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Contingency Management for Integrated Harm Reduction Among Men Who Have Sex with Men Who Use Methamphetamine in Los Angeles: A Pilot Assessment

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Abstract

Methamphetamine (MA) use is associated with HIV transmission among men who have sex with men (MSM) and lapses in medication adherence. Contingency Management (CM) is effective in reducing MA use, but studies of CM to support adherence to HIV prevention or treatment are limited. We conducted a pilot trial of a CM intervention to reduce MA use and improve PrEP/ART adherence among MSM prescribed a tenofovir (TFV)-based regimen for HIV prevention or treatment. Participants were randomly assigned to receive escalating incentives for either MA abstinence or TFV adherence (based on point-of-care urine testing), and to a monitoring schedule of either 2 or 3 visits/week for 4 weeks. 19 MSM were randomized to either CM for MA use or CM for PrEP/ART adherence (median age: 38; IQR: 28–46) and 15 were living with HIV. Participants attended 95.7% (67/70) of scheduled visits in the 2x/week arm and 74.8% (74/99) in the 3x/week arm. TFV adherence was higher among participants in the TFV adherence arm with 93.5% (n = 72/77) of urine samples positive for TFV, compared to 76.6% (n = 49/64) in the MA abstinence arm (p = 0.007). Participants in the MA abstinence arm had more urine samples negative for MA metabolites (20.3%, n = 13/64) than those receiving CM for TFV adherence (6.5%, n = 5/77; p = 0.021). A CM model for MA abstinence and PrEP/ART adherence using twice-weekly visits and urine testing for MA and TFV for MSM who use MA is feasible and potentially effective as an integrated harm reduction strategy.

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Funding

This study was supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS; P30 MH058107). CSB is supported by the National Institute on Drug Abuse (K23 DA054004). Urine testing was supported by R01AI143340 (MG).

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA

    Cheríe S. Blair & Jesse L. Clark

  2. Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA

    Monica Gandhi

  3. Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Steven Shoptaw, Christopher Blades & Jesse L. Clark

  4. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Steven Shoptaw

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  1. Cheríe S. Blair
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  5. Jesse L. Clark
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Contributions

SS, CB, MG, and JLC contributed to the study conception, design, and data collection. All authors contributed to the analysis. The first draft of the manuscript was written by CSB and all authors commented on multiple versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Cheríe S. Blair.

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The study was reviewed and approved by the Office of Human Research Participant Protection (OHRPP) at the University of California, Los Angeles (IRB#19-001996).

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All participants provided written informed consent prior to enrollment.

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Blair, C.S., Gandhi, M., Shoptaw, S. et al. Contingency Management for Integrated Harm Reduction Among Men Who Have Sex with Men Who Use Methamphetamine in Los Angeles: A Pilot Assessment. AIDS Behav 27, 1962–1971 (2023). https://doi.org/10.1007/s10461-022-03929-6

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