1. Implementation Science Retreat March 1, 2013 Louise Haynes, MSW Leslie Wilson, MA Adoption of HIV Counseling and Testing Following Completion of Randomized Clinical Trial

2. The Bridge NIDA Clinical Trials Network 2000-2013The Bridge NIDA Clinical Trials Network 2000-2013

3. Substance Abuse and HIV Risk Substance abuse continues as a major factor in transmission of HIV/AIDS, via injection and sexual risk behavior Substance abuse continues as a major factor in transmission of HIV/AIDS, via injection and sexual risk behavior One out of five people infected with HIV is unaware of the infection One out of five people infected with HIV is unaware of the infection Encouraging people at risk to be tested is a main HIV prevention strategy in the USA Encouraging people at risk to be tested is a main HIV prevention strategy in the USA Less than half of community substance abuse treatment programs offer HIV testing Less than half of community substance abuse treatment programs offer HIV testing NIDA Clinical Trials Network completed a trial comparing strategies for providing testing in community substance abuse treatment programs NIDA Clinical Trials Network completed a trial comparing strategies for providing testing in community substance abuse treatment programs LRADAC, one of 12 community research sites, adopted a program of rapid testing following the trial LRADAC, one of 12 community research sites, adopted a program of rapid testing following the trial

4. The Setting Lexington Richland Alcohol and Drug Abuse Council in Columbia, South Carolina Lexington Richland Alcohol and Drug Abuse Council in Columbia, South Carolina Large publicly-funded, not-for-profit agency Large publicly-funded, not-for-profit agency Residential, outpatient, medical detox, DUI, prevention services Residential, outpatient, medical detox, DUI, prevention services Prior to clinical trial, not offering HIV testing Prior to clinical trial, not offering HIV testing Despite SAMHSA initiative SC struggled to bring HIV testing into substance abuse treatment programs Despite SAMHSA initiative SC struggled to bring HIV testing into substance abuse treatment programs Beginning in 2003, LRADAC successfully participated in multiple HIV risk reduction trials (gender specific groups for HIV risk reduction) Beginning in 2003, LRADAC successfully participated in multiple HIV risk reduction trials (gender specific groups for HIV risk reduction)

5. 3 Phases of Implementation of HIV Testing at LRADAC 3 Phases of Implementation of HIV Testing at LRADAC 1. Clinical trial: enrollment Jan-May 2009 2. Pilot (detox program): Sept 2009-March 2010 3. Full implementation (detox and outpatient): ongoing

6. Phase 1 Clinical Trial Enrolled 1281 participants from 12 outpatient sites across US Enrolled 1281 participants from 12 outpatient sites across US LRADAC enrolled 115 participants LRADAC enrolled 115 participants Eligible sites not currently offering on-site testing Eligible sites not currently offering on-site testing 3 arms: 3 arms: 1. Brief counseling plus rapid on-site testing 2. Information (without counseling) plus rapid on-site testing 3. Referral for off-site testing (TAU)

7. Phase 1 (Clinical Trial) Lessons Learned Acceptability of testing Acceptability of testing Value of integrating research practices with established patient flow in agency: routine part of intake Value of integrating research practices with established patient flow in agency: routine part of intake Value of specialty counselors to provide testing Value of specialty counselors to provide testing

8. Phase 2 Pilot in Detox Program 16 bed medical detox 16 bed medical detox Agency decision to implement HIV testing, management support Agency decision to implement HIV testing, management support Transition from research to practice Transition from research to practice 1. Adaptation of procedures: approach, finger stick 2. Training of staff Support by research infrastructure Support by research infrastructure Buy-in of front line staff Buy-in of front line staff

9. Pilot (detox) September 2009 through April 2010 183 patients tested 183 patients tested 62% acceptance rate 62% acceptance rate Most common reason for refusal: recently tested Most common reason for refusal: recently tested

10. Phase 2 Pilot Lessons Learned Acceptability of testing without compensation Acceptability of testing without compensation Acceptability of finger stick Acceptability of finger stick Research procedures could be adapted Research procedures could be adapted

11. Phase 3 Full Implementation April 2010 to present Testing offered in detox and outpatient Testing offered in detox and outpatient Need for new sources of funding Need for new sources of funding Health Department grant received Health Department grant received New SAMHSA grant New SAMHSA grant

12. Update from LRADAC and DAODAS About half of the state-funded alcohol and drug treatment programs receive designated funds to provide HIV testing FY11 – Total HIV Rapid Tests performed is 1253 with LRADAC reporting 487 of the total. FY12 – Total HIV Rapid Test performed is 2125 with LRADAC reporting 970 of the total.

13. Summary CLINICAL Implementation of HIV Risk Reduction Intervention HIV testing was integrated into routine clinic practices HIV testing was integrated into routine clinic practices Philosophical changes Philosophical changes Acceptability to clients Acceptability to clients Leadership support Leadership support Incentive to agency: peer recognition, financial support Incentive to agency: peer recognition, financial support Champion Champion

14. State Wide Implementation SC has a network of 33 substance abuse treatment providers, contract with single state authority for block grant funds 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 Since 2006, Goal of state-wide implementation of HIV testing Funding available, but little implementation Funding available, but little implementation State Health Department (DHEC) had complex training requirements, not specific for substance abuse clinicians State Health Department (DHEC) had complex training requirements, not specific for substance abuse clinicians Following clinical trial, LRADAC recognized for having experience and knowledge to promote implementation 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 Course developed for counselor certification in HIV testing and counseling, offered at SC School of Alcohol and Drug Studies at Furman University

15. Conclusion Conclusion Participation in a clinical trial gave LRADAC valuable experience in conducting HIV rapid tests and using an HIV risk reduction intervention; addressing one of the challenges to implementation Participation in a clinical trial gave LRADAC valuable experience in conducting HIV rapid tests and using an HIV risk reduction intervention; addressing one of the challenges to implementation Opportunities for collaboration with LRADAC, DAODAS or other alcohol and drug treatment programs Opportunities for collaboration with LRADAC, DAODAS or other alcohol and drug treatment programs

16. For more information contact: Louise Haynes: hayneslf@musc.edu Louise Haynes: hayneslf@musc.eduhayneslf@musc.edu Leslie Wilson: lhipp@lradac.org Leslie Wilson: lhipp@lradac.org