Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine

Adam W Carrico, Torsten B Neilands, Samantha E Dilworth, Jennifer L Evans, Walter Gόmez, Jennifer P Jain, Monica Gandhi, Steven Shoptaw, Keith J Horvath, Lara Coffin, Michael V Discepola, Rick Andrews, William J Woods, Daniel J Feaster, Judith T Moskowitz, Adam W Carrico, Torsten B Neilands, Samantha E Dilworth, Jennifer L Evans, Walter Gόmez, Jennifer P Jain, Monica Gandhi, Steven Shoptaw, Keith J Horvath, Lara Coffin, Michael V Discepola, Rick Andrews, William J Woods, Daniel J Feaster, Judith T Moskowitz

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.

Keywords: HIV; contingency management; men who have sex with men; methamphetamine; mindfulness; positive affect.

© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

Figures

Figure 1
Figure 1
Screening, randomization and follow‐up for participants.
Figure 2
Figure 2
Any unsuppressed HIV viral load (≥200 copies/mL) over 15 months by treatment arm.

References

    1. Shoptaw S, Montgomery B, Williams CT, El‐Bassel N, Aramrattana A, Metsch L, et al. Not just the needle: the state of HIV‐prevention science among substance users and future directions. J Acquir Immune Defic Syndr. 2013;63 Suppl 2:S174–8.
    1. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV‐positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.
    1. Carrico AW, Riley ED, Johnson MO, Charlebois ED, Neilands TB, Remien RH, et al. Psychiatric risk factors for HIV disease progression: the role of inconsistent patterns of antiretroviral therapy utilization. J Acquir Immune Defic Syndr. 2011;56(2):146–50.
    1. Carrico AW, Hunt PW, Neilands TB, Dilworth SE, Martin JN, Deeks SG, et al. Stimulant use and viral suppression in the era of universal antiretroviral therapy. J Acquir Immune Defic Syndr, 2019;80(1):89–93.
    1. Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7
    1. Carrico AW, Shoptaw S, Cox C, Stall R, Li X, Ostrow DG, et al. Stimulant use and progression to AIDS or mortality after the initiation of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2014;67(5):508–13.
    1. Adams JW, Bryant KJ, Edelman JE, Fiellin DA, Gaither JR, Gordon AJ, et al. Association of cannabis, stimulant, and alcohol use with mortality prognosis among HIV‐infected men. AIDS Behav. 2018;22(4):1341–51.
    1. Johnson MO, Carrico AW, Chesney MA, Morin SF. Internalized heterosexism among HIV‐positive, gay‐identified men: implications for HIV prevention and care. J Consult Clin Psychol. 2008;76(5):829–39.
    1. Mayer KH, Skeer MR, O'Cleirigh C, Goshe BM, Safren SA. Factors associated with amplified HIV transmission behavior among American men who have sex with men engaged in care: implications for clinical providers. Ann Behav Med. 2014;47(2):165–71.
    1. Colfax G, Santos G‐M, Chu P, Vittinghoff E, Pluddemann A, Kumar S, et al. Amphetamine‐group substances and HIV. Lancet. 2010;376(9739):458–74.
    1. Prendergast M, Podus D, Finney J, Greenwell L, Roll J. Contingency management for treatment of substance use disorders: a meta‐analysis. Addiction. 2006;101(11):1546–60.
    1. Reback CJ, Peck JA, Dierst‐Davies R, Nuno M, Kamien JB, Amass L. Contingency management among homeless, out‐of‐treatment men who have sex with men. J Subst Abuse Treat. 2010;39(3):255–63.
    1. Shoptaw S,Reback CJ, Peck JA, Yang X, Rotheram‐Fuller E, Larkins S, et al. Behavioral treatment approaches for methamphetamine dependence and HIV‐related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005;78(2):125–34.
    1. Roll JM, Petry NM, Stitzer ML, Brecht ML, Peirce JM, McCann MJ, et al. Contingency management for the treatment of methamphetamine use disorders. Am J Psychiatry. 2006;163(11):1993–9.
    1. Metsch LR, Feaster DJ, Gooden L, Matheson T, Stitzer M, Das M, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: a randomized clinical trial. JAMA. 2016;316(2):156–70.
    1. Petry NM, Weinstock J, Alessi SM, Lewis MW, Dieckhaus K. Group‐based randomized trial of contingencies for health and abstinence in HIV patients. J Consult Clin Psychol. 2010;78(1):89–97.
    1. Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC. Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev. 2004;111(1):33–51.
    1. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652–69.
    1. Carrico AW, Carrico AW. Positive emotion: the sirens' song of substance use and the Trojan horse of recovery from addiction In: Gruber J, Moskowitz JT, editors. Positive emotion: Integrating the light sides and dark sides. New York, NY: Oxford University Press; 2014. p. 451–72.
    1. Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000;55(6):647–54.
