Raising the Living and Affected

Increasing HIV Testing, Including Rapid Testing, in Substance Abuse Treatment Programs

By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

Although the U.S. has made progress in reducing the number of new HIV infections among injection drug users and their sexual partners, CDC estimates that injection drug users represented 9% of new HIV infections in 2009 and 17% of those living with HIV in 2008. Since the U.S. HIV/AIDS epidemic began, more than 175,000 injection drug users with AIDS have died, including an estimated 4,759 in 2009.
With one in five of the estimated 1.2 million individuals in the U.S. who are HIV-positive unaware of their infection, and the majority of new HIV infections transmitted by these individuals, it is imperative that we enhance efforts to make HIV screening—and linkage to care for those found to be infected—more readily available, particularly among the most affected subpopulations.. According to the CDC, in 2009, an estimated 4,172 diagnosed HIV infections were attributed to injection drug use (IDU) (.ppt) in the 40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting since at least January 2006. Approximately 52% of IDUs living with a diagnosis of HIV infection at the end of 2008 were black/African American and 27% were Hispanic/Latino.
By offering HIV testing, including rapid HIV testing, to patients in substance abuse treatment programs, providers can help more individuals to become aware of their infection and seek care and treatment to protect their health and reduce their potential of transmitting the virus to others. The National HIV/AIDS Strategy (NHAS) recommends coupling HIV screening with substance abuse treatment programs as a key action step in our Nation’s overall efforts to prevent the spread of HIV in communities where it is most heavily concentrated. Advances in rapid HIV testing technology allow for HIV testing to be offered in a wider variety of settings, including substance abuse treatment programs. Several recent Federal activities are lending support to the implementation of such efforts.
NIDA Study Finds Onsite Rapid HIV Testing Works in Treatment Programs
First, a recent study from the National Institute on Drug Abuse (NIDA) demonstrated the value of on-site rapid HIV testing in drug treatment centers. Conducted by the NIDA Clinical Trials Network, the multisite HIV Rapid Testing and Counseling Study showed that offering onsite rapid testing in substance abuse treatment programs substantially increased testing rates and receipt of HIV test results. Onsite testing was found to be more effective than referrals for offsite testing—more than 80% of those tested onsite received their test results, as compared with only 18% who followed through when referred to another site for testing. A related study also showed that rapid testing can be implemented for less than $40 per test and is cost-effective.
The co-lead investigator, along with Lisa Metsch, Ph.D., of the University of Miami Miller School of Medicine, was Grant Colfax, MD, formerly the Director of the HIV Prevention Section in the San Francisco Department of Public Health and now the Director of the White House’s Office of National AIDS Policy.
NIDA and SAMHSA Partner to Promote Rapid HIV Testing in Treatment Programs
NIDA and the Substance Abuse Mental Health Services Administration’s (SAMHSA) Addiction Technology Transfer Center Network have partnered to create the “Blending Initiative,” a program to help move findings from drug abuse research into practice in front-line clinical settings. The Initiative has produced several user-friendly tools and products on the importance of onsite rapid HIV testing in substance abuse treatment programs. These products can be found on the Blending Initiative’s HIV Testing in Substance Abuse Treatment Programs website and include:

• Video interviews with researchers, treatment providers, and others about the value of onsite rapid HIV testing.
• A fact sheet that details the urgent need to provide HIV testing for people in substance abuse treatment programs due to high HIV prevalence among that population and information about findings from NIDA’s HIV Rapid Testing and Counseling Study.
• A resource guide with links implementation guidelines, funding information, and other testing resources.

SAMHSA Strengthens Efforts to Integrate Rapid HIV Testing in Substance Abuse Treatment
To complement and extend these efforts still further, in December 2011 SAMHSA published Rapid HIV Testing in Substance Abuse Treatment Facilities and disseminated it to its grantees, technical assistance providers, and others in the field of substance use disorders. The resource contains information about the benefits of and requirements for incorporating rapid HIV testing into substance use disorder treatment programs. Through its Minority AIDS Initiative Targeted Capacity Expansion: Integrated Behavioral Health/Primary Care Network Program SAMHSA awarded $14.2 million in new grants at the end of Fiscal Year 2011 to support behavioral health services in communities most impacted by HIV/AIDS. Funds awarded under these agreements can be used to support HIV testing, including rapid testing, and counseling located onsite at mental health and substance abuse community-based organizations.
I encourage readers to access these valuable resources and to learn more about how to connect people in substance abuse treatment programs to the vital care they need, including screening and treatment for HIV infection. If you currently provide HIV testing, consider sharing these resources with partners, or potential partners, who provide substance abuse treatment in your community to help them start or scale up their HIV testing activities.