Addiction Health Services Research Conference Lexington, KY Louise Haynes, MSW

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

2. “The Bridge”NIDA Clinical Trials Network2000-2010

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 • Clinical trial: enrollment Jan-May 2009 • Pilot (detox program): Sept 2009-March 2010 • Full implementation (detox and outpatient): ongoing

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

9. Phase 2Pilot in Detox • Agency decision to implement HIV testing and counseling • Transition from research to practice • Adaptation of procedures: approach, finger stick, timing of counseling • 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 2Lessons Learned • Acceptability of testing without compensation • Acceptability of finger stick • Adaptation of research procedures

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

14. Phase 3Lesson 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