1. Adoption of HIV Counseling and Testing Following Completion of Randomized Clinical Trial Louise Haynes 1, Beverly Holmes 2, Anna Amberg 2, Kathleen Brady 1, Lisa Metsch 3 1Psychiatry and Behavioral Sciences, Medical University of South Carolina, 2Lexington Richland Alcohol and Drug Abuse Council, 3 University of Miami Background CTN0032 Client Characteristics Conclusions Methods References State-Wide Expansion of Project 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 that participated in a randomized clinical trial (CTN 0032). The purpose of CTN 0032 was to evaluate different strategies to increase the acceptance of HIV testing and reduce HIV risk behaviors among patients in substance abuse treatment. 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. Study 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 - Used rapid test – 20 minutes for results - 3 arms: counseling and offer of testing, information and offer of testing, off-site referral - Which approach was more effective for getting tested and receiving results? - Ended 12-09 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;30:315-321. [doi: 1016/j.jsat.2006.02.006].Kritz, StGoldsmith, R. JBini, E J.Rotrosen, J Baker, SRobinson, JA.McAuliffe, P - 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, 2010 32% 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 Clinical Implementation (Pilot) 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 2009. Each new admission to detox was seen individually and offered 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 2010. -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 had little success -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 to be held at 2010 SC School of Alcohol and Drug Studies. DAODAS to offer scholarships to substance abuse providers. This two and a half day course will be used as model for on-going training initiative in state. -Goal is to establish testing programs in all of the 33 contract CTPs.