Effect of Continuing Care for Cocaine Dependence on HIV Sex-Risk Behaviors

Abstract

Evaluate the effect of continuing care interventions for cocaine use with HIV risk-reduction components on HIV sex-risk. Explore whether cocaine use at treatment initiation interacts with the type of continuing care intervention to affect HIV sex-risk. Cocaine dependent participants (N = 321) were randomized to: (1) Treatment as usual (TAU): intensive outpatient treatment, (2) TAU and telephone monitoring and counseling (TMC), and (3) TAU and TMC plus incentives for participation in telephone contacts (TMC+). Participants in TMC and TMC+ received a brief HIV intervention, with booster sessions as needed. Generalized estimating equations analysis compared TAU, TMC and TMC+ at 6, 12, 18, 24 months post-baseline on the following outcomes: overall HIV sex-risk, number of sexual partners, condom usage, exchange of drugs for sex, exchange of sex for drugs, exchange of money for sex, exchange of sex for money, and crack house visits. Overall sex-risk decreased for all treatment conditions at follow-up, with no treatment main effects. For people with no cocaine use at baseline, TAU experienced greater sex-risk reductions than TMC (p < .01) and TMC+ (p < .001). The three treatment conditions are effective in reducing HIV sex-risk. TMC with HIV risk-reduction components is unnecessary for cocaine-dependent clients who stop using cocaine early in treatment.

Keywords: Cocaine; Continuing care; HIV; Sex-risk.

Conflict of interest statement

Conflict of Interest Alexandra S. Wimberly declares that she has no conflict of interest. Megan Ivey declares that she has no conflict of interest. Lior Rennert declares that he has no conflict of interest. James R. McKay declares that he has no conflict of interest.

Figures

Fig. 1

Sex-risk scores by treatment arm. Sex-risk decreased for all treatment conditions from an average of 5.17 at baseline to 2.80 at Month 24. Treatment condition comparisons on sex-risk score were not significant (χ2 = 1.86, p = 0.39). Error bars represent standard error

Fig. 2

a Interaction of no cocaine use at baseline with treatment condition on sex-risk score. Among participants with no baseline cocaine use, those in TAU experienced a lower sex-risk score during follow-up than those in TMC (p < .01) and TMC+ (p < .001). Error bars represent standard error. b Interaction of cocaine use at baseline with treatment condition on sex-risk score. Among participants with baseline cocaine use, those in TMC and TMC+ experienced lower sex-risk scores during follow-up than those in TAU, but this was not significant. Error bars represent standard error