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Psychol Addict Behav. 2019 Aug 22. doi: 10.1037/adb0000504. [Epub ahead of print]

Enhancing patient navigation with contingent financial incentives for substance use abatement in persons with HIV and substance use.

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Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine.
San Francisco Department of Public Health.
UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital.
Department of Public Health Sciences, University of Miami Miller School of Medicine.
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University.
Hubert Department of Global Health, Rollins School of Public Health of Emory University.


Substance use can interfere with HIV treatment. A previous multisite clinical trial (Metsch et al., 2016) tested 2 behavioral interventions designed to improve treatment engagement in people with comorbid HIV and drug or heavy alcohol use. Clinical trial participants were randomized to treatment as usual (N = 264), patient navigation (PN; N = 266), or PN with contingency management (PN + CM; N = 271) for 6 months. PN + CM patients could earn financial incentives both for entering substance use disorder (SUD) treatment and for submitting urine and breath samples negative for opioids, stimulants, and alcohol. This secondary analysis compared frequencies of treatment entry and sample submission in the PN versus PN + CM groups and examined associations with viral suppression (defined as ≤200 copies/mL). Incentives were associated with a higher percentage of patients entering SUD treatment (PN = 25.5%; PN + CM = 47.6%; p < .001), a higher percentage submitting samples for drug testing (PN median = 2, interquartile range [IQR] = 0.5; PN + CM median = 8, IQR = 5.1; p < .0001) and a higher percentage submitting samples negative for targeted drugs and alcohol (PN median = 1, IQR = 0.3; PN + CM median = 6, IQR = 2.9; p < .0001). Within the PN + CM group, up to 58% of those with high rates of engagement in activities were virally suppressed at 6 months versus 24-29% in subgroups with lowest engagement. In conclusion, CM was feasibly incorporated into PN for persons with HIV and SUD and was associated with higher rates of engagement in targeted substance use abatement activities. CM has the potential to improve health outcomes in this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).



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