A Qualitative Analysis of Provider Barriers and Solutions to HIV Testing for Substance Users in a Small, Largely Rural Southern State
The work described in this manuscript was supported by a research grant (award number R01DA024575) to Dr. Katharine Stewart from the National Institute on Drug Abuse. It was also supported in part by the Arkansas Center for Minority Health Disparities (award number P20MD002329 from the National Institute on Minority Health and Health Disparities), the Arkansas Prevention Research Center (award number 1U48DP001943 from the Centers for Disease Control and Prevention), and by the UAMS Translational Research Institute (award number 1UL1RR029884 from the National Center for Advancing Translational Science). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding institutes and centers, the National Institutes of Health, or the Centers for Disease Control and Prevention.
For further information, contact: Patricia B. Wright, PhD, MPH, RN, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas; e-mail: firstname.lastname@example.org.
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.
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 semistructured 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 Software Development GmbH, Berlin, Germany). We used constant comparison and content analysis techniques to identify codes, categories, and primary patterns in the data.
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.
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.