HIV outreach for hard-to-reach populations: a cross-site perspective

This article examines the effectiveness of outreach as a vehicle for moving hard-to-reach substance abusing clients into substance abuse treatment. These clients were recruited by and participated in one of twelve HIV Outreach Demonstration Projects funded by the Center for Substance Abuse Treatment (CSAT). The analysis combines data across projects to provide a cross-site perspective. Data from 1675 clients were analyzed in this study. In addition, a comparison group of 3704 subjects was generated from the National Treatment Improvement Evaluation Study (NTIES) data. The results supported the hypothesis that clients representing traditional hard-to-reach populations would be more likely to enter treatment for substance abuse through participation in HIV Outreach programs than would clients exposed to treatment-specific recruiting methods (e.g. NTIES). The findings from this cross-site study support the view that HIV Outreach, as an integrated approach to several behavioral constellations, is more effective in recruiting clients to substance abuse treatment than are approaches that focus exclusively on substance abusing behavior. The HIV Outreach model is especially effective in reaching substance abusers earlier in the cycle of abuse. This has importance clinically for developing and focusing more effective methods for treatment for younger substance abusers with shorter histories of abuse. It also has implications for policy to guide the effective use of scarce treatment resources. Targeting specific populations and affiliation with substance abuse treatment providers were also influential in facilitating access to substance abuse treatment for groups at increased risk for HIV.