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Abstract: This poster discusses the results of a survey done as part of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”), emphasizing the perspective of state substance abuse and health departments in relationship to the treatment programs within their jurisdiction for three infection groups: HIV/AIDS, Hepatitis C virus, and sexually transmitted infections. State substance abuse and health departments were compared regarding priorities, written guidelines and availability of funding for 8 selected services for the 3 infections (24 comparisons). In addition, clarity of guidelines and availability of funding for the 8 services, as reported by administrators and clinicians at treatment programs offering these services were compared with guidelines and funding as reported by the states. Surveys were received from 48 states and DC (96%) representing 46 substance abuse and 42 health departments. The response rate from treatment program administrators and clinicians was 269 (84%) and 1723 (78%), respectively. There was general agreement between states and the two departments within the states regarding priorities and availability of funding (19 of 24 comparisons). While most states had guidelines for infection-related services, clarity of guidelines as expressed by treatment program administrators and clinicians was less than optimal. For funding, treatment program administrators indicated less availability than the states for all 24 comparisons, 19 of which were statistically significant. While states appear generally to have their priorities, guidelines and funding in place, the mosaic that constitutes the healthcare delivery system may be too complex for the treatment programs to access most efficiently.

Abstract:

Although substance abuse treatment programs are an important point of contact to provide health services to diagnose, treat and prevent transmission of hepatitis B (HBV) and hepatitis C (HCV) viral infection, little is known about the availability of these services in substance abuse programs. This presentation reports on a study that evaluated the prevalence and spectrum of HBV and HCV services offered by drug treatment programs in the U.S. A questionnaire-based survey of drug treatment programs within the National Drug Abuse Treatment Clinical Trials Network was conducted as part of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”). Completed questionnaires were received from 269 (84.3%) of the 319 program administrators. Although 78.7% of programs reported that they offered ongoing hepatitis training for clinical staff, only a minority of programs offered testing for HBsAg (37.7%), HBsAb (36.7%), HBcAb (27.7%), HBV DNA (7.8%), HCV antibodies (52.9%), HCV qualitative (10.1%) or quantitative (8.9%) PCR, and HCV genotyping (11.6%). Hepatitis A and B vaccinations were offered by 68.3% of programs, either on site (19.3%) or via referral (49.1%). Programs having clear guidelines for hepatitis testing were significantly more likely to offer each of the hepatitis tests as compared with those that did not have clear guidelines. Only 28.9% of programs offered HCV treatment either on-site or via referral.

Despite the importance of substance abuse in sustaining the hepatitis epidemics in the U.S., many substance abuse treatment programs do not offer comprehensive HBV, HCV and hepatitis vaccination services. Public health interventions to improve access to hepatitis testing, treatment and prevention for substance abusers are needed.

Abstract:

Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors. In this study, part of protocol CTN-0012, a national HIV screening trial, individuals seeking treatment for substance abuse at 12 community treatment programs were surveyed. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. Researchers used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing. The 1281 participants included 244 (19%) individuals who reported injecting drugs in the past 6 months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6 months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis.

Conclusions: Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. This study highlights the need for broadly implemented HCV prevention interventions for all IDUs seeking addiction treatment, and suggests such interventions might particularly decrease transmission behaviors of those aware of their HCV infection and prevent HCV infections in those HCV-negative/unaware. As HCV screening and treatment options advance, community based treatment programs have a greater opportunity to play a central role in reducing HCV transmissions and engaging HCV-infected IDUs in treatment.

Related protocols: CTN-0012

Abstract:

Although substance abuse treatment programs are important contact points for providing health services for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, availability of services in these programs has not been well characterized. This study evaluated the spectrum of HBV and HCV services offered by substance abuse treatment programs within the National Drug Abuse Treatment Clinical Trials Network (CTN). A survey of substance abuse treatment program administrators covered availability of testing for HBV and HCV, hepatitis A virus (HAV) and HBV immunization, and HCV medical and nonmedical services. There were also questions covering clarity of guidelines for HBV and HCV testing and HAV and HBV immunization. Differences between methadone and nonmethadone programs were examined.

