Regular article HIV testing and counseling in the nation's outpatient substance abuse treatment system, 1995–2005 Harold A. Pollack, (Ph.D.) a , Thomas D'Aunno, (Ph.D.) b, ⁎ a University of Chicago, Chicago, IL, USA b Columbia University, New York, NY, USA Received 2 July 2009; received in revised form 2 November 2009; accepted 31 December 2009 Abstract This article examines the extent to which U.S. outpatient substance abuse treatment (OSAT) facilities provide HIV counseling and testing (C&T) to clients between 1995 and 2005. We also examine organizational and client characteristics associated with OSAT facilities' provision of HIV C&T. Data were collected from a nationally representative sample of outpatient treatment facilities in 1995 (n = 618), 2000 (n = 571), and 2005 (n = 566). Results show that in 1995, 26.8% of OSAT clients received HIV C&T; by 2005, this proportion had increased, but only to 28.8%. Further, results from random-effects interval regression analysis show that C&T is especially widespread in public and nonprofit facilities, in methadone facilities, and in units that serve injection drug users and commercial sex workers. HIV C&T was also more widespread in units that employed formal intake protocols. Despite widespread efforts to increase HIV C&T services in OSAT care, only a small and stable minority of clients receive these services. Adoption of formal intake procedures may provide one vehicle to increase provision of C&T services. © 2010 Elsevier Inc. All rights reserved. Keywords: HIV counseling and testing; Substance abuse treatment; Opiate; Managed care 1. HIV testing and counseling in the nation's outpatient substance abuse treatment system HIV remains a principal threat to the health of men and women who use illicit drugs (Centers for Disease Control and Prevention [CDC], 2006). Despite some decline in HIV incidence among injection drug users (IDUs), an estimated 16% of recent HIV infections occur within this population (CDC, 2009). Although HIV infection is most prominent among IDUs, noninjecting drug users also experience high HIV risk (Des Jarlais et al., 2007). An important minority of drug users engage in commercial sex work. Substance use disorders are correlated with domestic violence, homelessness, and with other HIV behavioral risks. Injection and noninjection drug use are also important factors in sexually transmitted secondary infections (CDC, 2009; Trends in HIV/AIDS Diagnoses—33 states, 2001– 2004, 2005). Clinicians and policymakers have focused on the special role of outpatient substance abuse treatment (OSAT) services in HIV prevention (Metzger, Navaline, & Woody, 1998; Metzger & Navaline, 2003a, 2003b). This consensus is reflected in the Institute of Medicine's (IOM) No Time to Lose, which summarized policies to support best practices in HIV prevention (IOM, 2000). OSAT facilities serve patients who otherwise may have little contact with the health care system. Many OSAT facilities have the capacity and organizational linkages to refer HIV-infected clients to medical providers. OSAT facilities provide counseling and other services that may help clients maintain adherence to prescribed HIV therapies. Given the reality of high relapse and nonadherence rates, along with prevalent sexual risks, among OSAT clients, Journal of Substance Abuse Treatment 38 (2010) 307 – 316 ⁎ Corresponding author. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 W. 168th St., #617, New York, New York 10032. Tel.: +1 212 305 3524; fax: +1 212 305 3405. E-mail address: tdaunno@columbia.edu (T. D'Aunno). 0740-5472/10/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2009.12.004