Drug Abuse Treatment Clinical Trials Network --- Then

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1 L.S. Brown, MD, MPH; S. Kritz, MD; E. Bini, MD, MPH; J. Robinson, MEd, D. Alderson, MS; J. Rotrosen, MD and the NIDA Clinical Trials Network Infections and Substance Abuse Study (CTN-0012) Team Addiction Research & Treatment Corp, Brooklyn, NY; NYU School of Medicine and VA Hospital, NY, NY; Nathan Kline Institute, Orangeburg, NY; and NYS Psychiatric Institute, NY, NY

2 Drug Abuse Treatment Clinical Trials Network --- Then 17 Nodes with 116 Community Treatment Agencies Reaching into 26 States! Seattle Portland San Francisco (CA/AZ Node) Denver Detroit Cincinnati New York City Boston New Haven Long Island Philadelphia Baltimore/Richmond Los Angeles Albuquerque Raleigh/ Durham Charleston Miami CTN Study Sites

3 Acknowledgements Research Supported by the National Institute on Drug Abuse (NIDA) as part of a Cooperative Agreement (1U10DA013046) with the NIDA Clinical Trial Network There are no financial interests or disclosures to report for any authors involved in this project

4 Acknowledgements Patients and staff of the Addiction Research and Treatment Corporation, a communitybased substance abuse service agency

5 Did You Know This paper is 1 of 8 papers from the CTN-0012 study that has been published in a peer-reviewed journal. Skritz@ARTCNY.org To date, the infections and substance abuse study (NIDA CTN-0012) represents the only CTN study led by a LI (Dr. Brown), study site (ARTC) and institutional review board (ARTC IRB) not based in an academic medical center. One of only two health services research networkwide studies conducted by the CTN.

6 The Brown Principle Remember the three Rs What Motivates Providers/Clinicians are the four Rs Regulation Reimbursement Risk Management Reinforcement

7 Bottom line. These health services serve as another mechanism explaining the infection-related benefits of substance abuse treatment Despite barriers, treatment programs provide access to infection-related health services; more so in treatment programs with addiction services designed for women and minorities Removing these barriers may enhance the availability of infection-related health services especially important in treatment programs serving populations sustaining a greater burden of the consequences associated with these infections

8 Rationale: This Report HIV/HCV/STI: major causes of excess morbidity and mortality in the US Substance use: a major vehicle for the transmission of infection Women and Minorities: over-represented in the consequences of substance use and these infections.

9 Objectives: This Report To Describe: Range of Infection-Related Services Available Treatment Program Characteristics Patient Characteristics Perceived Barriers to Providing Infection-Related Services To Examine Associations Between: Availability of Addiction Services Targeted for Women or Minorities and: Treatment Program and Patient Characteristics Availability of Infection-Related Services Perceived Barriers to Providing Infection-Related Services

10 Study Population 319 treatment program administrators from 116 agencies in NIDA CTN 269 programs (84%) returned Ethical regulatory Expedited IRB Review Waiver of Informed Consent

11 Study Design Descriptive & Observational Cross-Sectional Survey (selected Items) Treatment Program & Patient Characteristics Availability of 7 Infection-related Services: Education, Risk Assessment, Counseling, Medical History & Physical Exam, Biological Testing, Medical Treatment, Medical Monitoring For 3 Infections: HIV, HCV, STI 8 Perceived Barriers to Providing Infection-Related Services: government regulations, treatment program policies, staff training, funding, patient health insurance, patient acceptance, staff acceptance, or other

12 Statistical Analysis Summary of Number (proportion) of respondents providing various answers Cross-tabulations of Availability of Addiction Services for Women or a Minority Population Group and: Treatment Program & Patient Characteristics Availability of 7 Infection-related Services for each of 3 Infections Perceived Barriers to Providing the Infection-related Services Chi-square (Fisher s Exact) Test with Odds ratios and 95% Confidence Intervals