Conclusions: Despite the importance of substance abuse in sustaining the hepatitis epidemics, few programs offer comprehensive HBV and HCV testing or HCV health care services. Because substance abuse treatment programs are an important point of contact to provide risk-reduction counseling, testing, and treatment for these infections, these identified shortcomings provide opportunities for public health intervention.

Related protocols: CTN-0012

Abstract:

In HIV care, evidence exists of relationships between clinical outcome and provider experience, knowledge, and expertise. However, relationships between clinician characteristics and availability of infection-related services have not been reported. This investigation, related to protocol CTN-0012, surveyed administrators and clinicians at participating CTN substance abuse treatment programs to examine the relationships between clinician characteristics and availability of infection-related services. The surveys captured infection-related knowledge, opinions, training, and expertise. Results found that among 1350 non-medical clinicians, mean percent correct responses to knowledge questions was 53%. For 366 medical clinicians, mean percent correct responses to knowledge questions was 62%. Comfort discussing intimate sexual relationships with women having sex with women was endorsed by 79% of non-medical staff compared to 71% of medical staff, while 95% of non-medical staff viewed substance abuse prevention as important compared to 97% of medical staff. Mean percent correct responses was significantly associated with expertise and opinions of clinicians, and HIV testing, but not counseling availability. HIV counseling and testing was associated with ongoing staff training and experience, and the program administrators’ opinion regarding necessity of full abstinence to successful HIV-related interventions. In conclusion, this study provided empirical support for relationships between availability of infection-related services and staff training, experience, and administrator opinions in addiction treatment programs.

Related protocols: CTN-0012

Abstract:

In this study, researchers and clinicians sought to identify barriers to offering services for HIV/AIDS, hepatitis C virus, and sexually transmitted infections in substance abuse treatment programs. They surveyed treatment program administrators and clinicians within the National Drug Abuse Treatment Clinical Trials Network to evaluate the availability of medical and non-medical services for patients with or at risk for acquiring these infections. A substantial proportion of programs do not offer services (particularly medical services) for these infections. The most commonly cited barriers were funding, health insurance benefits, patient acceptance, and staff training.

The findings highlight a missed opportunity to positively impact these infectious disease epidemics.

Related protocols: CTN-0012

Abstract:

Substance abuse is a risk factor for HIV infection. This study, part of protocol CTN-0012, describes the availability and types of HIV services offered in substance abuse programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). In a cross-sectional, descriptive, hypothesis-generating design, 269 of 319 treatment program administrators within the CTN provided information utilizing a standardized survey regarding program characteristics, patient characteristics, and availability of HIV services for 3 categories of patients: all patients, newly admitted patients, and HIV-infected patients. The range of HIV-related services provided on-site or via contractual arrangements varied from 10% (Pneumococcal vaccination) to 86% (drug testing) of the treatment programs. HIV antibody testing was provided by 57% of programs co-located in hospitals, medical schools and universities as compared to 35% of programs in family health or mental health facilities; 30% of free-standing addiction treatment agencies; and 50% of programs in other settings. Compared to programs without outpatient pharmacotherapy, programs providing outpatient pharmacotherapy provided a higher mean number of HIV-related health services for all patients, for newly admitted patients, and for HIV-infected patients. HIV-related services were significantly more available in programs where patients either engage in high risk sexual behaviors or are located in areas with higher HIV infection rates. In conclusion, co-location of HIV-related services and substance abuse programs are useful in containing these diseases, although there is great variability in the type of offered services.

Related protocols: CTN-0012

Abstract:

As part of protocol CTN-0012, this report examines associations between the availability of human immunodeficiency virus (HIV)-related health services in substance abuse treatment programs and characteristics of the programs and patients they serve. In a cross-sectional, descriptive design, and via a validated survey, program administrators within the National Drug Abuse Treatment Clinical Trials Network provided information on program characteristics, patient characteristics (rates of risky sexual and drug behaviors and HIV infection), and the availability of 31 different HIV-related health services. Of 319 programs, 84% submitted surveys. Service availability rates ranged from: 10% (pneumococcal vaccination) to 86% (drug testing) for the 6 HIV-related services offered to all patients, 13% (Pap smear for women) to 54% (tuberculin skin testing) for the 6 services offered to new patients, 2% (sterile injection equipment) to 64% (male condoms) for the 4 risk-reduction services, 37% (Pap smear for women) to 61% (tuberculin skin testing) for the 11 biological assessments offered to HIV-positive patients, and 33% (medical treatments) to 52% (counseling) for the 4 other services offered to HIV-positive patients. The availability of these HIV-related services was associated with clinical settings, the types of addiction treatment services, the rates of risky drug and sexual behaviors, and HIV infection rates among patients. Availability of such services was below published guidelines. While the results provide another basis for the infection-related prevention benefits of substance abuse treatment, the variability in the availability of HIV-related health care deserves further study and has health policy implications in determining how to utilize substance abuse treatment in reducing drug-related HIV transmission.

