title: Effect of Continuing Care for Cocaine Dependence on HIV Sex-Risk Behaviors.
abstract: Evaluate the effect of continuing care interventions for cocaine use with HIV risk-reduction components on HIV sex-risk. Explore whether cocaine use at treatment initiation interacts with the type of continuing care intervention to affect HIV sex-risk. Cocaine dependent participants (N = 321) were randomized to: (1) Treatment as usual (TAU): intensive outpatient treatment, (2) TAU and telephone monitoring and counseling (TMC), and (3) TAU and TMC plus incentives for participation in telephone contacts (TMC+). Participants in TMC and TMC+ received a brief HIV intervention, with booster sessions as needed. Generalized estimating equations analysis compared TAU, TMC and TMC+ at 6, 12, 18, 24 months post-baseline on the following outcomes: overall HIV sex-risk, number of sexual partners, condom usage, exchange of drugs for sex, exchange of sex for drugs, exchange of money for sex, exchange of sex for money, and crack house visits. Overall sex-risk decreased for all treatment conditions at follow-up, with no treatment main effects. For people with no cocaine use at baseline, TAU experienced greater sex-risk reductions than TMC (p < .01) and TMC+ (p < .001). The three treatment conditions are effective in reducing HIV sex-risk. TMC with HIV risk-reduction components is unnecessary for cocaine-dependent clients who stop using cocaine early in treatment.
authors.affiliation: School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA. schepa@sp2.upenn.edu.
authors.forename: Alexandra S
authors.initials: AS
authors.lastname: Wimberly
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Ivey
authors.affiliation: Biomedical Graduate Studies, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Lior
authors.initials: L
authors.lastname: Rennert
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Department of Behavioral Health, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: McKay
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D019970:Cocaine-Related Disorders / Q000628:therapy*; D017280:Condoms / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D013689:Telephone; D047568:Unsafe Sex / Q000706:statistics & numerical data*
keywords: Cocaine; Continuing care; HIV; Sex-risk