2021 Articles

HIV testing and counseling at U.S. substance use treatment facilities: A missed opportunity for early identification

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

Objective: The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States.

Methods: Analysis of the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in US substance use treatment facilities (excluding territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders, and subsequently compared using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, background HIV incidence, and facility characteristics.

Results: Among US Substance Use Treatment Facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. State proportions of facilities offering HIV testing and counseling ranged from 9.0%–62.8% and 19.2%–83.3%, respectively. Only three states reported HIV testing being offered by ≥50% of facilities. Sites offering medication for opioid use disorder (48.0% vs. 16.0%, respectively) or mental health services (31.2% vs. 24.1%, respectively) were significantly more likely to offer HIV testing than other sites.

Conclusion: Only 3 in 10 substance use treatment facilities offered HIV testing in 2018. This is a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.