Related protocols: CTN-0012

Abstract:

This study, part of protocol CTN-0012, examined availability of HIV services in substance abuse programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN), and associations between services, characteristics of programs, and patients treated. The range of HIV-related services provided on-site or via contractual arrangements varied from 10% (pneumococcal vaccination) to 86% (drug testing). HIV antibody testing was provided by 57% of programs located in hospitals, medical schools, and universities as compared to 35% of programs in family health or mental health facilities, 30% of free-standing agencies, and 50% in other settings. Compared to programs without outpatient pharmacotherapy, programs providing outpatient pharmacotherapy provided a higher mean number of HIV-related services for all patients, for newly admitted patients, and for HIV-infected patients. HIV-related services were significantly more available in programs where patients engaged in high risk sexual behaviors and had higher HIV infection rates.

The results of this study provide a plausible mechanism of how substance abuse treatment reduces HIV transmission via the availability of HIV prevention and medical services, and provides the basis for future hypothesis testing examining the utilization, effectiveness, and cost-effectiveness of HIV-related health services in substance abuse treatment. Given the public health significance of HIV disease and the role of substance use in its transmission, such studies are imperative.

Related protocols: CTN-0012

Abstract:

The prominence of healthcare disparities in public health discussions has spurred interest in the identification of those disparities, studying their causes, and pursuing possible remedies. It is well established that women and minority populations experience disparities in health and healthcare — i.e., differences in incidence, prevalence, mortality, morbidity, other consequences of disease, related to many factors including access to services — and that these disparities extend to issues around addiction and addiction-related infections.

The findings of this report suggest that there appear to be some alignment between services offered and these health and healthcare disparities. In a cross-sectional, descriptive design, treatment program administrators across the United States within the National Drug Abuse Treatment Clinical Trials Network (protocol CTN-0012) provided information on program characteristics, the availability of infection-related services (4 medical services and 3 nonmedical services for HIV, hepatitis C virus, and sexually transmitted infections), and barriers to providing infection-related services. Of 319 programs surveyed, 269 participated. Of these, 80% provided addiction services for special populations. Programs providing addiction services designed for at least one special population were more likely to provide infection-related health services, especially HIV-related education (94% vs. 85%) and patient counseling (76% vs. 60%) and were more likely to include outpatient addiction services (86% vs. 57%) and outreach and support services (92% vs. 70%). Primary barriers to providing infection-related services included government funding, private health insurance, and patient acceptance. But despite those barriers, programs with addiction services designed for women and nonwhite ethnic/racial populations provide infection-related health services more often than programs without these specially designed addiction services. The findings of this study strongly suggest that the tailoring of substance abuse treatment is an important public health strategy in addressing both the control of these infections and perhaps in reducing some of the disparities associated with them.

Related protocols: CTN-0012

Abstract:

Substance abuse treatment programs are an important platform for delivery of services for infectious diseases (ID) associated with drug and alcohol use. However, important components of ID care are not universally provided. Clinician training often focuses on information about ID. Less attention is paid to provider opinions and attitudes that may be barriers to providing ID services. In a national multi-site trial conducted by the National Drug Abuse Treatment Clinical Trials Network (CTN), protocol CTN-0012, we investigated the relationship between clinician opinions and the delivery of services for human immunodeficiency virus, hepatitis C virus, and sexually transmitted infections in substance abuse treatment settings. Survey data were collected from 1,723 clinicians at 269 CTN treatment programs. Clinician opinion was found to be significantly related to infectious disease service delivery. Implications for training are discussed.

