This study reports the feasibility, acceptability, and preliminary efficacy of the bio-behavioral community-friendly health recovery program—an integrated, HIV prevention intervention to improve pre-exposure prophylaxis (PrEP) adherence and HIV-risk reduction behaviors among high-risk people who use drugs. We used a within-subjects, pretest–posttest follow-up design to recruit participants, who were HIV-uninfected, methadone-maintained and reported HIV-risk behaviors and had initiated PrEP (n = 40; males: 55%). Participants were assessed at baseline (T0), immediately post-intervention (4 weeks: T4) and 4 weeks post-intervention (T8). Immediately after completing the four weekly intervention groups, participants underwent a post-intervention assessment including in-depth qualitative interviews. Feasibility was high, assessed by participant willingness to enroll (90.1%) and retention (95%). Results showed that participants were highly satisfied and perceived the intervention as valuable and acceptable [mean: 81.3 (range 0–100)]. Significant enhancements in self-reported PrEP adherence [F(2,74) = 7.500, p = 0.001] and PrEP-related knowledge [F(2,74) = 3.828, p = 0.026] were observed. Drug-related (e.g., injection of drugs, sharing of injection equipment) and sex-related (e.g., number of sexual partners, condomless sex) risk behaviors were reduced, while information, motivation, and behavioral skills (IMB) constructs increased. The results support feasibility and high acceptability and support further examination of the efficacy of this combination bio-behavioral intervention in a prospective clinical trial.
HIV prevention HIV risk Pre-exposure prophylaxis People who use drugs Substance abuse Methadone maintenance program
This is a preview of subscription content, log in to check access.
This work was supported by grants from the National Institute on Drug Abuse for research (R01 DA032290 to MMC) and for career development (K24 DA017072 to FLA; K02 DA033139 to MMC).
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to disclose.
The study protocol was approved by the Institutional Review Board (IRB) at the University of Connecticut and received board approval from APT Foundation Inc. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Marshall BDL, Friedman SR, Monteiro JFG, Paczkowski M, Tempalski B, Pouget ER, et al. Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs. Health Aff. 2014;33(3):401–9.CrossRefGoogle Scholar
Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12(3):335–53.CrossRefPubMedGoogle Scholar
Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;376(9737):268–84.CrossRefPubMedGoogle Scholar
Volkow ND, Montaner J. The urgency of providing comprehensive and integrated treatment for substance abusers with HIV. Health Aff (Project Hope). 2011;30(8):1411–9.CrossRefGoogle Scholar
CDC. Effective interventions: HIV prevention that works. Atlanta: CDC; 2017.Google Scholar
Sadeghi-Najafabadi M. The influence of neurocognitive impairment on hiv risk reduction intervention outcomes among drug dependent methadone-maintained patients. Storrs: University of Connecticut; 2013.Google Scholar
Worley MJ, Tate SR, Brown SA. Mediational relations between 12-step attendance, depression, and substance use in patients with comorbid substance dependence and major depression. Addiction. 2012;107(11):1974–83.CrossRefPubMedPubMedCentralGoogle Scholar
Huedo-Medina TB, Shrestha R, Copenhaver M. Modeling a theory-based approach to examine the influence of neurocognitive impairment on HIV risk reduction behaviors among drug users in treatment. AIDS Behav. 2016;20(8):1646–57.CrossRefPubMedPubMedCentralGoogle Scholar
CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014: a clinical practice guideline. Washington, DC: Department of Health and Human Services USA—Centers for Disease Control and Prevention; 2014.Google Scholar
Shrestha R, Karki P, Altice FL, Huedo-Medina TB, Meyer JP, Madden L, et al. Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment. Drug Alcohol Depend. 2017;173:107–16.CrossRefPubMedPubMedCentralGoogle Scholar
