Enhancing Substance Abuse Treatment Services to Address Hepatitis Infection Among Intravenous Drug Users Hepatitis Test and Vaccine Tracking Form
SUPPORTING STATEMENT
B. Collections of Information Employing Statistical Methods
1. Respondent Universe and Sampling Methods
To minimize response burden, SAMHSA will allow the designated Opioid Treatment Programs to self-select. The designated sites are in States that have a high prevalence of HIV/AIDS infection as defined in the Minority AIDS Initiative (MAI). The OTPs reside in California, New Mexico, New York, Ohio, Hawaii, Minnesota, Connecticut, Massachusetts, and Pennsylvania. (States Identified with High OTP Substance Abuse associated Morbidity)
Table 1: Providers within the 13 MAI States.
State |
OTPs |
Total Providers |
Ohio |
2 |
2 |
New Mexico |
1 |
1 |
California |
2 |
2 |
New York |
2 |
2 |
Hawaii |
1 |
1 |
Minnesota |
1 |
1 |
Connecticut |
1 |
1 |
Massachusetts |
1 |
1 |
Pennsylvania |
1 |
1 |
Total |
12 |
12 |
Sample Size: 264 Test Kits and 10, 628 Vaccines
Information Collection Procedures
When a client comes into the provider organization to request to be screened for hepatitis; the provider will select a no cost hepatitis test along with the corresponding Hepatitis Test and Vaccine Tracking Form. The provider will complete the form at the time the test is performed. After the completion of the form, it is placed in the client’s record. At the time the provider receives the results, a decision is made to continue with the vaccination series or refer the patient to follow-up services. Approximately one month after the initial intake, the forms are sent to the contractor.
Methods to Maximize Response Rates
SAMHSA/CSAT anticipates that they will receive near 80 percent response rate because the form would be completed whenever a no cost test kit or vaccine is administered by the provider. The test kits and vaccines will have a unique number as well as a lot number.
4. Test of Procedures
This form has been revised by removing all direct identifying variables that may represent possible risk of patient disclosure.
Statistical Consultants
This material has been reviewed by:
Randolph Edmead, M.S. Project Coordinator 301-589-4020
DB Consulting Group, Inc
Anthony Campbell, D.O. Government Project Officer 240-276-2702
SAMHSA/CSAT
List of Attachments
Attachment A: SAMHSA/CSAT Hepatitis Tracking Form
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Workplace Helpline Call Record Form |
| Author | ezeller |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |