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Improved adherence with contingency management.

Marc I Rosen1, Kevin Dieckhaus, Thomas J McMahon

  • 1Yale University School of Medicine, New Haven, Connecticut, USA. marc.rosen@yale.edu

AIDS Patient Care and Stds
|February 1, 2007
PubMed
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Contingency management (CM) significantly improved antiretroviral medication adherence and lowered viral load in individuals with substance use histories. However, these benefits diminished after the intervention period ended.

Area of Science:

  • Public Health
  • Behavioral Science
  • Infectious Disease Management

Background:

  • Suboptimal adherence to antiretroviral medication is a significant challenge in managing HIV/AIDS, particularly among disadvantaged populations with histories of illicit substance use.
  • Contingency management (CM) interventions, which use positive reinforcement, have demonstrated potential in improving medication adherence in various populations.

Purpose of the Study:

  • To evaluate the effectiveness of a brief contingency management (CM) intervention, utilizing electronic monitoring and substance abuse counseling, in improving antiretroviral medication adherence and viral load among individuals with a history of substance use.
  • To compare the outcomes of CM-based counseling with supportive counseling in this population.

Main Methods:

  • Fifty-six participants with suboptimal antiretroviral adherence and substance use histories were randomized to 16 weeks of either CM-based counseling or supportive counseling.

Related Experiment Videos

  • The CM intervention incorporated data from electronic pill-bottle caps (MEMS) and provided incentives for adherence, including prize drawings for perfect adherence.
  • Adherence, viral load, and urine toxicology were assessed throughout the treatment and a subsequent 16-week follow-up period.

    • Main Results:

    • Contingency management significantly increased medication adherence from 61% to 76% during the treatment phase compared to supportive counseling (p = 0.01).
    • The CM group also showed significantly lower mean log-transformed viral loads during the treatment phase.
    • However, differences in adherence and viral load between groups were not significant by the end of the 16-week follow-up period. Urine toxicology results did not differ significantly between groups.

    Conclusions:

    • A brief CM intervention can effectively improve antiretroviral adherence and reduce viral load in individuals with substance use histories.
    • The positive effects of CM on adherence and viral load may not be sustained long-term without continued intervention.
    • Further research is needed to develop strategies for extending the benefits of CM for long-term positive health outcomes.