    1. Carrico AW, Johnson MO, Colfax GN, Moskowitz JT. Affective correlates of stimulant use and adherence to anti‐retroviral therapy among HIV‐positive methamphetamine users. AIDS Behav. 2010;14(4):769–77.
    1. Carrico AW, Woods WJ, Siever MD, Discepola MV, Dilworth SE, Neilands TB, et al. Positive affect and processes of recovery among treatment‐seeking methamphetamine users. Drug Alcohol Depend. 2013;132(3):624–9.
    1. Carrico AW, Moskowitz JT. Positive affect promotes engagement in care after HIV diagnosis. Health Psychol. 2014;33(7):686–9
    1. Moskowitz JT, Carrico AW, Duncan LG, Cohn MA, Cheung EO, Batchelder A, et al. Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV. J Consult Clin Psychol. 2017;85(5):409–23.
    1. Ogedegbe GO, Boutin‐Foster C, Wells MT, Allegrante JP, Isen AM, Jobe JB, et al. A randomized controlled trial of positive‐affect intervention and medication adherence in hypertensive African Americans. Arch Intern Med. 2012;172(4):322–6.
    1. Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta‐analysis of randomized controlled studies. BMC Public Health. 2013;13:119.
    1. Brown KW, Ryan RA, Creswell JD. Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychol Inq. 2007;18(4):211–37.
    1. Witkiewitz K, Bowen S, Douglas H, Hsu SH. Mindfulness‐based relapse prevention for substance craving. Addict Behav. 2013;38(2):1563–71.
    1. Bowen S, Chawla N, Collins SE, Witkiewitz K, Hsu S, Grow J, et al. Mindfulness‐based relapse prevention for substance use disorders: a pilot efficacy trial. Subst Abus. 2009;30(4):295–305.
    1. Bowen S, Witkiewitz K, Clifasefi SL, Grow J, Chawla N, Hsu SH, et al. Relative efficacy of mindfulness‐based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547–56.
    1. Grossman P, Tiefenthaler‐Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3‐year follow‐up benefits in well‐being. Psychother Psychosom. 2007;76(4):226–33.
    1. Carrico AW, Jain J, Discepola MV, Olem D, Andrews R, Woods WJ, et al. A community‐engaged randomized controlled trial of an integrative intervention with HIV‐positive, methamphetamine‐using men who have sex with men. BMC Public Health. 2016;16:673.
    1. Gomez W, Olem D, Andrews R, Discepola MV, Ambrose P, Dilworth SE, et al. Optimizing contingency management with methamphetamine‐using men who have sex with men. Cogn Behav Pract. 2017;25(2):286–95.
    1. Carrico AW, Nation A, Gómez W, Sundberg J, Dilworth SE, Johnson MO, et al. Pilot trial of an expressive writing intervention with HIV‐positive methamphetamine‐using men who have sex with men. Psychol Addict Behav. 2015;29(2):277–82.
    1. Fredrickson BL, Tugade MM, Waugh CE, Larkin GR. What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. J Pers Soc Psychol. 2003;84(2):365–76.
    1. Flannery BA, Volpicelli JR, Pettinati HM. Psychometric properties of the Penn Alcohol Craving Scale. Alcohol Clin Exp Res. 1999;23(8):1289–95.
    1. Mimiaga MJ, Pantalone DW, Biello KB, Hughto JMW, Frank J, O'Cleirigh C. An initial randomized controlled trial of behavioral activation for treatment of concurrent crystal methamphetamine dependence and sexual risk for HIV acquisition among men who have sex with men. AIDS Care. 2019;31(9):1083–95.
    1. Parsons JT, John SA, Millar BM, Starks TJ. Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIV‐positive gay and bisexual men. AIDS Behav. 2018;22(8):2674–86.
    1. Carrico AW, Zepf R, Meanley S, Batchelder A, Stall R. Critical review: when the party is over: a systematic review of behavioral interventions for substance‐using men who have sex with men. J Acquir Immune Defic Syndr. 2016;73(3):299–306.
    1. Colfax GN, Santos GM, Das M, Santos DM, Matheson T, Gasper J, et al. Mirtazapine to reduce methamphetamine use: a randomized controlled trial. Arch Gen Psychiatry. 2011;68(11):1168–75.
    1. Carrico AW, Flentje A, Gruber VA, Woods WJ, Discepola MV, Dilworth SE, et al. Community‐based harm reduction substance abuse treatment with methamphetamine‐using men who have sex with men. J Urban Health. 2014;91(3):555–67.
    1. Gandhi M, Bacchetti P, Ofokotun I, Jin C, Ribaudo HJ, Haas DW, et al. Antiretroviral concentrations in hair strongly predict virologic response in a large human immunodeficiency virus treatment‐naive clinical trial. Clin Infect Dis. 2019;68(6):1044–7.
    1. Gandhi M, Bacchetti P, Rodrigues WC, Spinelli M, Koss CA, Drain PK, et al. Validation of a urine TFV immunoassay for real‐time PrEP and ART adherence testing. In: Conference on Retroviruses and Opportunistic Infections. Seattle WA: 2019.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir