Clinicians Involved in Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infection, and Sexually Transmitted Infections in Substance Abuse Treatment Programs: the National Drug Abuse Treatment Clinical Trials Network - PowerPoint PPT Presentation

About This Presentation
Title:

Clinicians Involved in Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infection, and Sexually Transmitted Infections in Substance Abuse Treatment Programs: the National Drug Abuse Treatment Clinical Trials Network

Description:

Randy Seewald, MD; Cheryl Smith, MD; Frank McCorry, PhD; ... Mid-Atlantic Node: Johns Hopkins Univ., Baltimore, MD; Medical College. of Virginia, Richmond ... – PowerPoint PPT presentation

Number of Views:48
Avg rating:3.0/5.0

less

Transcript and Presenter's Notes

Title: Clinicians Involved in Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infection, and Sexually Transmitted Infections in Substance Abuse Treatment Programs: the National Drug Abuse Treatment Clinical Trials Network


1
Clinicians Involved in Screening, Evaluation, and
Treatment of HIV/AIDS, Hepatitis C Viral
Infection, and Sexually Transmitted Infections in
Substance Abuse Treatment Programs the National
Drug Abuse Treatment Clinical Trials Network
  • L.S. Brown, MD, MPH S. Kritz, MD J. Rotrosen,
    MD R.J. Goldsmith, MD E. Bini, MD,
    MPH J. Robinson, MEd, and the NIDA Clinical
    Trials Network Infections Study (CTN-0012) Team
  • Poster Presentation at the Annual Meeting of the
    American Society on Addiction Medicine, San
    Diego, CA May 5, 2006

2
ABSTRACT
In the US, users of illicit drugs will largely
sustain the epidemics of HIV/AIDS, hepatitis C
(HCV), and sexually transmitted infections (STI).
Substance abuse treatment programs can play a
major role in stemming these epidemics. A
nationwide study, sponsored by the National Drug
Abuse Treatment Clinical Trials Network (NIDA
CTN) examines these three infection groups from
the perspective of administrators and clinicians
working in substance abuse treatment programs,
and the states within which they are located.
The NIDA CTN has over 100 Community Treatment
Programs (CTPs) with over 300 discreet substance
abuse treatment sites in 17 nodes across the US.
Three surveys were developed one each for
substance abuse treatment program administrators
and clinicians, and one for state health and
substance abuse department administrators. This
report examines HIV/AIDS, HCV, and STI-related
services provided by substance abuse treatment
programs in the NIDA CTN from the perspective of
the clinicians, medical and non-medical, expert
and non-expert, working in these programs. The
clinician survey looked at practices, program
guidelines, knowledge, barriers, and opinions of
clinicians caring for substance abusers within
their program. Completed surveys were obtained
from 1719 of 2207 targeted clinicians working at
265 substance abuse treatment sites. The
breakdown of completed surveys was (1) medical
expert 251 (2) medical non-expert 115 (3)
non-medical expert 522 and (4) non-medical
non-expert 831. The extensive data obtained
from this group of clinicians will be presented
to inform public policy to encourage best
practices in treating these epidemic infections.

3
ACKNOWLEDGEMENTS
  • Research Supported by National Institute on Drug
    Abuse (NIDA) as part of a Cooperative Agreement
    (1U10DA013046) with the NIDA CTN and other
    Protocol Team members consisting of
  • Randy Seewald, MD Cheryl Smith, MD Frank
    McCorry, PhD Dennis McCarty, PhD Donald Calsyn,
    PhD Leonard Handelsman, MD Steve Kipnis, MD
  • Patrick McAuliffe, MBA, LADC Al Hassen, MSW
    Karen Reese, CAC-AD Sherryl Baker, PhD
  • Shirley Irons Kathlene Tracy, PhD

