Go to Rehab, Get Tested for HIV

Drug abuse treatment programs should provide HIV testing

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) File this under things that just make sense: Providing HIV testing to people in drug abuse treatment programs. But currently, less than half of community-based programs make it available.

A new study has found that providing on-site testing at substance abuse programs is a cost-effective way to diagnose HIV.

It's important because injection drug users are a high-risk group for HIV, but many never learn their status and may unknowingly spread the virus to others.

"Know your status: Get tested for HIV."

The study was conducted by researchers at Weill Cornell Medical College, led by Dr. Bruce Shackman in the Department of Public Health. Dr. Shackman specializes in reviewing the evaluating the economic side of health interventions.

The President's National HIV/AIDS strategy calls for combining HIV screening and prevention counseling with substance abuse programs.

But previous studies have shown that less than half of community-based rehab programs actually make HIV testing available, whether the tests are done on-site, or patients are referred to an outside testing site.

Drug users are at high risk for HIV, because they're more likely to engage in risky behaviors like using dirty needles to inject, and having unprotected sex. Yet only 49 percent of injection drug users report having been tested.

The researchers set out to evaluate the cost-effectiveness of integrating HIV testing strategies in drug abuse treatment programs.

Back in 2009, The National Drug Abuse Treatment Clinical Trials Network conducted a study testing out three different ways of testing: Referring patients to an off-site testing facility, a basic rapid-results HIV test on-site, and the rapid-results test on-site with follow-up counseling.

The study had found that 80 percent of patients who were offered an on-site testing option got tested and learned their results. That's compared to 20 percent who had the option of going off-site for testing.

Dr. Shackman's team used the data from the 2009 to do their cost analysis. With a computer simulated model, they were able to predict life expectancy, and lifetime costs.

An important part of the study was determining a measurement called “quality-adjusted life years” (QALYs), which is based on the number of years of someone's life that would be added by getting tested for HIV. It takes into account the quality of life that the person would lead during each year.

They found that on-site testing, without risk reduction counseling, provided the biggest bang for the buck.

Providing the counseling was 90 percent more expensive, and did not seem to have a significant effect on the patients behavior.

"We found that on-site testing with a description of the testing procedure, without pre-test risk-reduction counseling, resulted in a beneficial cost-effectiveness ratio. This strategy provides better value than off-site referral,” said Dr. Shackman.

The study was published in September 2012 in the journal Drug and Alcohol Dependence.

Reviewed by: 
Review Date: 
September 11, 2012
Last Updated:
September 12, 2012