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A Remotely-Delivered CBT and Contingency Management Therapy for Substance Using People with HIV

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Abstract

Substance using HIV patients are at risk for non-adherence, and most prior interventions in this population have had only modest effects on adherence. Contingency management (CM) is a promising intervention. The Centralized Off-site Adherence Enhancement (CARE) program involved 12 telephone-delivered substance and adherence-targeted cognitive behavior therapy sessions coupled with CM for adherence to antiretroviral therapy (ART) and counseling participation. CM involved 6 weeks of escalating reinforcement for taking prescribed doses followed by 6 weeks of tapering variable rate reinforcement, and separate reinforcement for counseling ($806 possible). Participants’ adherence was measured by devices which wirelessly provided real-time notification of device-opening. HIV infected patients on ART (N = 10) with recent stimulant or alcohol use completed 10.2 of 12 possible telephone sessions, spent 42.8 min/call, and rated the counseling 6.2 on a 1–7 scale. Medication adherence improved from 81 to 93 % (p = 0.04). CARE appears to be acceptable and engaging.

Resumen

Los pacientes con VIH que utilizan substancias o alcohol están en riesgo de no adherirse al tratamiento, y la mayoría de las intervenciones anteriores de este grupo han demostrado efectos modestos en la adherencia. El Manejo de Contingencias (CM) es una intervención prometedora. El programa central para incrementar la adherencia a tratamiento (CARE por sus siglas en Inglés) se compone de 12 sesiones de asesoramiento vía telefónica que incluyen Terapia de Comportamiento Cognitivo (CBT por sus siglas en Inglés) teniendo como objetivo la adherencia y uso de sustancias, asi como el CM para mejorar la adherencia al tratamiento antirretroviral (ART). El CM involucra 6 semanas de sesiones de reforzamiento gradual para tomar las dosis prescritas, seguido por 6 semanas de sesiones de reforzamiento variable, proveyendo un estímulo por participación en las sesiones (de hasta $806). La adherencia de los participantes se midió mediante dispositivos inalámbricos que proporcionaron la notificación en tiempo real de apertura de estos dispositivos. Los pacientes infectados con VIH que tomaban tratamiento antirretroviral (N = 10) y que habían usado recientemente algún estimulante o alcohol completaron 10.2 sesiones telefónicas de 12 posibles, duraron 42.8 minutos en cada llamada, y calificaron las sesiones de asesoramiento de 6.2 en una escala de 1–7. La adherencia al tratamiento mejoró de un 81 % a un 93 % (p = 0.04). El programa CARE parece ser un método aceptable y prometedor.

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References

  1. Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, et al. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41(2):194–200.

    Article  PubMed  Google Scholar 

  2. Buchacz K, Baker RK, Palella FJ Jr, Chmiel JS, Lichtenstein KA, Novak RM, et al. AIDS-defining opportunistic illnesses in US patients, 1994–2007: a cohort study. Aids. 2010;24(10):1549–59.

    Article  PubMed  Google Scholar 

  3. Puhan MA, Van Natta ML, Palella FJ, Addessi A, Meinert C. Ocular Complications of ARG. Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. Clin Infect Dis. 2010;51(8):947–56.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  5. Bangsberg DR. Less than 95 % adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):939–41.

    Article  CAS  PubMed  Google Scholar 

  6. Bangsberg DR, Kroetz DL, Deeks SG. Adherence-resistance relationships to combination HIV antiretroviral therapy. Curr HIV/AIDS Rep. 2007;4(2):65–72.

    Article  PubMed  Google Scholar 

  7. Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS–a systematic review. Alcohol Alcohol. 2010;45(2):159–66.

    Article  PubMed  Google Scholar 

  8. Aloisi MS, Arici C, Balzano R, Noto P, Piscopo R, Filice G, et al. Behavioral correlates of adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S145–8.

    Article  PubMed  Google Scholar 

  9. Ortego C, Huedo-Medina T, Llorca J, Sevilla L, Santos P, Rodríguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011;15(7):1381–1396.

