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Project RETAIN: Providing Integrated Care for People With HIV Who Use Cocaine
Lisa R Metsch1, Daniel J Feaster2, Lauren K Gooden1
1Department of Sociomedical Sciences, Columbia University, New York, New York, USA.
Open Forum Infectious Diseases
|April 25, 2025
Summary
An integrated intervention did not improve viral suppression in people with HIV (PWH) who use cocaine. While the intervention increased substance use treatment engagement and reduced psychological distress, viral suppression rates remained similar between groups.
Area of Science:
- Public Health
- Infectious Diseases
- Addiction Medicine
Background:
- People with HIV (PWH) who use cocaine often have poor engagement in HIV care, leading to lower rates of virologic suppression.
- Cocaine use is a significant barrier to achieving and maintaining viral suppression in PWH.
- Understanding factors that hinder or promote care engagement is crucial for improving health outcomes in this population.
Purpose of the Study:
- To test the efficacy of an integrated intervention combining substance use treatment and outpatient HIV care.
- To determine if the intervention improves viral suppression rates in PWH who use cocaine and are not virally suppressed.
- To assess the intervention's impact on substance use and psychological distress.
Main Methods:
- Recruited 360 cocaine-using PWH without viral suppression across two US cities.
- Randomized participants to either treatment as usual (TAU) or an integrated intervention group.
- The intervention included patient navigation, motivational enhancement therapy, and cognitive-behavioral therapy for substance use. Viral suppression was assessed at 6 and 12 months.
Main Results:
- No significant difference in viral suppression rates between the intervention (15.6%) and TAU (17.1%) groups (P = .897).
- The intervention group showed significantly higher participation in substance use treatment (87.0%) compared to TAU (7.2%) (P < .001).
- Both groups experienced decreased stimulant use; the intervention group showed greater reduction in oxycodone use. Severe psychological distress declined more in the intervention group at 6 months (P = .0492).
Conclusions:
- The integrated intervention did not improve viral suppression among cocaine-using PWH over 12 months.
- The intervention successfully increased engagement in substance use treatment and reduced psychological distress.
- Further research is needed to develop interventions that enhance retention in care and viral suppression, addressing complex medical and psychosocial needs in this population.
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