A dozen addiction treatment centers that belong to the National Drug Abuse Treatment Clinical Trials Network have confirmed that patients are substantially more likely to receive an HIV test if it is offered at the treatment facility as opposed to being made available through a referral elsewhere.
And while some financial and logistical barriers persist in a drug treatment community where fewer than half of programs routinely offer on-site HIV testing, the results recently seen among a cross-section of providers offer hope that HIV testing can be effectively implemented as part of addiction treatment services.
A study published online ahead of print this month in the American Journal of Public Health found that around 80% of members of two patient groups that were offered on-site HIV tests actually were tested and received their results, compared with only 18.4% of a group that was referred off-site for testing.
The study also looked at whether a brief counseling session for patients on risk reduction strategies regarding sexual and substance-using behaviors would result in fewer incidences of unprotected sex over a six-month follow-up period. Researchers led by Lisa R. Metsch, PhD, of the University of Miami Miller School of Medicine, found no association between receiving the counseling and engaging in fewer risky sexual practices.
But Metsch emphasizes that this result should not be interpreted as a rejection of the potential value of risk reduction counseling. “In two other Clinical Trials Network studies that emphasized group-level interventions, counseling that involved five sessions was shown to be more effective,” she says. “We’re not making an overall statement about counseling here.”
The Centers for Disease Control and Prevention in 2006 fueled interest in the availability of HIV testing when it issued guidelines that encouraged all healthcare settings to offer HIV testing routinely. About one-fifth of the estimated 1 million-plus individuals in the U.S. who are HIV-positive do not know of their status, and the addiction treatment community is well aware of the risks this presents both to these individuals and others they encounter in their lives.
Metsch says that most of the sites in the study now are working toward making HIV testing a permanent component of their services (the sites include residential, outpatient and methadone maintenance programs). A great deal depends on securing funding, although she says the test kits have become less expensive and some states offer funding assistance through their health departments.
The Addiction Technology Transfer Center (ATTC) Network has released a video and fact sheet to encourage substance use treatment programs to initiate HIV testing. For more information, visit www.attcnetwork.org/explore/priorityareas/science/blendinginitiative/index.asp and click on “HIV Rapid Testing.”
In the Clinical Trials Network study, the individuals who were offered on-site testing were in one of two groups: a group that also received risk reduction counseling along with the testing and a group that received testing information only. The percentage of individuals who were tested and received results was actually higher in the information-only group than in the counseling group (84.8% vs. 79.7%). There was no significant difference between these two groups in unprotected sex, as well as no significant difference in unprotected sex between these groups and the group that was referred for HIV testing.
The testing plus counseling group did show more discontinuation of needle-sharing behaviors in the follow-up period, but this was considered a secondary outcome in this study. The researchers said this topic needs to be examined further in future studies.
Both the HIV tests and the counseling sessions were administered by addiction counselors at the treatment sites.