13 Substance Abuse Treatment Programs (N=269) Offering Addiction Services For Various Populations Population Percent of Programs with Tailored Services Women 73.9 African Americans 37.5 Latinos 43.3 American Indian/Alaskan Native 19.4 Asian 18.6 Hawaiian/Pacific Islander 15.7 No Women or Special Population 20.1 At Least One Special Population Group 79.9 One Special Population Group Special Population Groups or More Special Population Groups 20.1

14 Availability of Addiction Services Targeted for Women or Minorities and: Treatment Program and Patient Characteristics

15 Results: Treatment Program Characteristics 79% of Treatment Programs were not-for-profit; 6% for profit; 13% governmental Almost 80% of Treatment Programs had addiction services tailored to women or one minority population group Treatment Programs with addiction services tailored to women or one minority population group were more likely to provide: Outpatient addiction services (86% versus 57%, p<0.001) Support services (92% versus 70%, p=0.01)

16 Availability of Addiction Services Targeted for Women or Minorities and: Availability of Infection-Related Services

17 Percent of Treatment Programs Providing HIV-Related Health Services With and Without Addiction Services Designed For: TYPES OF HEALTH SERVICES WOMEN AFRICAN AMERICANS LATINO AMERICANS AMERICAN INDIANS/ ALASKAN NATIVES ASIANS HAWAIIANS/ PACIFIC ISLANDERS With Without With Without With Without With Without With Without With Without n=190 n=79 n=91 n=171 n=106 n=163 n=46 n=223 n=44 n=225 n=37 n=232 Education 92% 85% 95% 88% 94% 89% 95% 91% 98% 90% 95% 90% Risk Assessment 90% 85% 92% 88% 91% 88% 95% 88% 93% 88% 92% 89% Counseling 75% 64% 86% 64%* 82% 66%* 84% 70% 82% 71% 81% 70% Medical History & Physical Exam Biological Testing Medical Treatment Medical Monitoring 62% 57% 72% 55%* 66% 57% 65% 61% 60% 61% 61% 61% 54% 51% 60% 48% 57% 50% 52% 53% 45% 54% 47% 54% 45% 33% 64% 30%# 58% 33%# 56% 40% 56% 40% 53% 41% 53% 37% 67% 38%# 63% 39%# 60% 47% 58% 47% 60% 47% * p<0.05; # p<0.001

18 Percent of Treatment Programs Providing HCV-Related Health Services With and Without Addiction Services Designed For: TYPES OF HEALTH SERVICES WOMEN AFRICAN AMERICANS LATINO AMERICANS AMERICAN INDIANS/ ALASKAN NATIVES ASIANS HAWAIIANS/ PACIFIC ISLANDERS With Without With Without With Without With Without With Without With Without n=190 n=79 n=91 n=171 n=106 n=163 n=46 n=223 n=44 n=225 n=37 n=232 Education 82% 74% 84% 78% 81% 79% 89% 79% 86% 79% 83% 79% Risk Assessment 81% 66%* 82% 75% 81% 75% 86% 76% 84% 76% 78% 77% Counseling 66% 56% 76% 56%# 70% 58% 77% 60%* 74% 61% 69% 62% Medical History & Physical Exam Biological Testing Medical Treatment Medical Monitoring 55% 49% 65% 47%# 59% 48% 63% 52% 58% 53% 58% 53% 37% 38% 49% 30%# 43% 33% 48% 35% 37% 37% 36% 37% 32% 28% 51% 21%# 42% 23%# 48% 28%* 47% 28%* 44% 29% 39% 34% 56% 29%# 49% 31%* 57% 35%* 51% 36% 47% 37% * p<0.05; # p<0.001

