1. Characteristics of Screening, Evaluation, and Treatment of HIV/AIDS, Hepatitis C Viral Infections, and Sexually Transmitted Infections in Substance Abuse Treatment Programs (NIDA CTN-0012) L.S. Brown, MD, MPH; S. Kritz, MD; J. Rotrosen, MD; R.J. Goldsmith, MD; Edmund Bini, MD, MPH; J. Robinson, MEd; S. Baker, PhD, 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; University of Cincinnati Medical Center, Cincinnati, OH; and Nathan Kline Institute, Orangeburg, NY

2. ABSTRACT Introduction: In the US, users of illicit drugs will largely sustain the epidemics of HIV/AIDS, hepatitis C, and sexually transmitted infections. Substance abuse treatment programs can play a major role in stemming these epidemics. A nationwide CTN study, sponsored by NIDA, examines these three infection groups from the perspective of administrators and clinicians working in substance abuse treatment programs. The NIDA CTN has over 100 Community Treatment Programs (CTPs) with over 300 discreet substance abuse treatment sites in 17 nodes across the US. Methods: Three surveys were developed; one each for substance abuse treatment program administrators and clinicians, and one for state health and substance abuse department administrators. These surveys looked at service availability, government mandates, funding, and other key elements involved in evaluating and caring for patients in each of the three infection groups. Results: Completed surveys were obtained from 269 administrators and 1723 clinicians working at substance abuse treatment sites. At the state level, completed surveys were returned by administrators from 48 states and the District of Columbia. Preliminary data is presented. Summary: This study will allow for examination of associations between the activities at substance abuse treatment programs and the states within which they are located in dealing with the three infection groups. This data and other information can then be used to encourage “best practices” in treating these epidemic infections.

4. 17 Nodes with 116 Community Treatment Agencies Reaching into 26 States! Drug Abuse Treatment Clinical Trials Network Philadelphia Portland Los Angeles Charleston Miami Cincinnati Denver CTN Sites Seattle Raleigh/ Durham Long Island Boston San Francisco (CA/AZ Node) New York City Detroit Albuquerque Baltimore/Richmond New Haven

13. Administrator Surveys Contact CTP Directors for Treatment Program and Administrator contact information Survey materials mailed to Administrators Ensure IRB approval Administrator completes survey online or mails to Data Center; Administrator enters contact information for Clinicians Node Protocol Manager contacts Administrators that have not responded within two weeks Data Center contacts Administrators that have not completed the survey or Clinician contact information within 30 days Data Center contacts Administrators to resolve any data queries After four weekly attempts, Administrators flagged as non-responders by the Data Center Node Protocol Managers contact non-responder Administrators weekly For Administrators that refuse to participate or still have not responded after two additional weeks, the Node Protocol Manager alerts the Node Principal Investigator

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

15. State Surveys Data Center mails survey material to State Administrators Project Manager enters State Administrator contact information into the Data Center system State Administrator completes the survey online or mails to Data Center Project Manager contacts State Administrators that have not completed survey within 30 days After four weekly attempts to contact State Administrators, the Project Manager flags them as non-responders Project Manager contacts State Administrators to resolve data queries Data Center reviews data and communicates any issues to Project Manager

19. Characteristics of Treatment Programs * Percentages do not total 100% due to rounding and non-respondents 45 (16.7) 103 (38.1) 46 (17.0) 33 (12.2) 5 (1.9) 4 (1.5) 9 (3.3) 15 (5.6) 3 (1.1) 7 (2.6) 269 Largest source of revenue County/local grants State funds Medicaid Federal grants VA Benefits Medicare Private contracts/insurance Self-pay Other Unknown 212 (78.5) 15 (5.6) 36 (13.4) 6 (2.2) 268 Corporate structure Private not-for-profit Private for profit Government Other Number (%) of Treatment Programs * Number of Surveys with Valid Responses Characteristic

20. Characteristics of Treatment Programs * Percentages do not total 100% due to rounding and non-respondents # Responses were not mutually exclusive for this item 79 (29.4) 59 (21.9) 59 (21.9) 64 (23.8) Non-Medical Staff 0-7 8-11 12-17 18+ 55 (20.4) 31 (11.5) 64 (23.8) 54 (20.1) 57 (21.2) Medical Staff 0 1 2-3 4-7 8+ 148 (55.0) 89 (33.1) 206 (76.6) 227 (84.4) 256 242 257 259 Addiction Services Offered # Inpatient or residential services Outpatient pharmacotherapy Other outpatient services Outreach & support services 145 (53.9) 52 (19.3) 53 (19.7) 250 Patient census ≤ 500 500 – 1000 >1000 Number (%) of Treatment Programs * Number of Surveys with Valid Responses Characteristic

21. HIV/AIDS, HCV & STI-RELATED SERVICES IN SUBSTANCE ABUSE TREATMENT PROGRAMS: NIDA CTN ADMINISTRATOR RESPONSES (N=269) 105 (39) 95 (35) 117 (43) Clinical Monitoring 92 (34) 78 (29) 103 (38) Pharmacotherapies Administered/ Prescribed 109 (40) 93 (34) 131 (49) Biological Assessments 133 (49) 135 (50) 150 (56) History & Physical Examination 163 (60) 159 (59) 178 (66) Patient Counseling 205 (76) 200 (74) 226 (84) Patient Education 195 (77) 194 (77) 224 (89) Risk Assessment n (%) n (%) n (%) STIs HCV HIV/AIDS

22. PRELIMINARY RESULTS : TREATMENT PROGRAM CHARACTERISTICS BY HIV/AIDS, HCV & STI-RELATED SERVICES: 56 (74) 61 (82) 65 (87) 61 (82) n (%) Methadone 12 (80) 13 (87) 13 (87) 15 (93) n (%) For-Profit 51 (35) 33 (45) 76 (38) STI Biological Assessments 92 (63) 54 (73) 123 (62) STI Patient Counseling 92 (63) 48 (66) 114 (57) HCV Patient Counseling 105 (74) 59 (82) 146 (75) HIV Provider Education n (%) n (%) n (%) Drug Free Residential Non-Profit

31. ...And… THERE IS MORE DATA