Enhancing Patient Navigation With Contingent Financial Incentives for Substance Use Abatement in Persons With HIV and Substance Use

Maxine L. Stitzer, Natalie Gukasyan, Tim Matheson, James L. Sorensen, Daniel J. Feaster, Rui Duan, Lauren Gooden, Carlos del Rio, Lisa R. Metsch

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalPsychology of Addictive Behaviors
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Patient Navigation
Motivation
HIV
Substance-Related Disorders
Alcohols
Therapeutics
Clinical Trials
Pharmaceutical Preparations
Opioid Analgesics
Urine
Health

Keywords

  • Abstinence incentives
  • Contingency management
  • HIV and substance use
  • HIV health outcomes
  • Substance use disorder treatment

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Enhancing Patient Navigation With Contingent Financial Incentives for Substance Use Abatement in Persons With HIV and Substance Use. / Stitzer, Maxine L.; Gukasyan, Natalie; Matheson, Tim; Sorensen, James L.; Feaster, Daniel J.; Duan, Rui; Gooden, Lauren; del Rio, Carlos; Metsch, Lisa R.

In: Psychology of Addictive Behaviors, 01.01.2019.

Research output: Contribution to journalArticle

Stitzer, Maxine L. ; Gukasyan, Natalie ; Matheson, Tim ; Sorensen, James L. ; Feaster, Daniel J. ; Duan, Rui ; Gooden, Lauren ; del Rio, Carlos ; Metsch, Lisa R. / Enhancing Patient Navigation With Contingent Financial Incentives for Substance Use Abatement in Persons With HIV and Substance Use. In: Psychology of Addictive Behaviors. 2019.
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abstract = "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.",
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AB - 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.

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