Group-based randomized trial of contingencies for health and abstinence in HIV patients.
OBJECTIVE
Contingency management (CM) treatments are usually applied individually for drug abstinence, but CM can also be targeted toward health behaviors and implemented in groups. This study evaluated effects of a group-based CM intervention that focused on reinforcing health behaviors.


METHODS
HIV-positive patients with cocaine or opioid use disorders (n = 170) were randomized to weekly CM or 12-step (TS) groups for 24 weeks (mean attendance was 10.8 +/- 8.1 sessions for CM participants and 9.0 +/- 6.9 session for TS participants). During the treatment period, both groups received compensation for attendance ($10 per session) and submission of urine samples (about $2 per sample). In addition, participants received $25 for submitting samples and completing evaluations at Months 1, 3, 6, 9, and 12; 65-75 of the 81 participants assigned to TS and 71-80 of the 89 participants assigned to CM completed these evaluations. During the treatment period, patients in the CM group received chances to win prizes contingent upon completing health activities and submitting substance-free specimens (M = $260, SD = $267).


RESULTS
Mean attendance was 10.8 +/- 8.1 sessions for CM participants and 9.0 +/- 6.9 sessions for TS participants. CM participants submitted a significantly greater number of consecutive drug-free specimens than did TS participants (5.2 +/- 6.0 vs. 3.7 +/- 5.6), but proportions of negative samples did not differ between groups during treatment or at follow-up evaluations. From pre- to posttreatment, CM participants showed greater reductions in viral loads and HIV-risk behaviors than did TS participants, but these effects were not maintained throughout the follow-up period.


CONCLUSIONS
These data suggest the efficacy of group-based CM for HIV-positive substance abusers, but more research is needed to extend the long-term benefits.
Petry
Nancy M
NM
Department of Medicine.
Weinstock
Jeremiah
J
Department of Medicine.
Alessi
Sheila M
SM
Department of Medicine.
Lewis
Marilyn W
MW
College of Social Work.
Dieckhaus
Kevin
K
Department of Medicine.
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D016009:Chi-Square Distribution; D019970:Cocaine-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011615:Psychotherapy, Group / Q000379:methods*; D012055:Reinforcement Schedule; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load