Despite More Opioid Treatment Centers, Fewer HIV Tests

Fewer opioid treatment centers are offering HIV testing to patients, and are testing fewer patients overall, a recent study suggests.

Although the number of opioid treatment centers increased from 2005 to 2011, the availability and use of on-site HIV testing has declined markedly, a study suggests.

The percentage of programs offering HIV testing fell from 93% in 2005 to 64% in 2011, according to the results of a study published in the February 2014 edition of Health Services Research. The number of patients receiving testing decreased as well, from 41% in 2005 to 17% in 2011.

“Although 64% of OTPs [opioid treatment programs] offer some form of HIV testing services (on- or off-site) in 2011, only a small minority of clients actually receive HIV testing within these programs,” the researches noted. “Within the 2011 survey wave, only 17% of OTP clients were reported to have received HIV testing services. Almost 36% of clients received treatment in facilities that reported that they did not offer any HIV testing services.”

Despite the overall decrease in HIV testing, state laws tended to positively affect testing rates, researchers noted. When the Centers for Disease Control and Prevention (CDC) changed its testing guidelines in 2006, states incorporated the changes into their laws, making the recommendations legally binding. The guideline revisions include offering posttest risk-reduction counseling only to patients who tested HIV positive and incorporating informed-consent procedures to testing—patients receiving routine testing are told they will receive an HIV test as well, and their consent is implied unless they specifically decline the test.

“The results show that state laws are significantly associated with both the likelihood that OTPs will offer HIV testing, and the percent of their clients tested,” researchers noted. “Specifically, OTPs located in states that changed their regulations between 2005 and 2011 to make them consistent with CDC guidelines for consent with testing were both more likely to offer HIV testing and to have higher proportions of clients tested… Similarly, OTPs located in states that followed CDC guidelines and dropped requirements for pretest counseling between 2005 and 2011 also were much more likely to have higher proportions of clients tested.”

Researchers collected data from nationally representative samples of opioid treatment centers for the years 2005 and 2011. The research incorporated a combination of research surveys and calls to opioid treatment centers, in which researchers spoke to treatment centers’ administrative directors and clinical directors. Their questions included whether the center provided HIV testing to patients, as well as the percentage of patients receiving testing services either on-site or off-site.

Researchers found 1121 opioid treatment centers in 393 counties in the 2005 data, and 1425 opioid treatment centers in 492 counties in 2009 data. The 2009 data were merged with researcher-collected 2011 data from 134 counties, they said. Each analysis included demographic information about patients, as well as relevant program affiliations, whether the program was not for profit or for profit, and the type of opioid maintenance therapy offered.

In general, treatment programs serving a high proportion of Hispanic patients or a high proportion of injectable drug users were more likely to offer HIV tests and to test patients. Nonprofit programs, whether public or private, were also more likely to offer testing services than for-profit programs. Programs offering methadone maintenance therapy exclusively and programs that were the only source of opioid treatment in an area were also more likely to offer testing and to test patients for HIV.

“OTP providers can play a central role in HIV prevention,” the authors wrote. “Our results suggest, however, that OTP facilities are not providing the broad HIV testing called for by public health authorities…Efforts to identify and address barriers to expanded HIV testing should be a high priority for public health policy and practice. To begin, states should reexamine, and if necessary, revise their regulations that govern HIV testing to make them consistent with CDC recommendations for consent and counseling.”