    Article  PubMed  Google Scholar 

  10. Rosen MI, Black AC, Arnsten JH, Goggin K, Remien RH, Simoni JM, et al. Association between use of specific drugs and antiretroviral adherence: findings from MACH 14. AIDS Behav. 2013;17(1):142–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retrovir. 2010;26(5):511–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Baum MK, Rafie C, Lai S, Sales S, Page B, Campa A. Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. JAIDS J Acquir Immune Defic Syndr. 2009;50(1):93–9. doi:10.1097/QAI.0b013e3181900129.

    Article  Google Scholar 

  13. Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008;22(11):1355–63 (London, England).

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Sullivan LE, Botsko M, Cunningham CO, O’Connor PG, Hersh D, Mitty J, et al. The impact of cocaine use on outcomes in HIV-infected patients receiving buprenorphine/naloxone. JAIDS J Acquir Immune Defic Syndr. 2011;56:S54–61. doi:10.1097/QAI.0b013e3182097576.

    Article  CAS  Google Scholar 

  15. Cofrancesco J Jr, Scherzer R, Tien PC, Gibert CL, Southwell H, Sidney S, et al. Illicit drug use and HIV treatment outcomes in a US cohort. Aids. 2008;22(3):357–65.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Hicks PL, Mulvey KP, Chander G, Fleishman JA, Josephs JS, Korthuis PT, et al. The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care. 2007;19(9):1134–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008. doi:10.1002/14651858.CD000011.pub3.

  18. Rigsby MO, Rosen MI, Beauvais JE, Cramer JA, Rainey PM, O’Malley SS, et al. Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention. J Gen Intern Med. 2000;15(12):841–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Rosen MI, Dieckhaus K, McMahon TJ, Valdes B, Petry NM, Cramer J, et al. Improved adherence with contingency management. AIDS Patient Care STDS. 2007;21(1):30–40.

    Article  PubMed  Google Scholar 

  20. Sorensen JL, Haug NA, Delucchi KL, Gruber V, Kletter E, Batki SL, et al. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug Alcohol Depend. 2007;88(1):54–63.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Dallery J, Raiff BR, Grabinski MJ. Internet-based contingency management to promote smoking cessation: a randomized controlled study. J Appl Behav Anal. 2013;46(4):750–64.

    Article  PubMed  Google Scholar 

  22. Dallery J, Glenn IM, Raiff BR. An Internet-based abstinence reinforcement treatment for cigarette smoking. Drug Alcohol Depend. 2007;86(2–3):230–8.

    Article  PubMed  Google Scholar 

  23. Stoops WW, Dallery J, Fields NM, Nuzzo PA, Schoenberg NE, Martin CA, et al. An internet-based abstinence reinforcement smoking cessation intervention in rural smokers. Drug Alcohol Depend. 2009;105(1–2):56–62.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Alessi SM, Petry NM. A randomized study of cellphone technology to reinforce alcohol abstinence in the natural environment. Addiction. 2013;108(5):900–9 (Abingdon, England).

    Article  PubMed Central  PubMed  Google Scholar 

  25. Raiff BR, Dallery J. Internet-based contingency management to improve adherence with blood glucose testing recommendations for teens with type 1 diabetes. J Appl Behav Anal. 2010;43(3):487–91.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Ferster CB, Skinner BF. Schedules of reinforcement. New York: Appleton-Century-Crofts; 1957.

  27. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.

    Article  PubMed  Google Scholar 

  28. McHugh RK, Hearon BA, Otto MW. Cognitive behavioral therapy for substance use disorders. Psychiatr Clin N Am. 2010;33(3):511–25.

    Article  Google Scholar 

  29. Muller I, Yardley L. Telephone-delivered cognitive behavioural therapy: a systematic review and meta-analysis. J Telemed Telecare. 2011;17(4):177–84.

    Article  PubMed  Google Scholar 

  30. Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. JAMA. 2012;307(21):2278–85.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Himelhoch S, Medoff D, Maxfield J, Dihmes S, Dixon L, Robinson C, et al. Telephone based cognitive behavioral therapy targeting major depression among urban dwelling, low income people living with HIV/AIDS: results of a randomized controlled trial. AIDS Behav. 2013;17(8):2756–64.

    Article  PubMed  Google Scholar 

  32. Collier AC, Ribaudo H, Mukherjee AL, Feinberg J, Fischl MA, Chesney M. A randomized study of serial telephone call support to increase adherence and thereby improve virologic outcome in persons initiating antiretroviral therapy. J Infect Dis. 2005;192(8):1398–406.

