Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users.
Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.
Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD, 21224. Electronic address: mstitzer@jhmi.edu.
Maxine
M
Stitzer
Department of Psychiatry and Behavioral Science, University of Washington.
Donald
D
Calsyn
San Francisco Department of Public Health, 25 Van Ness Avenue Suite 500, San Francisco, CA, 94102. Electronic address: tim.matheson@sfdph.org.
Timothy
T
Matheson
UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue SFGH Building 20, Rm. 2117, San Francisco, CA, 94110. Electronic address: james.sorensen@ucsf.edu.
James
J
Sorensen
Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032. Electronic address: Lkg2129@columbia.edu.
Lauren
L
Gooden
Department of Sociomedical Sciences Mailman School of Public Health, Columbia University Columbia University, 722 West 168th Street, Room 918, New York, NY, 10032. Electronic address: lm2892@columbia.edu.
Lisa
L
Metsch
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D015897:Comorbidity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D062526:Patient Navigation / Q000379:methods*; D012054:Reinforcement, Psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*
Behavior targets; Contingency management; HIV disease; Health care incentives; Substance use disorders