Related protocols: CTN-0012

Abstract:

Community-based substance abuse treatment programs provide HIV, hepatitis C virus, and sexually transmitted infection services. As part of a larger study within the CTN (protocol CTN-0012, “Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”), the authors explored the relations between state (including Washington, D.C.) funding and guidelines and substance abuse treatment program practices.

State agency administrators and substance abuse treatment program administrators and clinicians were surveyed regarding eight infection-related services. Although state funding for infection-related services is widely available, substance abuse treatment programs do not always access it. Substance abuse treatment program guidelines are clearer in states that have written guidelines. Improved communication between state agencies and substance abuse treatment programs may enhance service.

Related protocols: CTN-0012

Abstract:

The National Drug Abuse Treatment Clinical Trials Network conducted this study, part of protocol CTN-0012, to determine the availability of and factors associated with infection-related health services in substance abuse treatment settings. In a cross-sectional descriptive design, state policies, reimbursement for providers, state level of priority, and treatment program characteristics were studied via written surveys of administrators of substance abuse treatment programs and of state health and substance abuse departments. Data from health departments and substance abuse agencies in 48 states and from 269 substance abuse treatment programs revealed that HIV/AIDS services are more frequent than hepatitis C virus or sexually transmitted infection-related services, and that nonmedical services are more frequent than medical services. While the availability of infection-related health services is associated with medical staffing patterns, addiction pharmacotherapy services, and state priorities, reimbursement was the most significant determining factor.

These findings suggest that greater funding of these health services in substance abuse treatment settings, facilitated by supportive state policies, represents an effective response to the excess morbidity and mortality of these substance use-related infections.

Related protocols: CTN-0012

Abstract:

This poster describes the background and aims, methods, and outcomes of one facet of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”). The protocol examined the associations between HIV/AIDS, hepatitis C (HCV), and sexually transmitted infection (STI)-related services provided by substance abuse treatment programs in the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN), and the states within which they are located.

This poster focuses specifically on the proportion of substance abuse treatment programs that did not offer health services for HIV/AIDS, HCV, and STI, and the identification of barriers to offering these services. Researchers conducted surveys of drug treatment program administrators and clinicians within the CTN to evaluate the availability of four medical services (medical history/physical examination, biological testing, medical treatment, and medical monitoring), four non-medical services (provider education, patient education, patient risk assessment, and patient counseling), funding, and other key elements involved in testing, evaluating, and caring for patients with HIV, HCV, and STI.

A high proportion of substance abuse treatment programs did not offer any of the four medical services either onsite or by referral. A lower proportion of programs did not offer any of the four non-medical services on-site or by referral. The most common barriers identified by program administrators and clinicians included funding, patient health insurance benefits, patient acceptance, and staff training, with funding identified as the single biggest obstacle to providing health services for these infections.

In conclusion, health service delivery for HIV/AIDS, HCV, and STI is less than optimal in drug treatment programs, and there are numerous barriers to providing these services. Public health interventions to overcome these barriers to care afford an opportunity to enhance treatment and prevention.

Related protocols: CTN-0012

Abstract:

This poster describes the rationale, objectives, procedures, and outcomes of one facet of protocol CTN-0012 (“Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs”). The protocol examined the associations between HIV/AIDS, hepatitis C (HCV), and sexually transmitted infection (STI)-related services provided by substance abuse treatment programs in the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN), and the states within which they are located.

The poster focuses specifically on the availability of Hepatitis C virus services (including medical history/physical exam; biological testing; patient treatment, monitoring, and education; provider education; patient risk assessment; and patient counseling) offered by substance abuse treatment programs, as well as the determination of whether HCV-related health services differ between programs that do and do not have clear guidelines for hepatitis testing, and methadone and non-methadone programs. The study used a cross-sectional survey sent to 319 treatment program administrators in the CTN; 269 administrators (84.3%) replied to the survey, representing a geographically diverse location from across the US. Despite the importance of substance abuse in sustaining the HCV epidemic in the U.S., the data shows that many substance abuse treatment programs do not offer comprehensive HCV-related services. Public health interventions to improve access to hepatitis testing, treatment, and prevention for substance abusers are needed.

Related protocols: CTN-0012