19 Percent of Treatment Programs Providing STI-Related Health Services With and Without Addiction Services Designed For: TYPES OF HEALTH SERVICES WOMEN AFRICAN AMERICANS LATINO AMERICANS AMERICAN INDIANS/ ALASKAN NATIVES ASIANS HAWAIIANS/ PACIFIC ISLANDERS With Without With Without With Without With Without With Without With Without n=190 n=79 n=91 n=171 n=106 n=163 n=46 n=223 n=44 n=225 n=37 n=232 Education 82% 76% 89% 77%* 87% 76%* 87% 81% 84% 81% 86% 81% Risk Assessment 79% 71% 86% 73%* 83% 74% 84% 77% 86% 77% 84% 77% Counseling 66% 60% 81% 54%# 73% 57%* 76% 61% 79% 61%* 72% 63% Medical History & Physical Exam Biological Testing Medical Treatment Medical Monitoring 54% 48% 65% 44%# 59% 47% 56% 52% 55% 52% 51% 52% 44% 39% 56% 35%# 48% 39% 50% 42% 55% 40% 41% 43% 38% 29% 57% 24%# 49% 28%# 53% 33% 55% 32%* 49% 34% 44% 36% 63% 31%# 55% 33%# 58% 39% 58% 39%* 56% 40% * p<0.05; # p<0.001

20 Results: Infection-Related Health Services Non-medical services were provided more frequently than medical services Treatment Programs with addiction services tailored to women or one minority population group were more likely to provide: HIV-related patient education (94% versus 85%, p=0.05) HIV-related counseling (76% versus 60%, p=0.03) Treatment Programs with addiction services tailored to women were more likely to provide: HIV-related medical monitoring (53% versus 37%, p=0.03); odds ratio: 1.93 (95% CI: ) HCV-related risk assessment (81% versus 66%, p=0.01); odds ratio: 2.23 (95% CI: )

21 Results: Infection-Related Health Services (Cont d) Of the 21 infection-related health services (7 services x 3 infections): 16 of 21 were more available in treatment programs with addiction services designed for African Americans 9 of 21 were more available in treatment programs with addiction services designed for Latino Americans 5 of 21 were more available in treatment programs with addiction services designed for American Indians/Alaskan Natives 4 of 21 were more available in treatment programs with addiction services designed for Asian Americans

22 Availability of Addiction Services Targeted for Women or Minorities and: Perceived Barriers to Providing Infection- Related Services

23 RESULTS: Barriers to Providing Infection-Related Health Services In Treatment Programs with addiction services designed for special populations: Funding was the most cited barrier; especially for medical services as compared to non-medical services Health Insurance was the 2nd most cited barrier: For 19 of 21 infection services in programs designed for women For all infection services in programs designed for African Americans For 16 of 21 infection services in programs designed for Latino Americans For 10 of 21 infection services in programs designed for American Indians/Native Alaskans For 5 of 21 infection services in programs designed for Asians For 6 of 21 infection services in programs designed for Hawaiians/Pacific Islanders

24 Results: Barriers to Providing Infection- Related Health Services (Cont d) In Treatment Programs with addiction services designed for special populations: Patient Acceptance was the 3rd most cited barrier: For 11 of 21 infection services in programs designed for American Indians/Native Alaskans For 16 of 21 infection services in programs designed for Asians For 15 of 21 infection services in programs designed for Hawaiians/Pacific Islanders

25 Limitations Self-reporting of study population may be biased Generalizability of results No information about utilization, costs, efficiency, or effectiveness

26 Conclusions Nearly 80% of treatment programs provide addiction services designed for at least one special population Treatment programs offer an array of infectionrelated health services Infection-related health services were more available in treatment programs with minoritytailored addiction services Funding, patient health insurance, and patient acceptance were the most cited barriers

27 Conclusions Implications are: These health services serve as another mechanism explaining the infection-related benefits of substance abuse treatment Despite barriers, treatment programs provide access to infectionrelated health services, more so in treatment programs with addiction services designed for women and minorities Removing these barriers may enhance the availability of infection-related health services especially important in treatment programs serving populations sustaining a greater burden of the consequences associated with these infections

28 Acknowledgements The over 3,000 Patients and 275 staff of the Addiction Research and Treatment Corporation, a community-based substance abuse treatment agency with a legacy of patient-centered care for over 43 years

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