Pilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women

  • Danita Jemison
  • Sequoia Jackson
  • Olorunleke Oni
  • Deva Cats-Baril
  • Shawdae Thomas-Smith
  • Abigail Batchelder
  • Allan Rodriguez
  • Samantha E. Dilworth
  • Lisa R. Metsch
  • Deborah Jones
  • Daniel J. Feaster
  • Conall O’Cleirigh
  • Gail Ironson
  • Adam W. CarricoEmail author
Original Paper


This pilot randomized controlled trial examined the feasibility and acceptability of a Syndemics intervention targeting the intersection of stimulant use, trauma, and difficulties with HIV disease management in cocaine-using women. All participants received contingency management (CM) for 3 months with financial incentives for stimulant abstinence during thrice-weekly urine screening and refilling antiretroviral medications monthly. Sixteen participants were randomized to complete four expressive writing (n = 9) or four neutral writing (n = 7) sessions delivered during the CM intervention period. Completion rates for writing sessions were high (15 of 16 women completed all four sessions) and engagement in CM urine screening was moderate with women randomized to expressive writing providing a median of 11 non-reactive urine samples for stimulants. There were non-significant trends for those randomized to expressive writing to provide more CM urine samples that were non-reactive for stimulants, report greater decreases in severity of cocaine use, and display reductions in log10 HIV viral load at 6 months. Although the Syndemics intervention was feasible and acceptable to many women, qualitative interviews with eligible participants who were not randomized identified structural and psychological barriers to engagement. Further clinical research is needed to test the efficacy of Syndemics interventions with HIV-positive, cocaine-using women.


Cocaine Contingency management Expressive writing Syndemics Viral load 



This project was supported by a pilot award from the Miami Center for AIDS Research (P30-AI073961; Pahwa, PI). Additional support was provided by the Center for HIV and Research in Mental Health (P30-MH116867; Safren, PI). We would also like to thank Ms. Arnetta Phillips for coordinating recruitment efforts for this project. We are grateful to Dr. Ranjini Valiathan for her support in conducting assays to measure CD4+ T-cell count and HIV viral load. Finally, we would like to thank Ji-Young Lee, Todd Jackson, Catherine Zaw, Jared Lee, and Erin Collier for their assistance in implementing the research protocol. Most importantly, we are grateful to the study participants who placed a great deal of trust in our team for this project.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Danita Jemison
    • 1
  • Sequoia Jackson
    • 1
  • Olorunleke Oni
    • 2
  • Deva Cats-Baril
    • 1
  • Shawdae Thomas-Smith
    • 3
  • Abigail Batchelder
    • 4
  • Allan Rodriguez
    • 5
  • Samantha E. Dilworth
    • 6
  • Lisa R. Metsch
    • 7
  • Deborah Jones
    • 1
  • Daniel J. Feaster
    • 1
  • Conall O’Cleirigh
    • 4
  • Gail Ironson
    • 8
  • Adam W. Carrico
    • 1
    • 9
    Email author
  1. 1.Department of Public Health Sciences, School of MedicineUniversity of MiamiMiamiUSA
  2. 2.Department of Family MedicineJackson Memorial HospitalMiamiUSA
  3. 3.Department of Family MedicineJohn H. Stroger HospitalChicagoUSA
  4. 4.Department of PsychiatryHarvard Medical School/Massachusetts General HospitalBostonUSA
  5. 5.Department of Medicine, School of MedicineUniversity of MiamiMiamiUSA
  6. 6.Department of Medicine, School of MedicineUniversity of CaliforniaSan FranciscoUSA
  7. 7.Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  8. 8.Department of Psychology, College of Arts and SciencesUniversity of MiamiCoral GablesUSA
  9. 9.University of Miami Miller School of MedicineMiamiUSA

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