| Abstract: | Objectives. We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment.Methods. Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing.Results. We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P < .001; Mantel-Haenszel risk ratio = 4.52; 97.5% confidence interval CI] = 3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P = .39; incidence rate ratio IRR] = 1.04; 97.5% CI = 0.95, 1.14) or the 2 on-site testing arms (P = .81; IRR = 1.03; 97.5% CI = 0.84, 1.26).Conclusions. This study demonstrated on-site rapid HIV testing’s value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.There are approximately 50 000 new HIV infections in the United States each year, with incidence remaining stable between 2006 and 2009.1 Among the more than 1 million people living with HIV in the United States, approximately one fifth do not know they are infected.2 This has led to expanded efforts to increase HIV testing, as recently outlined in the US National HIV/AIDS Strategy.3 In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening of all adults and adolescents in health care settings,4 with other medical groups following with similar recommendations.5,6Medical care settings and community-based testing sites are where most testing occurs,7 but the CDC and others have called for expanded testing in other locales serving high-risk persons, including drug treatment programs.4 Previous studies have shown that, despite high HIV prevalence in drug treatment programs (ranging from more than 3% in noninjection drug users non-IDUs] to 27% in IDUs8,9) and the well-established link among substance use, sexual risk behaviors, and HIV, fewer than half of US drug treatment programs offer HIV testing on site.10–12The role of risk-reduction counseling in the HIV testing process remains a central question, because of both questions of efficacy in reducing HIV infection rates and its implications for the time and personnel required for the recommended scale-up of testing. In a major policy shift, the 2006 CDC testing guidelines specify that risk-reduction counseling should only be required for persons who test HIV-positive.In the era of rapid HIV testing, the effectiveness of brief risk-reduction counseling for reducing risk behavior in persons who test HIV-negative is unknown. The seminal US trial, Project RESPECT13 demonstrated that two 20-minute counseling sessions in conjunction with conventional HIV testing for sexually transmitted disease (STD) clinic patients including IDUs14 significantly increased self-reported condom use and reduced STD incidence. However, in the 15 years since RESPECT, the context for HIV testing has changed dramatically: rapid testing is now widespread, effective treatment has greatly reduced HIV-related morbidity and mortality, and many people report having been tested for HIV at least once.To examine the efficacy of on-site rapid testing and risk-reduction counseling in increasing receipt of results and reducing HIV risk behaviors in drug treatment program patients, the National Drug Abuse Treatment Clinical Trials Network (CTN) conducted the HIV Rapid Testing and Counseling Study (CTN 0032). The aims were to quantify the degree to which available on-site rapid HIV testing increases testing and receipt of results, and to determine whether counseling affects testing acceptance and reduces HIV risk behaviors. |
