DMHAS Rapid HIV Testing Initiative Update: Benefits, Data, and Funding

1. The Division of Mental Health and Addiction Services (DMHAS) Rapid HIV Testing Initiative Update July 25, 2013

2. HIV/AIDS Update • 36,648 people were reported to be living with HIV or AIDS in New Jersey as of December 31, 2012 • Injection Drug Use (IDU) and sexual contact remain the major modes of exposure to HIV infection • The proportion of reported cases with HIV/AIDS who were exposed through IDU is lower than in the past, while the proportion of cases that were exposed through sexual contact is increasing

3. HIV/AIDS Update (cont’d) • Seventy-nine percent of persons living with HIV/AIDS are 40 years of age or older • Thirty-four percent of those living with HIV/AIDS are females • Fifty-three percent of females living with HIV are currently between the ages of 20-49

4. National HIV and Substance Abuse Data for 2009 • According to the National Survey of Substance Abuse Treatment Services (N-SSATS) • Slightly more than half (55%) of all substance abuse treatment facilities reported providing HIV/AIDS education and counseling to their clients • 28% of substance abuse treatment facilities provided on-site HIV testing • 9% provided specialized programs or groups for individuals living with HIV

5. Benefits of HIV Testing in Substance Abuse Treatment Programs • Counseling and testing strategies reduce high-risk behavior • Reduces transmission of HIV to others, including perinatal transmission • Improves client survival and life expectancy: Linkage to care and treatment • Disease progression is slowed with early intervention

6. DMHAS Funding for HIV-Related Services • DMHAS spends 5% of its State Set-Aside Block Grant (Federal funding) on HIV-Related Services • DMHAS contracts for Early Intervention Services (EIS) at five (5) substance abuse treatment agencies and funds HIV Case Management positions at fourteen (14) agencies • Obligates funds through a Memorandum of Agreement (MOA) with RWJ Medical School to implement rapid HIV testing technology at licensed substance abuse treatment agencies • Obligates a small portion of funds through a MOA with the Public Health and Information Environmental Laboratory (PHILEP) ensuring a provision of testing and diagnostic support services for DAS licensed treatment agencies

7. MOA for Rapid HIV Testing • Robert Wood Johnson Key Responsibilities • Provides administrative services to include consultation and lab oversight to ensure rapid HIV testing for clients in State licensed substance use disorder treatment programs • Ensures personnel training programs are in place so that personnel conducting rapid HIV tests are trained in appropriate testing procedures • Provides technical assistance to DMHAS agencies to ensure clients are offered testing at admission and again thereafter every six months (for those individuals who test negative) • Assumes role of inventory manager purchasing all test kits, controls and other bulk laboratory supplies • Collects data and maintains reporting systems for all sites for the purpose of facilitating monthly reporting to DMHAS

8. Substance Abuse Treatment Programs Approved for Rapid HIV Testing • Any NJ State licensed Opioid Treatment Program (OTP) • HIV-funded Substance Abuse and Mental Health Services Administration (SAMHSA) grantees • Programs in cities where a current Syringe Access Program (SAP) is located • Atlantic City • Camden • Jersey City • Newark • Paterson • Any licensed substance abuse treatment program that is within one of the four top “Impact Counties” for People Living with HIV/AIDS (PLWHA) • Essex • Hudson • Union • Passaic

9. DMHAS Federal Block Grant Report • Number of individuals tested for HIV • Number of HIV tests conducted • Number of tests that were positive for HIV • Number of individuals who prior to the 12-month reporting data were unaware of their HIV infection • Number of HIV-infected individuals who were diagnosed and referred into treatment and care during the 12-month period

10. DMHAS Rapid HIV Testing Annual Totals

12. NJ Substance Abuse Treatment Program Survey • Objective • To examine current HIV testing practices • Identify barriers to implementing rapid HIV testing • Methods • Survey Monkey link sent to 205 licensed substance abuse treatment agencies in December 2011

13. Results for 19 sites that receive tests from DMHAS • Report 50% or more of their current clients have been HIV-tested • 52.6% of programs • 44% of programs take “opt-out” approach for testing clients • Most common barriers to HIV testing: • Client disinterest (32%) • HIV related stigma (26%) • Inadequate staffing (21%) • Staff or employee work load (16%) • Phlebotomy not available (16%)

14. Results for 19 sites that receive tests from DMHAS • Reasons clients refuse testing • Percent of licensed sites that report clients frequently or always refuse for the following reason: • Clientalready knows status (47%) • Client doesn’t believe he/she is at risk (32%) • Nota priority to client (16%) • Client doesn’t want to know his/her HIV status (16%) • Fear(37%) • Clientwants to get tested elsewhere (5%)

15. Next Steps: Future Planning to Increase HIV Testing • License new DMHAS sites • Launch Statewide mobile HIV testing pilot • Increase training/education for counselors, nurses and other agency staff • Motivational Interviewing (MI)