HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification

Riano, Nicholas S.; Borowsky, Hannah M; Arnold, Emily; Olfson, Mark; Walkup, James; Vittinghoff, Eric; Cournos, Francine; Dawson, Lindsey; Bazazi, Alexander R.; Crystal, Stephen; Mangurian, Christina

doi:10.1176/appi.ps.202000524

Cited by 8 publications

(3 citation statements)

References 20 publications

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“…Prevention of new HIV infections is among the priorities of the National HIV/AIDS strategy [28]. Yet, despite evidence supporting the role of drug use treatment in HIV prevention, only a small percentage (approximately 30%) of drug use treatment programs provide HIV services [34,35]. Furthermore, SSPs offer the opportunity to engage hard-to-reach PWID for HIV prevention [36].…”

Section: Discussionmentioning

confidence: 99%

Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs

Sokale,

Wilkerson,

Wermuth

et al. 2024

AIDS Behav

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Evaluating routine HIV testing and treatment and use of services for people who inject drugs (PWID) is critical to curb the ongoing HIV epidemic. We analyzed data from the 2018 National HIV Behavioral Surveillance of PWID aged 18 years or older, recruited using respondent-driven sampling and offered anonymous HIV testing after survey. We performed bivariate and multivariable analyses with log-linked Poisson regression of the generalized linear models to examine the associations between demographics and PWID service use, pastyear HIV testing, and current antiretroviral therapy (ART) use. Among 10,311 HIV-negative PWID, 56% reported past-year HIV testing, and of the 553 HIV-positive PWID, 69% reported current ART use. Of the HIV-negative PWID, 64% (2874/4482) in drug treatment and 62% (3386/5440) who used syringe service programs (SSPs) reported past-year HIV testing. Among HIV-positive PWID, 75% (187/248) in drug treatment and 67% (200/298) SSP participants were on ART. In the adjusted multivariable model, past-year HIV testing was associated with drug use treatment (aPR 1.26, 95% CI 1.23-1.31) and SSP participation (aPR 1.19, 95% CI 1.13-1.26) among HIV-negative PWID. Current ART use was associated with drug use treatment (aPR 1.13, 95% CI 1.00-1.28) but the link was not signi cant probably due to small sample size. Findings support the expansion and improvement of PWID-targeted services, into comprehensive programs, including drug use treatment, SSP, and HIV testing and treatment.

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Section: Discussionmentioning

confidence: 99%

Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs

Sokale,

Wilkerson,

Wermuth

et al. 2024

AIDS Behav

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“…9 Efforts to create systemlevel changes to advance routine (versus risk-based) HIV testing for people with schizophrenia and other SMI have stalled in many cases, or have been unevenly implemented within particular health care settings across the US, such as emergency departments, substance use treatment facilities, and state-run psychiatric hospitals. [10][11][12] This complexity is further compounded by the fragmented US health care delivery system. People with schizophrenia commonly access care through 3 delivery systems (mental health, substance use disorder, and physical health care) that are frequently siloed geographically, financially, and electronically.…”

Section: Introductionmentioning

confidence: 99%

“…9 Efforts to create system-level changes to advance routine (versus risk-based) HIV testing for people with schizophrenia and other SMI have stalled in many cases, or have been unevenly implemented within particular health care settings across the US, such as emergency departments, substance use treatment facilities, and state-run psychiatric hospitals. 10–12…”

Section: Introductionmentioning

confidence: 99%

Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia

Thomas

Vittinghoff

Koester

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative sample of Medicaid enrollees with and without schizophrenia. Methods: Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002–2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. Results: Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. Conclusion: Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.

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Availability of Testing for Sexually Transmitted Infections and HIV in U.S. Outpatient Mental Healthcare Settings

Bunting,

Wang,

et al. 2023

AIDS Behav

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HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification

Cited by 8 publications

References 20 publications

Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs

Past-Year HIV Testing, Current Antiretroviral Therapy Use, and Participation in Services for People Who Inject Drugs

Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia

Availability of Testing for Sexually Transmitted Infections and HIV in U.S. Outpatient Mental Healthcare Settings

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