Open AccessPilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women
Author(s) -
Danita Jemison,
Sequoia Jackson,
Olorunleke Oni,
Deva Cats-Baril,
Shawdae Thomas-Smith,
Abigail Batchelder,
Allan Rodríguez,
Samantha E. Dilworth,
Lisa R. Metsch,
Deborah L. Jones,
Daniel J. Feaster,
Conall O’Cleirigh,
Gail Ironson,
Adam W. Carrico
Publication year - 2019
Publication title -
aids and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.994
H-Index - 106
eISSN - 1573-3254
pISSN - 1090-7165
DOI - 10.1007/s10461-019-02625-2
Subject(s) - randomized controlled trial , contingency management , abstinence , psychological intervention , medicine , health psychology , intervention (counseling) , cocaine dependence , stimulant , psychiatry , clinical psychology , physical therapy , public health , addiction , nursing
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 log 10 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.