1. Addiction Health Services Research Conference Lexington, KY Louise Haynes, MSW Adoption of HIV Counseling and Testing Following Completion of Randomized Clinical Trial

2. “The Bridge” NIDA Clinical Trials Network 2000-2010

3. Background  Less than half of community substance abuse treatment programs offer HIV testing  NIDA Clinical Trials Network recently completed a trial (CTN0032) comparing strategies for providing testing in community substance abuse treatment programs  Report of the experience of one community treatment program that implemented on-site HIV rapid testing following completion of NIDA clinical trial.  Focus on lessons learned

4. Community Programs: Challenges to Conducting HIV Research and Implementing HIV Services  Culture change  Particularly for psychosocial rehab programs (often 12 Step focused) - little past experience in HIV services  Psychosocial rehab programs less likely to have medical staff  Specialty clinics staffed by counselors without specific training in HIV risk reduction strategies. Counselor discomfort with discussion of sexual issues with clients

5. The Setting  Lexington Richland Alcohol and Drug Abuse Council, Columbia South Carolina  Large publicly-funded, not-for-profit agency  Residential, outpatient, medical detox, DUI, prevention services  Prior to clinical trial, not offering HIV testing  Despite SAMHSA initiative SC struggled to bring HIV testing into substance abuse treatment programs

6. 3 Phases of Implementation: Lessons learned in each phase of implementation 1. Clinical trial: enrollment Jan-May 2009 2. Pilot (detox program): Sept 2009-March 2010 3. Full implementation (detox and outpatient): ongoing

7. Phase 1 CTN 0032  Outpatient settings  Oral swab  RESPECT2 counseling  LRADAC enrolled 115 participants between Jan and May 2009  Follow-up at 1 and 6 months

8. Phase 1 Lessons Learned  Acceptability of testing  Value of integrating research practices with established patient flow in agency  Value of specialty counselors to provide testing

9. Phase 2 Pilot in Detox  Agency decision to implement HIV testing and counseling  Transition from research to practice 1. Adaptation of procedures: approach, finger stick, timing of counseling 2. Training of staff  Support of agency management  Support by research infrastructure  Buy-in of front line staff

10. Pilot (Phase 2) September 2009 through April 2010  183 patients tested  62% acceptance rate  Most common reason for refusal: recently tested

11. Phase 2 Lessons Learned  Acceptability of testing without compensation  Acceptability of finger stick  Adaptation of research procedures

12. Phase 3 Full Implementation  Increased complexity of implementation  Testing offered in detox and outpatient  Decrease in availability of research staff for testing  Need for new source of funding  Health Department grant received  Train additional staff

13. Phase 3 May to Sept 2010  Detox: 52% accepted 52% accepted  Outpatient: 18% accepted 18% accepted  Total patients tested in Phase 3 (full implementation): 191

14. Phase 3 Lesson Learned  Need for program specific strategy  Need for Quality Assurance  Need for clear chain of command  Need for stable, adequate funding  Training could be streamlined

15. Summary  Phase 1: randomized clinical trial, enrolled 115, two arms offered on-site testing, one arm TAU  Phase 2: pilot in detox, 62% acceptance, 183 tested  Phase 3: full implementation, detox and outpatient, 52% acceptance in detox, 18% in outpatient, 191 tested  Post RCT – 374 patients tested on site in 12 month period  Pre RCT – 0 patients tested on site

16. Summary CLINICAL Implementation of HIV Risk Reduction Intervention  Process of change and acceptance - Agency participated in multiple HIV risk reduction trials  RCT implementation was successful  Integrated into routine clinic practices  Philosophical changes  Acceptability to clients  Leadership support  Incentive to agency: peer recognition, financial support  Champion

17. Participation in a clinical trial gives a community treatment program:  valuable experience in conducting HIV rapid tests  using an HIV risk reduction intervention  addresses one of the challenges to implementation

18. State Wide Implementation  SC has a network of 33 substance abuse treatment providers, contract with single state authority for block grant funds  Since 2006, Goal of state-wide implementation of HIV testing  Funding available, but little implementation  State Health Department had little knowledge of SA treatment programs. Complex training requirements.  Following clinical trial, LRADAC recognized for having experience and knowledge to promote implementation  Course developed for counselor certification in HIV testing and counseling, offered at SC School of Alcohol and Drug Studies at Furman University

19. For more information contact:  Louise Haynes: hayneslf@musc.edu

20. Thanks  LRADAC – Beverly Holmes, Study Coordinator; Leslie Wilson, Debbie Francis  Lisa Metsch, Lauren Gooden, lead team of CTN0032  Kathleen Brady, PI, Southern Consortium