4
17 Nodes with 116 Community Treatment Agencies
Reaching into 26 States!
Drug Abuse Treatment Clinical Trials Network
Seattle
Portland
New York City
Detroit
Boston
New Haven
Denver
Long Island
Philadelphia
Cincinnati
San Francisco (CA/AZ Node)
Baltimore/Richmond
Raleigh/ Durham
Albuquerque
Los Angeles
Charleston
Miami
CTN Sites
5
STUDY SITES
  • New York Node New York University, New York, NY
  • South Carolina Node Medical University of South
    Carolina, Charleston, SC
  • Florida Node University of Miami, Coral Gables,
    FL
  • Great Lakes Node Wayne State University,
    Detroit, MI
  • Ohio Valley Node University of Cincinnati,
    Cincinnati, OH
  • Rocky Mountain Node University of CO Health
    Sciences Center, Denver, CO
  • New England Node Yale University, New Haven, CT
  • Delaware Valley Node University of Pennsylvania,
    Philadelphia, PA
  • Mid-Atlantic Node Johns Hopkins Univ.,
    Baltimore, MD Medical College
  • of
    Virginia, Richmond
  • Pacific Region Node University of California at
    Los Angeles, CA
  • Oregon Node Oregon Health Sciences University,
    Portland, OR
  • Washington Node University of Washington,
    Seattle, WA
  • Long Island Node NY State Psychiatric Institute,
    New York, NY
  • North Carolina Node Duke University,
    Raleigh/Durham, NC
  • Southwest Node University of New Mexico,
    Albuquerque, NM
  • Northern New England Node McLean Hospital,
    Belmont, MA
  • California-Arizona Node University of California
    at San Francisco, CA

6
STUDY RATIONALE
  • HIV/HCV/STI major causes of excess morbidity and
    mortality in the US
  • Substance abuse a major vehicle for the
    transmission of infection
  • Scope of, and challenges to identifying,
    counseling, and treating persons with these
    infections in substance abuse treatment will
    assist in developing effective interventions

7
IMPORTANT ABREVIATIONS
  • HIV Human Immunodeficiency Virus
  • AIDS Acquired Immunodeficiency Syndrome
  • HCV Hepatitis C Virus
  • STI Sexually Transmitted Infections
  • CTP Community Treatment Program
  • CTN Clinical Trials Network
  • SOP Standard Operating Procedures
  • IRB Institutional (Human Subject) Review Board

8
IMPORTANT DEFINITIONS
  • Treatment Program vs. NIDA CTN CTP
  • Services Assessed
  • Provider Education
  • Patient Education
  • Patient Risk Assessment
  • Patient Counseling
  • Patient Medical History Physical Exam
  • Patient Biological Testing
  • Patient Treatment
  • Patient Monitoring
  • Medical vs. Non-Medical Clinical Staff
  • Expert Clinical Staff

9
PRIMARY OBJECTIVES
  • TO DESCRIBE
  • Range of Infection-Related Services Available
  • Clinician Characteristics (training, knowledge,
    behavior)
  • Opinions
  • Perceived Barriers to Providing Infection-Related
    Services
  • TO EXAMINE ASSOCIATIONS BETWEEN
  • CTPs Availability of Selected Infection Services
  • Other Constructs Listed Above

10
DESIGN AND POPULATION
  • STUDY DESIGN
  • Cross-sectional Survey
  • Descriptive Exploratory
  • STUDY POPULATION
  • CTP Clinicians

11
ETHICAL, REGULATORY ADMINISTRATIVE
CONSIDERATIONS
  • Expedited IRB Approval
  • Waiver of Informed Consent
  • Training for Node Protocol Managers

12
STUDY PROCEDURES
  • Node Protocol Managers
  • Information Sheet In Lieu of Informed Consent
  • Survey Administration
  • Paper or Electronic
  • Central data acquisition

13
Clinician Surveys
Statistician selects Clinicians from Treatment
Programs based on contact information provided by
Administrators
Clinician surveys mailed
Randomization
Clinician completes survey online or mails to
Data Center
Gathering sessions held for Clinicians to
complete surveys
Completed surveys mailed to Data Center
If non-responder is a randomly selected
Clinician, the next eligible Clinician on the
selection list is sent a survey
Data Center contacts non-responders after 30
days flagged as non-responders after four weekly
failed attempts
Data Center contacts Clinicians to resolve any
data queries

