TY - JOUR
KW - Adult
KW - Anti-Retroviral Agents/therapeutic use
KW - Behavior Therapy
KW - Central Nervous System Stimulants/administration & dosage/adverse effects
KW - Cocaine-Related Disorders/complications
KW - Feasibility Studies
KW - Female
KW - HIV Infections/drug therapy/psychology
KW - HIV Seropositivity
KW - Humans
KW - Interviews as Topic
KW - Male
KW - Middle Aged
KW - Motivation
KW - Patient Acceptance of Health Care
KW - Pilot Projects
KW - Qualitative Research
KW - Reimbursement, Incentive
KW - Syndemic
KW - Treatment Outcome
KW - Viral Load
KW - Writing
KW - cocaine
KW - Contingency management
KW - Expressive writing
KW - Syndemics
AU - D. Jemison
AU - S. Jackson
AU - O. Oni
AU - D. Cats-Baril
AU - S. Thomas-Smith
AU - A. Batchelder
AU - A. Rodriguez
AU - S. E. Dilworth
AU - L. R. Metsch
AU - D. Jones
AU - D. J. Feaster
AU - C. O'Cleirigh
AU - G. Ironson
AU - A. W. Carrico
A1 - 
AB - This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log(10) HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.
AD - Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA.; Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA.; Department of Family Medicine, Jackson Memorial Hospital, Miami, USA.; Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA.; Department of Family Medicine, John H. Stroger Hospital, Chicago, USA.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, USA.; Department of Medicine, School of Medicine, University of Miami, Miami, USA.; Department of Medicine, School of Medicine, University of California, San Francisco, USA.; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.; Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA.; Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA.; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, USA.; Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, USA.; Department of Public Health Sciences, School of Medicine, University of Miami, Miami, USA. a.carrico@miami.edu.; University of Miami Miller School of Medicine, 1120 NW 14th Street, Office 1005, Miami, FL, 33136, USA. a.carrico@miami.edu.
BT - AIDS and behavior
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 9
DO - 10.1007/s10461-019-02625-2
IS - 9
JF - AIDS and behavior
LA - eng
M1 - Journal Article
N2 - This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log(10) HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.
PY - 2019
SN - 1573-3254; 1090-7165; 1090-7165
SP - 2467
EP - 2476
EP - 
T1 - Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women
T2 - AIDS and behavior
TI - Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 31407212
U3 - 10.1007/s10461-019-02625-2
VL - 23
VO - 1573-3254; 1090-7165; 1090-7165
Y1 - 2019
Y2 - Sep
ER -