Abstract
Introduction: In the era of HIV treatment as prevention (TasP), evidence-based interventions that optimize viral suppression among people who use stimulants such as methamphetamine are needed to improve health outcomes and reduce onward transmission risk. We tested the efficacy of positive affect intervention delivered during community-based contingency management (CM) for reducing viral load in sexual minority men living with HIV who use methamphetamine. Methods: Conducted in San Francisco, this Phase II randomized controlled trial tested the efficacy of a positive affect intervention for boosting and extending the effectiveness of community-based CM for stimulant abstinence to achieve more durable reductions in HIV viral load. From 2013 to 2017, 110 sexual minority men living with HIV who had biologically confirmed, recent methamphetamine use were randomized to receive a positive affect intervention (n = 55) or attention-control condition (n = 55). All individual positive affect intervention and attention-control sessions were delivered during three months of community-based CM where participants received financial incentives for stimulant abstinence. The 5-session positive affect intervention was designed to provide skills for managing stimulant withdrawal symptoms as well as sensitize individuals to natural sources of reward. The attention-control condition consisted of neutral writing exercises and self-report measures. Results: Men randomized to the positive affect intervention displayed significantly lower log10 HIV viral load at six, twelve and fifteen months compared to those in the attention-control condition. Men in the positive affect intervention also had significantly lower risk of at least one unsuppressed HIV RNA (≥200 copies/mL) over the 15-month follow-up. There were concurrent, statistically significant intervention-related increases in positive affect as well as decreases in the self-reported frequency of stimulant use at six and twelve months. Conclusions: Delivering a positive affect intervention during community-based CM with sexual minority men who use methamphetamine achieved durable and clinically meaningful reductions in HIV viral load that were paralleled by increases in positive affect and decreases in stimulant use. Further clinical research is needed to determine the effectiveness of integrative, behavioural interventions for optimizing the clinical and public health benefits of TasP in sexual minority men who use stimulants such as methamphetamine.
| Original language | English (US) |
|---|---|
| Article number | e25436 |
| Journal | Journal of the International AIDS Society |
| Volume | 22 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2019 |
Funding
This project was supported by the National Institute on Drug Abuse (R01-DA033854; Carrico, Woods, and Moskowitz, PIs) and the National Institute of Mental Health (K24-MH093225; Moskowitz, PI). Additional support for this project was provided by the University of California, San Francisco Center for AIDS Research's Virology Core (P30-AI027763; Volberding, PI) and the Center for HIV Research and Mental Health (P30-MH116867; Safren, PI). Funding for publication was provided by the AIDS Healthcare Foundation Global Public Health Institute at the University of Miami. The authors thank multiple staff members who have contributed time and effort to the successful execution of this project including: Mr. Justin Lagana-Jackson, Mr. David Olem, Mr. Paul Cotten, Ms. Maya Earle, and Dr. Jeffrey Sundberg. We are also thankful for the support of Dr. Teri Leigler who oversaw HIV viral load assays before her death. Dr. Leigler was a kind and dedicated colleague who cared deeply about ending the HIV/AIDS epidemic. This project was inspired by the mentorship of Dr. Michael Siever, a pioneer in harm reduction substance use disorder treatment for sexual minority men. The authors also thank Dr. James Dilley and Ms. Lori Thoemmes who provided field site space for the study team at the Alliance Health Project. Finally, the authors are grateful to the study participants for choosing to join this project. This project was supported by the National Institute on Drug Abuse (R01-DA033854; Carrico, Woods, and Moskowitz, PIs) and the National Institute of Mental Health (K24-MH093225; Moskowitz, PI). Additional support for this project was provided by the University of California, San Francisco Center for AIDS Research's Virology Core (P30-AI027763; Volberding, PI) and the Center for HIV Research and Mental Health (P30-MH116867; Safren, PI). Funding for publication was provided by the AIDS Healthcare Foundation Global Public Health Institute at the University of Miami. This project was supported by the National Institute on Drug Abuse (R01‐DA033854; Carrico, Woods, and Moskowitz, PIs) and the National Institute of Mental Health (K24‐MH093225; Moskowitz, PI). Additional support for this project was provided by the University of California, San Francisco Center for AIDS Research's Virology Core (P30‐AI027763; Volberding, PI) and the Center for HIV Research and Mental Health (P30‐MH116867; Safren, PI). Funding for publication was provided by the AIDS Healthcare Foundation Global Public Health Institute at the University of Miami.
Keywords
- HIV
- contingency management
- men who have sex with men
- methamphetamine
- mindfulness
- positive affect
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Infectious Diseases
