A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State

Abstract

Purpose Integrating HIV testing programs into substance use treatment is a promising avenue to help increase access to HIV testing for rural drug users. Yet few outpatient substance abuse treatment facilities in the United States provide HIV testing. The purpose of this study was to identify barriers to incorporating HIV testing with substance use treatment from the perspectives of treatment and testing providers in Arkansas. Methods We used purposive sampling from state directories to recruit providers at state, organization, and individual levels to participate in this exploratory study. Using an interview guide, the first and second authors conducted semi-structured individual interviews in each provider’s office or by telephone. All interviews were recorded, transcribed verbatim, and entered into ATLAS.ti software (ATLAS.ti Scientific Sofware Development GmbH, Berlin, Germany). We used constant comparison and content analysis techniques to identify codes, categories, and primary patterns in the data. Findings The sample consisted of 28 providers throughout the state, 18 from the substance use system and 10 from the public/ community health system. We identified 7 categories of barriers: environmental constraints, policy constraints, funding constraints, organizational structure, limited inter- and intra-agency communication, burden of responsibility, and client fragility. Conclusions This study presents the practice-based realities of barriers to integrating HIV testing with substance use treatment in a small, largely rural state. Some system and/or organization leaders were either unaware of or not actively pursuing external funds available to them specifically for engaging substance users in HIV testing. However, funding does not address the system-level need for coordination of resources and services at the state level.

Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine

“…Exactly why fewer rural people who use cocaine find HIV testing sites as acceptable remains unclear, but we posit that it could be explained by doubts about the need for HIV testing, stigma associated with getting tested, and concern about the confidentiality of testing results, which were cited as barriers to HIV testing in a qualitative research study conducted among rural AAs using cocaine in Arkansas (42). In related research, we found that worse perceptions of the effectiveness of local substance use treatment was negatively associated with a preference to seek local over non-local substance use treatment (43).…”

“…In recognition of the potential benefits of integrating HIV testing and substance use treatment, both the Centers for Disease Control and Prevention (48) and Veterans Administration (VA) recommend that all persons being treated at substance abuse facilities be tested for HIV (49). However, prior research indicates that the majority of substance abuse facilities do not offer HIV testing (42,50). Despite these potential advantages, this study suggests that integration of testing in drug treatment centers may encounter some barriers, particularly in rural settings.…”

Correlates of HIV Testing Among Rural African American Cocaine Users

“…Self‐report of HIV testing among African American drug users may be less than accurate. In a qualitative study among rural African American cocaine users, both men and women said they knew they had been tested for HIV because their blood was taken for lab tests by their health care providers, or because they had been treated in emergency departments for accidents or injuries (Wright, Curran, Stewart, & Booth, ). Young women reported they had been tested for HIV because they had a Pap test every year (Wright et al, ).…”

Qualitative research on point-of-care testing strategies and programs for HIV

“…Some studies have explored challenges of incorporating HIV testing with substance use treatment from the perspectives of treatment and testing providers in Arkansas (USA) [26]. Furthermore, a study on antenatal care services in rural Uganda showed why HIV testing uptake is low during those services, which depends on the women's social context and the existing healthcare settings [27].…”