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Riano NS, Borowsky HM, Arnold EA, Olfson M, Walkup JT, Vittinghoff E, Cournos F, Dawson L, Bazazi AR, Crystal S, Mangurian C. HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification. Psychiatr Serv 2021; 72:1385-1391. [PMID: 34126780 PMCID: PMC8639611 DOI: 10.1176/appi.ps.202000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States. METHODS Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics. RESULTS Among U.S. substance use treatment facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. Across states, the proportions of facilities offering HIV testing ranged from 9.0% to 62.8%, and the proportion offering counseling ranged from 19.2% to 83.3%. In only three states was HIV testing offered by at least 50% of facilities. HIV testing was significantly more likely to be offered in facilities that offered medication for opioid use disorder (48.0% versus 16.0% in those not offering such medication) or mental health services (31.2% versus 24.1% in those not offering such services). Higher state-level HIV incidence was related to an increased proportion of facilities offering HIV testing. CONCLUSIONS Only three in 10 substance use treatment facilities offered HIV testing in 2018. This finding represents a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.
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Affiliation(s)
- Nicholas S Riano
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Hannah M Borowsky
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Emily A Arnold
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - James T Walkup
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Francine Cournos
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Lindsey Dawson
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Alexander R Bazazi
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences (Riano, Bazazi, Mangurian), School of Medicine (Borowsky, Arnold), Center for AIDS Prevention Studies (Arnold), and Department of Epidemiology and Biostatistics (Vittinghoff, Mangurian), University of California, San Francisco, San Francisco; New York State Psychiatric Institute, New York City (Olfson, Cournos); Department of Psychiatry, Vagelos College of Physicians and Surgeons (Olfson), and Mailman School of Public Health (Cournos), Columbia University, New York City; Institute for Health, Health Care Policy and Aging Research (Walkup) and Center for Health Services Research (Crystal), Rutgers University, New Brunswick, New Jersey; Kaiser Family Foundation, HIV Policy, Washington, D.C. (Dawson)
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Gooden L, Metsch LR, Pereyra MR, Malotte CK, Haynes LF, Douaihy A, Chally J, Mandler RN, Feaster DJ. Examining the Efficacy of HIV Risk-Reduction Counseling on the Sexual Risk Behaviors of a National Sample of Drug Abuse Treatment Clients: Analysis of Subgroups. AIDS Behav 2016; 20:1893-906. [PMID: 26837631 PMCID: PMC4970956 DOI: 10.1007/s10461-016-1300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV counseling with testing has been part of HIV prevention in the U.S. since the 1980s. Despite the long-standing history of HIV testing with prevention counseling, the CDC released HIV testing recommendations for health care settings contesting benefits of prevention counseling with testing in reducing sexual risk behaviors among HIV-negatives in 2006. Efficacy of brief HIV risk-reduction counseling (RRC) in decreasing sexual risk among subgroups of substance use treatment clients was examined using multi-site RCT data. Interaction tests between RRC and subgroups were performed; multivariable regression evaluated the relationship between RRC (with rapid testing) and sex risk. Subgroups were defined by demographics, risk type and level, attitudes/perceptions, and behavioral history. There was an effect (p < .0028) of counseling on number of sex partners among some subgroups. Certain subgroups may benefit from HIV RRC; this should be examined in studies with larger sample sizes, designed to assess the specific subgroup(s).
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Affiliation(s)
- Lauren Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Miami Research Center, Columbia University, 1120 NW 14th Street, Room 1030, Miami, FL, 33136, USA
| | - C Kevin Malotte
- Department of Health Science, California State University, Long Beach, CA, USA
| | - Louise F Haynes
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack Chally
- Johns Hopkins University, Baltimore, MD, USA
- EMMES Corporation, Inc., Rockville, MD, USA
| | - Raul N Mandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
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Edelman EJ, Chantarat T, Caffrey S, Chaudhry A, O’Connor P, Weiss L, Fiellin DA, Fiellin LE. The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients. Drug Alcohol Depend 2014; 139:79-85. [PMID: 24726429 PMCID: PMC4029496 DOI: 10.1016/j.drugalcdep.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown. METHODS We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using generalized estimating equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing. RESULTS Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p<0.001), while non-condom use did not (23% vs. 21%, p=0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use. CONCLUSIONS While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
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Affiliation(s)
- E. Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | | | - Sarah Caffrey
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Amina Chaudhry
- Chase Brexton Health Care, 1111 North Charles Street, Baltimore, MD 21201
| | - Patrick O’Connor
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Linda Weiss
- New York Academy of Medicine, 1216 5 Avenue, New York, NY 10029
| | - David A. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Lynn E. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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