Disparities in InfectionRelated Services in Substance Abuse Treatment Programs for Underserved Popul

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Disparities in Infection-Related Services in
Substance Abuse Treatment Programs for
Underserved Populations

• 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 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

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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 Study Sites
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ACKNOWLEDGEMENTS

• Research Supported by the National Institute on
  Drug Abuse (NIDA) as part of a Cooperative
  Agreement (1U10DA013046) with the NIDA Clinical
  Trial Network
• This is the 3rd report from this study. The
  others
• Brown LS, et. al. Characteristics of substance
  abuse treatment programs providing services for
  HIV/AIDS, hepatitis C virus infection, and
  sexually transmitted infections The National
  Drug Abuse Treatment Clinical Trials Network. J.
  Substance Abuse Treatment, 200630 315-321.
• Brown LS, et. al. Health services for HIV/AIDS,
  hepatitis C virus, and sexually transmitted
  infections in substance abuse treatment programs.
  Public Health Reports (in press).
• There are no financial interests or disclosures
  to report for any authors involved in this project

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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.

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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

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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

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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

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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 (Fishers Exact) Test with Odds ratios
  and 95 Confidence Intervals

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SUBSTANCE ABUSE TREATMENT PROGRAMS (N269)
OFFERING ADDICTION SERVICES FOR VARIOUS
POPULATIONS
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Percent of Treatment Programs Providing
HIV-Related Health Services With and Without
Addiction Services Designed For
p 11
Percent of Treatment Programs Providing
HCV-Related Health Services With and Without
Addiction Services Designed For
p 12
Percent of Treatment Programs Providing
STI-Related Health Services With and Without
Addiction Services Designed For
p 13
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
• support services (92 versus 70, p0.01)

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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,
  p0.05)
• HIV-related counseling (76 versus 60, p0.03)
• Treatment Programs with addiction services
  tailored to women were more likely to provide
• HIV-related medical monitoring (53 versus 37,
  p0.03) odds ratio 1.93 (95 CI 1.07-3.49)
• HCV-related risk assessment (81 versus 66,
  p0.01) odds ratio 2.23 (95 CI 1.18-4.20)

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RESULTS Infection-Related Health Services
(contd)

• 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

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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

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RESULTS Barriers to Providing Infection-Related
Health Services (contd)

• 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

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LIMITATIONS

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

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CONCLUSIONS

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

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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 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