title: Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial.
abstract: This clinical trial evaluated a contingency management intervention designed to improve medication adherence among HIV-positive methadone maintenance patients. After a 4-week baseline observation phase, eligible participants (N=66) were randomly assigned to: (a) medication coaching sessions every other week to assist with adherence strategies (comparison group) or (b) medication coaching plus voucher reinforcement for opening electronic medication caps on time (voucher group). Baseline adherence (percent doses taken/percent total possible doses) was 51% using electronic measurement, 75% using self-report and 75% using pill count. The intervention was provided for 12 weeks, with a 4-week follow-up. The primary outcome results of the clinical trial indicated effectiveness during the intervention, with significant mean adherence differences between voucher and comparison groups using electronic measurement (78% versus 56%), pill count (86% versus 75%), and self-report (87% versus 69%). Differences between groups faded after vouchers were discontinued. Contingency management shows promise as a strategy to promote antiretroviral medication adherence in this population.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco General Hospital, Building 20, Ward 21, 1001 Potrero Avenue, Box 0852, San Francisco, CA 94110, USA. james.sorensen@ucsf.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Sorensen
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Haug
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.forename: Valerie
authors.initials: V
authors.lastname: Gruber
authors.forename: Evan
authors.initials: E
authors.lastname: Kletter
authors.forename: Steven L
authors.initials: SL
authors.lastname: Batki
authors.forename: Jacqueline P
authors.initials: JP
authors.lastname: Tulsky
authors.forename: Paul
authors.initials: P
authors.lastname: Barnett
authors.forename: Sharon
authors.initials: S
authors.lastname: Hall
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012201:Reward; D013997:Time Factors; D014040:Token Economy
chemical_list: D019380:Anti-HIV Agents; D009294:Narcotics; D008691:Methadone