title: Improved adherence with contingency management.
abstract: Contingency management (CM) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged populations. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidenced suboptimal adherence during a baseline assessment were randomly assigned to 16 weeks of weekly CM-based counseling or supportive counseling, followed by 16 additional weeks of data collection and adherence feedback to providers. The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening (MEMS) and brief substance abuse counseling. CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence. Potential total earnings averaged $800. Mean MEMS-measured adherence to the reinforced medication increased from 61% at baseline to 76% during the 16-week treatment phase and was significantly increased relative to the supportive counseling group (p = 0.01). Furthermore, mean log-transformed viral load was significantly lower in the CM group. However, by the end of the 16-week follow-up phase, differences between groups in adherence and viral load were no longer significantly different. Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase. A brief CM-based intervention was associated with significantly higher adherence and lower viral loads. Future studies should evaluate methods to extend effects for longer term benefits.
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut, USA. marc.rosen@yale.edu
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
authors.forename: Kevin
authors.initials: K
authors.lastname: Dieckhaus
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McMahon
authors.forename: Barbara
authors.initials: B
authors.lastname: Valdes
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Petry
authors.forename: Joyce
authors.initials: J
authors.lastname: Cramer
authors.forename: Bruce
authors.initials: B
authors.lastname: Rounsaville
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003376:Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D015819:Substance Abuse, Intravenous; D016312:Treatment Refusal; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents