TY - JOUR
KW - Adult
KW - Anti-Retroviral Agents/therapeutic use
KW - Behavior Therapy/methods
KW - Central Nervous System Stimulants
KW - Comorbidity
KW - Female
KW - HIV Infections/epidemiology/therapy
KW - Humans
KW - Male
KW - Middle Aged
KW - Outcome and Process Assessment, Health Care
KW - Pilot Projects
KW - Substance-Related Disorders/epidemiology/therapy
KW - ART
KW - HIV
KW - Stimulants
KW - Behavioral Activation
KW - Contingency management
AU - M. J. Mimiaga
AU - E. F. Closson
AU - D. W. Pantalone
AU - S. A. Safren
AU - J. A. Mitty
A1 - 
AB - There is a high prevalence of stimulant use among HIV-infected individuals, which is associated with suboptimal antiretroviral therapy (ART) adherence, HIV treatment interruptions, detectable HIV viral load, and transmission of HIV via increased sexual risk behavior. Contingency management (CM) is an initially effective treatment for stimulant use. However, the effects of CM are not sustained after the active intervention has ended. One potential contributor to the intractability of existing treatments may be a lack of attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. As a potential approach to address the CM rebound effect - informed by our formative qualitative research with the participant population - we conducted an open pilot trial of an intervention combining CM-BA for HIV-infected individuals with stimulant use disorder. Participants completed weekly BA therapy sessions (10-16 sessions) and thrice-weekly toxicology screenings (12 weeks); contingencies were rewarded for negative toxicology tests to support reengagement into positive life activities. Major assessments were conducted at baseline, 3-, and 6-months. Toxicology screening was repeated prior to the 6-month assessment. Eleven participants with stimulant use disorder enrolled; 7 initiated treatment and completed the full intervention. The mean age was 46 (SD = 5.03) and 14% identified as a racial/ethnic minority. Of the completers, the mean change score in self-reported stimulant use within the past 30 days (within-person change; reduction in self-reported stimulant use) was 4.14 days at 3 months and 5.0 days at 6 months [Cohen's d = 0.89]. The mean change score in weekly toxicology screens (reduction in positive toxicology screens) was .71 at 3 months and 1 at 6 months [Cohen's d = 1.05]. Exit interviews indicated that the integrated intervention was well received and acceptable. This study provides preliminary evidence that a combined CM-BA intervention for this population was feasible (100% retention at 6-months), acceptable (100% of intervention sessions attended; participants rated the intervention 'acceptable' or 'very acceptable'), and may be an option to augment the potency and sustained impact of CM for this population. Future pilot testing using a randomized controlled design is warranted.
AD - a Departments of Behavioral and Social Sciences, Epidemiology, and Psychiatry and Human Behavior , Brown University , Providence , RI , USA.; b The Fenway Institute, Fenway Health , Boston , MA , USA.; b The Fenway Institute, Fenway Health , Boston , MA , USA.; c Department of Public Health, Environments and Society , London School of Hygiene and Tropical Medicine , London , UK.; b The Fenway Institute, Fenway Health , Boston , MA , USA.; d Department of Psychology , University of Massachusetts Boston , Boston , MA , USA.; b The Fenway Institute, Fenway Health , Boston , MA , USA.; e Department of Psychology , University of Miami , Coral Gables , FL , USA.; b The Fenway Institute, Fenway Health , Boston , MA , USA.; f Department of Medicine , Brown University , Providence , RI , USA.
BT - Psychology, Health & Medicine
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 3
DO - 10.1080/13548506.2018.1515492
IS - 3
JF - Psychology, Health & Medicine
LA - eng
M1 - Journal Article
N2 - There is a high prevalence of stimulant use among HIV-infected individuals, which is associated with suboptimal antiretroviral therapy (ART) adherence, HIV treatment interruptions, detectable HIV viral load, and transmission of HIV via increased sexual risk behavior. Contingency management (CM) is an initially effective treatment for stimulant use. However, the effects of CM are not sustained after the active intervention has ended. One potential contributor to the intractability of existing treatments may be a lack of attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. As a potential approach to address the CM rebound effect - informed by our formative qualitative research with the participant population - we conducted an open pilot trial of an intervention combining CM-BA for HIV-infected individuals with stimulant use disorder. Participants completed weekly BA therapy sessions (10-16 sessions) and thrice-weekly toxicology screenings (12 weeks); contingencies were rewarded for negative toxicology tests to support reengagement into positive life activities. Major assessments were conducted at baseline, 3-, and 6-months. Toxicology screening was repeated prior to the 6-month assessment. Eleven participants with stimulant use disorder enrolled; 7 initiated treatment and completed the full intervention. The mean age was 46 (SD = 5.03) and 14% identified as a racial/ethnic minority. Of the completers, the mean change score in self-reported stimulant use within the past 30 days (within-person change; reduction in self-reported stimulant use) was 4.14 days at 3 months and 5.0 days at 6 months [Cohen's d = 0.89]. The mean change score in weekly toxicology screens (reduction in positive toxicology screens) was .71 at 3 months and 1 at 6 months [Cohen's d = 1.05]. Exit interviews indicated that the integrated intervention was well received and acceptable. This study provides preliminary evidence that a combined CM-BA intervention for this population was feasible (100% retention at 6-months), acceptable (100% of intervention sessions attended; participants rated the intervention 'acceptable' or 'very acceptable'), and may be an option to augment the potency and sustained impact of CM for this population. Future pilot testing using a randomized controlled design is warranted.
PY - 2019
SN - 1465-3966; 1354-8506; 1354-8506
SP - 374
EP - 381
EP - 
T1 - Applying behavioral activation to sustain and enhance the effects of contingency management for reducing stimulant use among individuals with HIV infection
T2 - Psychology, Health & Medicine
TI - Applying behavioral activation to sustain and enhance the effects of contingency management for reducing stimulant use among individuals with HIV infection
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 30211620
U3 - 10.1080/13548506.2018.1515492
VL - 24
VO - 1465-3966; 1354-8506; 1354-8506
Y1 - 2019
Y2 - Mar
ER -