitoring) were
  provided by a substantially higher percentage of
  sites where it was state mandated

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SUMMARY

• There is substantial variation in the of
  programs offering the various services for a
  particular infection group
• There is consistency in the of programs
  offering a particular service for all three
  infection groups

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...And THERE IS MORE DATA