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Relationships Between HIV Disease Knowledge, Opinions, Training, Experience, And Service Availability At Substance Abuse Treatment Programs. Steven Kritz, MD; Melissa Lin, MS; Roberto Zavala, MD; Lawrence S. Brown, Jr., MD, MPH

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Relationships Between HIV Disease Knowledge, Opinions, Training, Experience, And Service Availability At Substance Abuse Treatment Programs

Steven Kritz, MD; Melissa Lin, MS; Roberto Zavala, MD; Lawrence S. Brown, Jr., MD, MPH

Addiction Research and Treatment Corporation, Brooklyn, NY

Introduction & Background

Data Source & IRB Approval

Results

Limitations

  • HIV disease − a major cause of morbidity & mortality, substantially associated with substance abuse
  • Substance abuse treatment – recommended to reduce substance abuse-related HIV infection
  • In HIV care, evidence exists of relationships between clinical outcomes and provider experience and knowledge
  • However, relationships between clinician characteristics and availability of infection-related services have not been reported
  • We investigated these relationships among clinical staff and associations with availability of HIV counseling and testing services among addiction treatment programs
  • Data Source: Survey instrument
  • Approved via expedited review and waiver of informed consent by Institutional Review Boards with jurisdiction over the participating treatment programs.
  • The data derives from surveys submitted by administrators from 269 (84%) of 319treatment programs within the CTN located in 26 states & DC
  • 1716 (78%) of 2210 clinicians from the 269 CTN treatment programs participated
  • No portion of the country or the CTN was over-represented among the 50 non-responding programs
  • For 366 medical clinicians, mean percent correct responses to knowledge questions was 65%
  • Among 1350 non-medical clinicians, mean percent correct responses to knowledge questions was 59%
  • For 772 expert and 944 non-expert clinicians, mean percent correct responses to knowledge questions was 64% and 57%, respectively
  • For 251 medical expert and 115 medical non-expert clinicians, mean percent correct responses to knowledge questions 68% and 60%, respectively
  • Mean percent correct responses (knowledge) was significantly associated with clinician opinions (p<.01) and experience (p<.01)
  • Knowledge was also associated with HIV testing (p<.05), but not counseling availability
  • In 84% of cases, HIV counseling and testing was associated with ongoing staff training and experience (p<.05)
  • Comfort discussing intimate sexual relationships with women having sex with women was endorsed by 71% of medical staff compared to 79% of non-medical staff
  • 97% of medical staff viewed substance abuse prevention as important compared to 95% of non-medical staff
  • 33% of program administrators (but not clinicians) believe full abstinence is necessary for successful HIV-related interventions
  • This investigation did not include information about the costs, effectiveness or utilization of HIV-related services or patient satisfaction
  • Lack of random selection may impact generalizablility of the findings
  • Definitions and categorizations for the expert/non-expert groups may not have been optimal, since they were decided by the programs administrators

The Surveys

  • All administrators and clinicians at participating CTN substance abuse treatment programs were eligible
  • Each group had a different survey with some questions that overlapped
  • Surveys captured infection-related knowledge, opinions, training and experience
  • Opinions were assessed using 5-point Likert scale, while the knowledge component contained 20 closed-end questions

Conclusions

This study provided empirical support for relationships between knowledge, opinions, ongoing training, and experience; and availability of HIV-related services at substance abuse treatment programs

Objectives

Study Sites

  • To learn the empirical evidence of an association between clinician knowledge and a) clinician opinions and b) clinician experience pertaining to HIV-related health
  • To learn the association between the availability of infection-related health services in addiction treatment programs and the opinions of the administrators of these programs
  • To learn the association between the availability of infection-related health services in addiction treatment programs and ongoing staff training pertaining to infection-related health

Administrator Survey

Northern New England Node: McLean Hospital, Belmont, MA

New England Node: Yale University, New Haven CT

New York Node: New York University, New York, NY

Long Island Node: New York State Psychiatric Institute, New York, NY

Delaware Valley Node:University of Pennsylvania, Philadelphia, PA

Mid-Atlantic Node: Johns Hopkins University, Baltimore, MD

Medical College of Virginia, Richmond, VA

South Carolina Node: Medical University of South Carolina, Charleston, SC

North Carolina Node: Duke University, Raleigh/Durham, NC

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

Southwest Node: University of New Mexico, Albuquerque, NM

Pacific Region Node: University of California at Los Angeles, Los Angeles, CA

California-Arizona Node: University of California at San Francisco, San Francisco, CA

Oregon Node: Oregon Health Sciences University, Portland, OR

Washington Node: University of Washington, Seattle, WA

Consisted of 112 questions divided into 8 sections:

  • Structure and Service Setting (6)
  • Patient Characteristics (3)
  • Staff Characteristics (10)
  • Reimbursement Issues (24)
  • Practices (30)
  • Program Guidelines (8)
  • Barriers (27)
  • Opinions (4)

Acknowledgments

Methods

Clinician Survey

Discussion

Research supported by the National Institute on Drug Abuse (NIDA)

as part of a Cooperative Agreement with the NIDA Clinical Trials

Network (2U10DA013046)

Its contents are solely the responsibility of the authors and do not

necessarily represent the official views of the NIH or NIDA CTN

Other protocol team members were:

Randy Seewald MD, Frank McCorry PhD, Dennis McCarty PhD,

Donald Calsyn PhD, Leonard Handelsman MD, Steven Kipnis

MD, Al Hasson MSW, Karen Reese CAC-AD, Sherryl Baker

PhD, Cheryl Smith PhD, Shirley Irons, Kathlene Tracy PhD,

Pat McAuliffe MBA, LADC

  • This investigation highlighted five major findings:
    • Knowledge score between medical and non-medical personnel was very similar
    • Mean percent correct responses (knowledge) was significantly associated with opinions and experience of clinicians, and HIV testing, but not counseling availability
    • Both medical and non-medical personnel view substance abuse prevention as an important tool
    • HIV counseling and testing was associated with ongoing staff training and experience
    • Program administrators felt that full abstinence from substance use is needed for successful HIV interventions
  • Consisted of 90 questions divided into 5 sections:
      • Practices (31)
      • Program Guidelines (8)
      • Knowledge (20)
      • Barriers (27)
      • Opinion (4)
  • Survey was given to medical & non-medical personnel,
  • further categorized as expert & non expert by Program
  • Administrators
  • Study Design
    • Cross sectional survey
    • Descriptive exploratory
  • Study Population
    • Administrators and clinicians at substance abuse treatment programs within the NIDA Clinical Trials Network

There are no financial interests or other disclosures to report for any of the authors involved in this project.

A copy of this presentation will be available electronically after the meeting from the NIDA CTN Library:

http://ctndisseminationlibrary.org