1. HIV/AIDS-Related Health Services in Substance Abuse Treatment Programs Authors & Affiliations Lawrence S. Brown, Jr, MD, MPH, Steven Kritz, MD, Edmund J. Bini, MD, MPH, Ben Louie, BA, Jim Robinson, MEd, Donald Alderson, MS, John Rotrosen, MD Addiction Research and Treatment Corporation, Brooklyn, NY New York University School of Medicine / VA New York Harbor Healthcare System, New York, NY Nathan Kline Institute, Orangeburg, NY

2. Disclosures There are no financial interests or other disclosures to report for any of the authors involved in this project

3. Drug Abuse Treatment Clinical Trials Network 17 Nodes with 116 Community Treatment Programs Reaching into 26 States & DC Philadelphia Portland Los Angeles Charleston Miami Cincinnati Denver CTN Sites (2003-2005) Seattle Raleigh/ Durham Long Island Boston San Francisco New York City Detroit Albuquerque Baltimore/Richmond New Haven

4. Study Sites Northern New England Node: McLean Hospital, Belmont, MA New England Node: Yale University, New Haven CT New York Node: New York University, New York, NY Long Island Node: NY State Psychiatric Institute, New York, NY Delaware Valley Node: University of Pennsylvania, Philadelphia, PA Mid-Atlantic Node: Johns Hopkins University, Baltimore, MD Medical College of Virginia, Richmond, VA South Carolina Node: Medical University of South Carolina, Charleston, SC North Carolina Node: Duke University, Raleigh/Durham, NC 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 Southwest Node: University of New Mexico, Albuquerque, NM Pacific Region Node: University of California at Los Angeles, Los Angeles, CA California-Arizona Node: University of California at San Francisco, San Francisco, CA Oregon Node: Oregon Health Sciences University, Portland, OR Washington Node: University of Washington, Seattle, WA

5. Background HIV disease -- a major cause of morbidity & mortality, substantially associated with substance abuse. Substance abuse treatment – recommended to reduce substance abuse-related HIV infection. Little is known about how drug treatment programs reduce substance abuse-related HIV infection.

6. Objectives To describe: 1.Characteristics of the substance abuse treatment programs 2.Characteristics of the patients served 3.Range of HIV-related services offered: All patients New admissions HIV+ patients

7. Methods Study Design Cross sectional survey Descriptive exploratory Study Population Administrators at substance abuse treatment programs within the NIDA Clinical Trials Network

8. Methods Data Source: Survey instrument Approved waiver of informed consent by Institutional Review Boards with jurisdiction over the participating treatment programs.

9. The Survey Consisted of 112 questions divided into 8 sections: 1.Structure and Service Setting (6) 2.Patient Characteristics (3) 3.Staff Characteristics (10) 4.Reimbursement Issues (24) 5.Practices (30) 6.Program Guidelines (8) 7.Barriers (27) 8.Opinions (4)

10. …more on the survey Drug treatment program administrators were advised to describe: Main clinical setting Types of addiction services Types of HIV-related services They also were asked about: Estimated HIV infection prevalence Risk behaviors

11. Results The data derives from surveys submitted by administrators from 269 (84%) of 319 treatment programs within the CTN located in 26 states & DC No portion of the country or the CTN was over-represented among the 50 non- responding programs

12. About the treatment programs Approximately 80% of the treatment programs were private not-for-profit agencies The program types were: 61%: free-standing facilities 14%: hospitals, medical schools or universities 13%: co-located in mental health, family health or child health centers 12%: other types of healthcare facilities

13. …more about the treatment programs Most treatment programs offered two or more addiction treatment services 88% offered outreach and support services 80% had other outpatient services: detox, intensive outpatient, housing or aftercare 55% offered inpatient detox or residential services 37% provided outpatient pharmacotherapy services, such as methadone

14. HIV-Related Treatment Services at Substance Abuse Treatment Programs

16. Mean Number of HIV-Related Treatment Services By Program and Patient Characteristics of Substance Abuse Treatment Programs

18. ...And… THERE IS MORE DATA

19. Discussion The results of this study provide a plausible mechanism of how substance abuse treatment reduces HIV transmission via the availability of: HIV-related prevention services HIV-related medical services This provides the basis for: future hypothesis-testing health service studies examining the utilization, effectiveness, and cost-effectiveness of HIV-related health services provided by substance abuse treatment programs

20. This investigation highlighted four major findings: Rates for HIV-related education, behavioral risk assessment and HIV testing are lower than authoritative guidelines Hospital and university-based programs offered the most services HIV-related services are higher in programs with higher HIV infection and risk behavior rates A previous publication from this study showed that greater service availability can be achieved by drafting state guidelines and providing information on funding sources directly to the programs Discussion

21. Limitations This investigation did not include information about the costs, effectiveness or utilization of HIV-related services or patient satisfaction It did not include data validating the information provided by treatment program administrators Lack of random selection may impact generalizablility of the findings

22. Conclusions Given the public health significance of HIV disease and the role of substance use in its transmission, further studies to examine the reasons for the wide variability of HIV-related service availability are warranted

23. Acknowledgements Research supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreement with the NIDA CTN (2U10DA013046). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NIDA CTN Other protocol team members are: Randy Seewald MD, Frank McCorry PhD, Dennis McCarty PhD, Donald Calsyn PhD, Leonard Handelsman MD, Steven Kipnis MD, Al Hasson MSW, Karen Reese CAC-AD, Sherryl Baker PhD, Cheryl Smith PhD, Shirley Irons, Kathlene Tracy PhD, Pat McAuliffe MBA, LADC