Barriers to Providing Health Services for HIV/AIDS, Hepatitis C Virus Infection, and Sexually Transmitted Infections in Substance Abuse Treatment Programs in the United States Edmund J. Bini, MD, MPH 1, Steven Kritz, MD 2, Lawrence S. Brown, Jr, MD, MPH 2,3, Jim Robinson, MEd 4, Don Alderson, MS 5, John Rotrosen, MD 6 1 Division of Gastroenterology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY; 2 Addiction Research and Treatment Corporation, Brooklyn, NY; 3 Department of Public Health, Weill Medical College, Cornell University, New York, NY; 4 Nathan Kline Institute, Orangeburg, NY; 5 New York State Psychiatric Institute, New York, NY; 6 Department of Psychiatry, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY Methods Background & Aim Methods Results Conclusions References Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and sexually transmitted infections (STI) are major public health problems worldwide The use and abuse of illicit substances is also a major public health problem, and substance abuse is largely responsible for sustaining the epidemics of HIV, HCV, and STI in the United States To date, however, the limited multicenter data that are available demonstrate that HIV/AIDS, HCV, and STI health services are not universally available in all drug treatment programs The reasons why these services are not offered are unknown The primary aim of this study was to determine barriers to offering health services for HIV/AIDS, HCV, and STI within substance abuse treatment programs in the United States Characteristics of the 269 Substance Abuse Programs Results Completed surveys were received from  269 of the 319 program administrators (84.3%)  1,723 of the 2,210 clinicians (78.0%) To assess barriers to delivering health services for the 3 targeted infections, program administrators were provided with a list of 7 barriers and were asked to choose yes or no for each of the 7 barriers to delivering each of the 4 medical and 4 non-medical services The treatment program clinician surveys were sent by mail to 2,210 randomly selected clinicians at each of the programs The questions that assessed clinician barriers were identical to the questions in the program administrator survey CharacteristicPercent Corporate structure Private not-for-profit Private for-profit Government Other 78.7% 5.6% 13.4% 2.2% Nature of the program Hospital/Medical School/University Mental Health/Family/Child Services Center Free-Standing Other 13.9% 12.7% 60.7% 12.7% Largest source of revenue County/local grants State funds Medicaid Federal grants Other 17.2% 39.3% 17.6% 12.6% 13.4% Addiction services offered Inpatient or residential services Outpatient pharmacotherapy Other outpatient services Outreach & support services 55.0% 36.8% 80.2% 87.6% Medical staff (MD, PA, NP, RN, LPN, etc.) 0 1 – 3 4 or more 21.1% 36.4% 42.5% Non-medical staff 0 – 7 8 – or more 30.3% 45.2% 24.5% Current patient census 0 1 – – 1,000 1,000 or more 2.0% 56.9% 20.4% 20.8% Percent of patients infected with HIV 0 1 – – or more 12.4% 65.7% 12.4% 9.6% Percent of patients infected with HCV 0 1 – – or more 9.2% 30.1% 12.1% 48.6% Percent of patients infected with STI 0 1 – – or more 8.3% 57.5% 15.0% 19.2% HIV/AIDS, HCV, and STI Services Offered by the 269 Substance Abuse Programs HIV/AIDS Services Offered HCV Services Offered STI Services Offered P-Value Patient medical history and physical exam59.8%52.9%51.6%0.14 Patient biological testing52.4%36.8%42.2%<0.01 Patient treatment41.5%30.8%35.8%0.04 Patient monitoring47.4%37.5%41.2%0.08 Provider education73.2%67.3%60.8%0.01 Patient education89.3%78.4%80.1%<0.01 Patient risk assessment88.5%75.8%76.5%<0.01 Patient counseling71.8%62.4%63.7%0.06 The target population for this study