The Substance Abuse and Mental Health Services Administration (SAMHSA) and their Addiction Technology Transfer Center (ATTC) network, along with the National Institute on Drug Abuse (NIDA), are urging substance abuse treatment programs to step up rapid testing for HIV during the time patients are in treatment programs. Patients in substance abuse treatment are at high risk of HIV infection because they may engage in injection drug use and unsafe sex.
The need for rapid HIV testing is compelling, with new HIV cases in the U.S. appearing at a steady rate of about 50,000 per year. About one person in five who is HIV positive is unaware of it—and those are the people, according to SAMHSA, who transmit most new cases of HIV. Identifying them and getting them into treatment could impact the spread of HIV.
Rapid tests for onsite use are inexpensive and widely available to Opioid Treatment Programs (OTPs) and other programs through the local health department and the State Authority. Positive rapid test results must be confirmed by traditional blood tests. Rapid test results take one to 20 minutes, so patients can learn their HIV status in a single visit. Despite this, and despite the well-known link between substance misuse and HIV infection, fewer than half of U.S. drug treatment programs offer HIV testing onsite. OTPs do better than most programs; 69 percent of OTPs offer onsite HIV testing.
How Effective Are Onsite Testing and Counseling?
To find out, SAMHSA-ATTC /NIDA carried out a multisite HIV Rapid Testing and Counseling Study, enrolling adults from four types of programs—outpatient medication-assisted treatment, outpatient psychosocial, intensive outpatient, and residential. Participants were either HIV-negative or of unknown HIV status, and had not been HIV-tested during the previous 12 months. They were divided randomly into three HIV testing groups:
- Onsite, with brief risk-reduction counseling
- Onsite, with verbal information about testing only
- Referred for offsite testing
More than 80 percent of those tested onsite received their test results, compared to only 18 percent who followed through when referred offsite. The results support routine rapid HIV testing and providing patients with information about testing, but not risk-reduction counseling for those who tested HIV–. Patients were glad to have test results so quickly, and said they “felt safe,” and were “so happy” about being able to be tested in their own program, rather than being referred elsewhere, according to Louise Haynes, MSW. Onsite testing was a real asset to the program.
The HIV Rapid Testing Initiative
The HIV Rapid Testing in Substance Abuse Treatment Program is a joint effort by the SAMHSA-ATTC /NIDA Blending Initiative to put the results of medical research—such as new rapid diagnostic tests—into the hands of treatment providers as quickly as possible. Spurred by an Institute of Medicine report of a 17-year gap between the publication of research results and their practical impact on patient care, the Blending Initiative speeds the dissemination of findings from research-based drug abuse treatment into community-based practice. Its website offers a Fact Sheet, Resource Guide, Marketing Materials, Training Information, State-Specific Testing Laws, and other resources, including a Budget Worksheet to help OTPs set up an HIV Rapid Testing Program.