    Article  PubMed  Google Scholar 

  33. Carroll KM. A cognitive-behavioral approach: treating cocaine addiction. Rockville: NIDA; 1998.

    Google Scholar 

  34. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–17.

    Article  CAS  PubMed  Google Scholar 

  35. Rosen MI, Ryan C, Rigsby M. Motivational Enhancement and MEMS review to improve medication adherence. Behav Chang. 2002;19:183–90.

    Article  Google Scholar 

  36. Wagner GJ, Kanouse DE, Golinelli D, Miller LG, Daar ES, Witt MD, et al. Cognitive-behavioral intervention to enhance adherence to antiretroviral therapy: a randomized controlled trial (CCTG 578). Aids. 2006;20(9):1295–302.

    Article  PubMed  Google Scholar 

  37. Safren S, O’Cleirigh C, Bullis J, Otto M, Stein M, Pollack M. An introduction to delivering cognitive behavioral therapy for adherence and depression (CBT-AD) for individuals living with HIV infection. 5th International conference on HIV treatment adherence. Miami; 2010.

  38. Safren SA, O’Cleirigh CM, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80(3):404–15.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Tetrault JM, Kozal MJ, Chiarella J, Sullivan LE, Dinh AT, Fiellin DA. Association between risk behaviors and antiretroviral resistance in HIV-infected patients receiving opioid agonist treatment. J Addict Med. 2013;7(2):102–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Sobel LC, Sobel MB. Timeline follow-back: a technique for assessing self-reported alcohol consumption. In: Allen JP, Litten RZ, editors. Measuring alcohol consumption: psychosocial and biochemical methods. Totowa: Human Press; 1992. p. 41–72.

    Chapter  Google Scholar 

  41. Litman GK, Stapleton J, Oppenheim AN, Peleg M, Jackson P. Relationship between coping behaviors, their effectiveness and alcoholism relapse and survival. Br J Addict. 1984;79:283–91.

    Article  CAS  PubMed  Google Scholar 

  42. Lamb RJ, Kirby KC, Morral AR, Galbicka G, Iguchi MY. Improving contingency management programs for addiction. Addict Behav. 2004;29(3):507–23.

    Article  CAS  PubMed  Google Scholar 

  43. Herbert JD, Goetter EM, Forman EM, Yuen EK, Erford BM, Milillo JJ, et al. Crossing the line: interstate delivery of remote psychological services. Behav Ther. 2012;35:145–52.

    Google Scholar 

  44. Liu H, Miller LG, Golin CE, Hays RD, Wu T, Wenger NS, et al. Repeated measures analyses of dose timing of antiretroviral medication and its relationship to HIV virologic outcomes. Stat Med. 2007;26(5):991–1007.

    Article  PubMed  Google Scholar 

  45. Liu H, Miller LG, Hays RD, Golin CE, Wu T, Wenger NS, et al. Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors. J Acquir Immune Defic Syndr. 2006;41(3):315–22.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the patients who have participated in the CARE study. This work was supported by Grant R34DA031643 from the National Institute on Drug Abuse (NIDA)/National Institute of Health (NIH). Portions of the paper were presented in June, 2013, at the 8th International Conference on HIV Treatment and Prevention Adherence, Miami, FL.

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, 495 Congress Ave. - MRU Second Floor, New Haven, CT, 06517, USA

    Brent A. Moore, Marc I. Rosen, Karen Ablondi & Anna Sullivan

  2. Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA

    Yan Wang & Honghu Liu

  3. School of Dentistry, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA

    Jie Shen & Honghu Liu

  4. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA

    Mario Guerrero, Lisa Siqueiros & Eric S. Daar

  5. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA

    Eric S. Daar & Honghu Liu

  6. VA Connecticut Healthcare System, West Haven, CT, 06516, USA

    Brent A. Moore, Marc I. Rosen, Karen Ablondi & Anna Sullivan

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  1. Brent A. Moore
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Correspondence to Brent A. Moore.

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Moore, B.A., Rosen, M.I., Wang, Y. et al. A Remotely-Delivered CBT and Contingency Management Therapy for Substance Using People with HIV. AIDS Behav 19 (Suppl 2), 156–162 (2015). https://doi.org/10.1007/s10461-014-0990-x

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