included treatment program administrators (program directors or managers) and treatment program clinicians in all substance abuse treatment programs within the National Drug Abuse Treatment Clinical Trials Network (CTN) in the United States The CTN includes a large number of treatment programs whose mission is to improve the quality of drug abuse treatment throughout the country using evidence-based medicine and science as the vehicle The treatment program administrator surveys were sent by mail to each of the administrators of the 319 treatment programs within the CTN This comprehensive survey assessed the structure of the treatment program, staffing, funding, characteristics of the patients enrolled in the program, services offered for HIV/AIDS, HCV, and STI, and barriers to offering services for these infections For each of the 3 infections, we assessed the availability of 8 health services (offered either on-site or by contractual agreement with another provider), including  4 medical services (medical history/physical examination, biological testing, medical treatment, medical monitoring)  4 non-medical services (provider education, patient education, patient risk assessment, patient counseling) Barriers to Providing HIV/AIDS, HCV, and STI Services Reported by Program Administrators Medical ServicesNon-Medical Services Barriers to Providing Services Patient Medical History and Physical Exam Patient Biological Testing Patient Treatment Patient Monitoring Provider Education Patient Education Patient Risk Assessment Patient Counseling HIV/AIDS Government regulations 11.8%16.0%17.9%14.3%9.4%9.1%5.8%10.5% Treatment program policies 14.2%18.3%19.2%18.4%8.2%7.4%7.1%11.3% Staff training27.0%29.2%34.9%34.0%41.5%39.4%32.8%39.5% Funding56.7%63.8%70.4%64.9%64.2%58.4%47.9%62.0% Patient/client health insurance benefits 48.3%52.1%58.6%53.8%34.6%42.3%35.8%51.9% Patient/client acceptance 32.8%37.3%41.4%39.3%17.0%38.6%33.8%43.3% Staff acceptance11.0%16.5%14.3%16.0%13.3%13.0%11.3%15.9% Other barriers4.8%3.4%8.2%6.5%3.4%5.4%2.1%6.7% HCV Government regulations 13.2%14.2%15.7%16.3%7.4%7.0%5.7%8.7% Treatment program policies 11.8%20.7%22.9%20.6%8.3%7.0%8.3%12.3% Staff training27.6%31.7%39.6%36.8%41.3%44.7%36.2%43.9% Funding55.3%65.1%71.7%63.4%65.2%61.5%48.5%60.3% Patient/client health insurance benefits 49.1%57.1%59.4%53.9%34.3%42.1%35.6%48.7% Patient/client acceptance 33.8%39.8%47.8%43.7%13.0%33.8%31.0%39.7% Staff acceptance11.8%16.4%17.0%17.5%12.2%12.4%12.7%14.2% Other barriers8.3%10.3%8.8%8.6%6.9%7.6%4.1%8.2% STI Government regulations 11.7%14.7%14.2%12.3%8.1%10.3%8.2%10.8% Treatment program policies 13.7%20.3%16.4%17.8%10.2%13.2%9.4%12.0% Staff training31.8%31.9%36.1%31.9%42.2%45.1%33.8%41.3% Funding53.4%59.2%63.8%57.8%62.3%59.7%50.8%59.0% Patient/client health insurance benefits 47.4%53.0%55.2%50.4%32.3%41.6%36.4%49.8% Patient/client acceptance 33.8%36.2%37.4%39.5%14.8%34.8%35.5%40.9% Staff acceptance11.7%16.5%16.0%15.8%13.3%14.2%10.3%15.5% Other barriers6.6% 6.5%6.7%4.8%5.2%7.9% The frequency and types of barriers reported by program administrators and clinicians were similar Only the barriers reported by the program administrators are presented Median Number of the 8 Health Services Offered for HIV/AIDS, HCV, and STI P <0.01 Proportion of Programs That Did Not Offer Any of the 4 Medical or 4 Non-Medical Services for HIV/AIDS, HCV, and STI P <0.01 No Medical Services No Non-Medical Services Health service delivery for HIV/AIDS, HCV, and STI is less than optimal in drug treatment programs in the United States There are numerous barriers to providing these services Public health interventions to overcome barriers to care afford an opportunity to enhance treatment and prevention of these infections