HIV rapid testing in substance abuse treatment: implementation following a clinical trial.

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.

Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the Antiretroviral Treatment and Access Studies site survey.

The Ryan White Comprehensive AIDS Resources Emergency Act 1990 (CARE Act) is one of the largest federal programmes funding medical and support services for individuals with HIV disease. Data that report services and gaps in service coverage from the organizational perspective are very limited. The Antiretroviral Treatment and Access Studies included a mail survey of 176 HIV medical care facilities in four US inner cities on clinic characteristics, services and practices, and patient characteristics. Characteristics of 143 (85%) responding Ryan White (RW) funded and non-RW funded facilities are described. RW funded facilities reported offering more services than non-funded facilities including evening/weekend hours (49% vs. 18%), transportation (71% vs. 22%), and on-site risk reduction counselling (88% vs. 55%). More RW funded facilities reported offering on-site adherence support services, such as support groups (44% vs. 12%), formal classes (20% vs. 2%), and pillboxes (83% vs. 43%), and served a larger proportion of uninsured patients (41% vs. 4%) than non-funded facilities. Our analysis showed that the RW funded HIV care facilities offered more clinic, non-clinic, and adherence support services than non-RW funded facilities, indicating that the disparities in services were still related to CARE Act funding, controlling for private-public facility type.