Adoption of HIV Counseling and Testing Following Completion of Randomized Clinical Trial Louise Haynes 1, Beverly Holmes 2 Camille Peay 2, Lisa Metsch 3 1Psychiatry and Behavioral Sciences, Medical University of South Carolina, 2Lexington Richland Alcohol and Drug Abuse Council, 3 University of Miami Background Clinical Implementation (Pilot)State-Wide Implementation Methods References State-Wide Expansion of Project In 2010, the National Institute on Drug Abuse Clinical Trials Network (CTN) completed a study designed to evaluate strategies for providing rapid HIV testing in inpatient and outpatient substance use treatment programs. This study demonstrated the value of on-site rapid HIV testing in drug treatment centers but found no additional benefit from HIV sexual risk-reduction counseling. LRADAC, a community-based treatment program (CTP) in Columbia, SC and a participating CTP in the Southern Consortium Node of the NIDA Clinical Trials Network (CTN), was one of twelve sites. Staff to conduct HIV testing and HIV risk-reduction counseling were recruited and hired prior to implementation of the clinical trial. The staff were trained and certified to conduct testing and counseling as per study protocol. Participant Inclusion Criteria: Participating in substance abuse treatment service at the site Adult English speaking Willing to sign locator form HIV negative or unknown status Eligible sites Not offering testing Inpatient and outpatient sites Methadone and psychosocial rehab Study N=1281 Arm 1 (offer of testing and counseling) N=433 Arm 2 (offer of testing and information) N= 419 Arm 3 (offer of referral for off site testing) N= 429 Brown, L S.Brown, L S. ; Kritz, St ; Goldsmith, R. J ; Bini, E J. ; Rotrosen, J ; Baker, S ; Robinson, JA. ; McAuliffe, P. Characteristics of Substance Abuse Treatment Programs Providing Services for HIV/AIDS, Hepatitis C Virus Infection, and Sexually Transmitted Infections: The National Drug Abuse Treatment Clinical Trials Network. Journal of Substance Abuse Treatment 2006;30: [doi: 1016/j.jsat ].Kritz, StGoldsmith, R. JBini, E J.Rotrosen, JBaker, SRobinson, JA. McAuliffe, P Haynes LF, Korte JE, Holmes BE, Gooden L, Matheson T, Feaster DJ, Leff JA, Wilson L, Metsch LR, Schackman BR. HIV rapid testing in substance abuse treatment: Implementation following a clinical trial. Eval Program Planning Feb 28. [Epub ahead of print] Example of successful “science to practice” Participation in research can facilitate programmatic changes in community treatment programs Substance abuse clients in detox were receptive to offer of HIV testing and counseling Potential to reach beyond agency – state wide implementation Substance abuse continues to be a major factor in the transmission of HIV/AIDS, via injection and sexual risk behavior. Encouraging persons at risk for HIV to be tested is one of the main HIV prevention strategies in the United States. Previous studies have shown that many substance abuse treatment programs do not offer on-site HIV testing. Although the NIDA Clinical Trials Network was established to “bridge the gap” between research and practice, dissemination of evidence based practices studied in the CTN is challenging. Clients Tested (LRADAC Detox Program) September 8, 2009 to April 15, % Female 49% Black (consistent with patient population in detox) 319 Rapid Tests Offered 194 Accepted (61%) Reasons offered for not accepting test 69% Recently tested 10% (of those refusing test) reported being HIV positive Other reasons: perceived no risk, undecided about being tested, not interested N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 N = 1281 Arm 1 (offer of testing and counseling) N= 433 Arm 2 (information only and offer of testing) N= 419 Arm 3 (offer of referral for off site testing) N= 429 Agency- Wide Implementation Following completion of the study. LRADAC adopted (for clinical practice) the counseling (RESPECT2) and testing procedures used in the trial. The testing and counseling were piloted in the detoxification unit beginning September Each new admission to detox was seen individually and offered an appointment for confidential testing and counseling. Initially, the counseling and testing were conducted by staff trained as part of CTN0032. Subsequently, the research staff trained a program staff member to conduct the testing and counseling. Agency-wide implementation to follow in Clients Tested (Agency-Wide) April 16, 2010 to May 31, Clients Tested 33% Acceptance Rate 40% Female 59% Black Reasons offered for not accepting test 41% Recently tested 46% No Risk Factors In Fiscal Year 2010, there were 12 local substance abuse treatment agencies that were endorsed to conduct HIV testing. In Fiscal Year 2011, an additional 4 agencies were added. Figure #1 compares LRADAC to all of the additional state supported substance abuse treatment providers who conducted HIV testing in South Carolina from 7/1/2010 to 1/31/2011. Conclusion Well established collaborative relationship between Southern Consortium Node (MUSC) and SC Single State Authority (DAODAS) DAODAS’ multi-year attempt to establish HIV testing programs in SC’s substance abuse treatment system had progressed slowly Training required to certify substance abuse treatment staff was obtained through the state health department (DHEC), and training requirements were burdensome and not tailored for substance abuse providers Collaboration between Southern Consortium Node, LRADAC, DAODAS, and DHEC resulted in development of certification course held at 2010 SC School of Alcohol and Drug Studies. DAODAS offered scholarships to substance abuse providers. Figure #1: LRADAC compared to all of the additional state supported substance abuse treatment providers who are conducting HIV tests in South Carolina. Following the pilot LRADAC moved to full implementation, including both detox and outpatient programs.