Data Center monitors the data entry of Clinicians
14
MEASUREMENTS ANALYTICAL METHODS
  • SAMPLING METHODOLOGYAt Each CTP
  • All Expert Clinicians Designated by the CTP
  • 10 randomly sampled Non-Expert Clinicians,
  • in a ratio of MedicalNon-Medical reflecting
    that of
  • the CTPs clinical staff
  • ANALYTIC METHODOLOGIES
  • Experts will be analyzed separately
  • Clinicians may decline next randomly
  • selected person will be asked to participate

15
STATISTICAL ELEMENTS
  • Sample Size and Precision of the Estimated Mean
  • Analytic Plan
  • Descriptive stats for survey variables
  • Principal Component or Cluster or Factor Analysis
    to group and reduce the number of variables
  • Structural Equation Models to test for
    associations

16
RESULTS
  • Surveys Obtained from 1719 Clinicians of 2207
    Targeted (78)
  • 831 Non-Medical Non-Experts (48)
  • 115 Medical Non-Experts (7)
  • 522 Non-Medical Experts (30)
  • 251 Medical Experts (15)

17
HIV/AIDS, HCV STI-RELATED SERVICES INSUBSTANCE
ABUSE TREATMENT PROGRAMS NIDA CTN ADMINISTRATOR
RESPONSES (N269)
HIV/AIDS HCV STIs
SERVICE n () n () n ()
Provider Education 186 (69) 171 (63) 155 (57)
Patient Education 226 (84) 200 (74) 205 (76)
Risk Assessment 224 (89) 194 (77) 195 (77)
History Physical Examination 150 (56) 135 (50) 133 (49)
Testing 131 (49) 93 (34) 109 (40)
Counseling 178 (66) 159 (59) 163 (60)
Treatment 103 (38) 78 (29) 92 (34)
Monitoring 117 (43) 95 (35) 105 (39)
18
CLARITY OF HIV GUIDELINES OF CLINICIANS
SCORING GUIDELINES AS CLEAR
NON - EXPERT EXP ERT
SERVICE Non-Med Medical Non-Med Medical OVERALL
Provider Education 50 55 56 49 52
Patient Education 57 60 66 54 60
Risk Assessment 57 54 65 59 60
History Physical Exam 56 66 53 76 58
Testing 35 47 42 59 41
Counseling 49 52 54 58 52
Treatment 43 55 46 55 47
Monitoring 39 42 38 51 41

19
CLARITY OF HCV GUIDELINES OF CLINICIANS
SCORING GUIDELINES AS CLEAR
NON - EXPERT EXP ERT
SERVICE Non-Med Medical Non-Med Medical OVERALL
Provider Education 42 53 43 45 43
Patient Education 48 54 51 48 49
Risk Assessment 48 50 54 54 51
History Physical Exam 53 64 50 74 56
Testing 32 44 37 54 37
Counseling 41 47 45 51 44
Treatment 39 52 40 48 41
Monitoring 35 42 32 43 36

20
CLARITY OF STI GUIDELINES OF CLINICIANS
SCORING GUIDELINES AS CLEAR
NON - EXPERT EXP ERT
SERVICE Non-Med Medical Non-Med Medical OVERALL
Provider Education 40 50 41 40 41
Patient Education 47 51 50 41 47
Risk Assessment 46 48 51 46 48
History Physical Exam 49 64 49 73 53
Testing 28 42 35 50 35
Counseling 39 45 44 44 41
Treatment 37 53 40 51 41
Monitoring 32 42 31 43 34

21
SUMMARY
  • There is
  • substantial variation in the of programs
    offering the various services for a particular
    infection group
  • consistency in the of programs offering a
    particular service for all three infection groups

22
SUMMARY
  • Clarity of guidelines for the 8 targeted services
    is generally about 50 or less for all three
    infection groups, with the following exceptions
  • History Physical Exam (medical experts and
    non-experts) for all three infection groups
  • Patient Education and Risk Assessment
    (non-medical experts) for HIV

23
SUMMARY
  • Significant opportunities exist to explore other
    associations between the HIV/AIDS, HCV
    STI-related services offered and
  • Clinician Characteristics (training, knowledge,
    behavior)
  • Opinions
  • Perceived Barriers to Providing Infection-Related
    Services
Write a Comment
User Comments (0)
About PowerShow.com