Kuo I, Olsen H, Patrick R, Phillips G II, Magnus M, Opoku J, et al. Willingness to use HIV pre-exposure prophylaxis among community-recruited, older people who inject drugs in Washington, DC. Drug Alcohol Depend. 2016;164:8–13.CrossRefPubMedGoogle Scholar
Shrestha R, Altice F, Karki P, Copenhaver M. Developing an integrated, brief bio-behavioral HIV prevention intervention for high risk drug users in treatment: the process and outcome of formative research. Front Immunol. 2017;8:561.CrossRefPubMedPubMedCentralGoogle Scholar
Brown G, Reeders D, Dowsett GW, Ellard J, Carman M, Hendry N, et al. Investigating combination HIV prevention: isolated interventions or complex system. J Int AIDS Soc. 2015;18(1):20499.CrossRefPubMedPubMedCentralGoogle Scholar
Brown JL, Sales JM, DiClemente RJ. Combination HIV prevention interventions: the potential of integrated behavioral and biomedical approaches. Curr HIV/AIDS Rep. 2014;11(4):363–75.CrossRefPubMedPubMedCentralGoogle Scholar
Meade CS, Towe SL, Skalski LM, Robertson KR. Independent effects of HIV infection and cocaine dependence on neurocognitive impairment in a community sample living in the southern United States. Drug Alcohol Depend. 2015;149:128–35.CrossRefPubMedPubMedCentralGoogle Scholar
Potvin S, Stavro K, Rizkallah E, Pelletier J. Cocaine and cognition: a systematic quantitative review. J Addict Med. 2014;8(5):368–76.CrossRefPubMedGoogle Scholar
Anderson AM, Higgins MK, Ownby RL, Waldrop-Valverde D. Changes in neurocognition and adherence over six months in HIV-infected individuals with cocaine or heroin dependence. AIDS Care. 2015;27(3):333–7.CrossRefPubMedGoogle Scholar
Shrestha R, Huedo-Medina T, Altice F, Krishnan A, Copenhaver M. Examining the acceptability of mHealth technology in HIV prevention among high-risk drug users in treatment. AIDS Behav. 2016;21:3100–10.CrossRefGoogle Scholar
Shrestha R, Huedo-Medina T, Copenhaver M. Sex-related differences in self-reported neurocognitive impairment among high-risk cocaine users in methadone maintenance treatment program. Subst Abuse Res Treat. 2015;9:17–24.Google Scholar
SAMHSA. National registry of evidence-based programs and practices (NREPP). Rockville: SAMHSA; 2015.Google Scholar
Carroll KM, Nich C, Sifry RL, Nuro KF, Frankforter TL, Ball SA, et al. A general system for evaluating therapist adherence and competence in psychotherapy research in the addictions. Drug Alcohol Depend. 2000;57(3):225–38.CrossRefPubMedGoogle Scholar
Dowling-Guyer S, Johnson ME, Fisher DG, Needle R, Watters J, Andersen M, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994;1(4):383–92.CrossRefGoogle Scholar
Copenhaver M, Lee I, Baldwin P. A randomized controlled trial of the community-friendly health recovery program (CHRP) among high-risk drug users in treatment. AIDS Behav. 2013;17(9):2902–13.CrossRefPubMedGoogle Scholar
Avants SK, Margolin A, Usubiaga MH, Doebrick C. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. J Subst Abuse Treat. 2004;26(2):67–78.CrossRefPubMedGoogle Scholar
Liu A, Colfax G, Cohen S, Bacon O. The spectrum of engagement in HIV prevention: proposal for a pre-exposure prophylaxis (PrEP) cascade. In: 7th international conference on HIV treatment and prevention adherence, Miami, FL (2012).Google Scholar
Spector AY, Remien RH, Tross S. PrEP in substance abuse treatment: a qualitative study of treatment provider perspectives. Subst Abuse Treat Prev Policy. 2015;10(1):1–10.CrossRefPubMedPubMedCentralGoogle Scholar
Siedner MJ, Haberer JE, Bwana MB, Ware NC, Bangsberg DR. High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study. BMC Med Inform Decis Mak. 2012;12:56.CrossRefPubMedPubMedCentralGoogle Scholar
Tolan PH, Gorman-Smith D, Henry D, Schoeny M. The benefits of booster interventions: evidence from a family-focused prevention program. Prev Sci. 2009;10(4):287–97.CrossRefPubMedGoogle Scholar
Liu A, Colfax G, Cohen S, Bacon O, Kolber M, Amico K, et al. The spectrum of engagement in HIV prevention: proposal for a PrEP cascade. In: 7th international conference on HIV treatment and prevention adherence, Miami Beach, FL (2012).Google Scholar