Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.</p> <p>Methods</p> <p>We randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57).</p> <p>Results</p> <p>Retention at 24 weeks was 84%. Comparing consecutive study visits, non-concordant UAI declined significantly in both study arms. During the intervention, CM and control participants were comparably likely to provide urine samples containing methamphetamine (adjusted relative risk [aRR] = 1.09; 95%CI: 0.71, 1.56) and to report non-concordant UAI (aRR = 0.80; 95%CI: 0.47, 1.35). However, during post-intervention follow-up, CM participants were somewhat more likely to provide urine samples containing methamphetamine than control participants (aRR = 1.21; 95%CI: 0.95, 1.54, <it>P </it>= 0.11). Compared to control participants, CM participants were significantly more likely to report weekly or more frequent methamphetamine use and use of more than eight quarters of methamphetamine during the intervention and post-intervention periods.</p> <p>Conclusions</p> <p>While it is possible to enroll and retain MSM who use methamphetamine in a trial of CM conducted outside drug treatment, our data suggest that CM is not likely to have a large, sustained effect on methamphetamine use.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <b>NCT01174654</b></p

Social Determinants of Health and Care Outcomes Among People with HIV in the United States

Fewer than 70% of people with HIV (PWH) in the United States have achieved durable viral suppression. To end the HIV epidemic in the United States, clinicians, researchers, and public health practitioners must devise ways to remove barriers to effective HIV treatment. To identify PWH who experience challenges to accessing health care, we created a simple assessment of social determinants of health (SDOH) among PWH and examined the impact of cumulative social and economic disadvantage on key HIV care outcomes

Pre-exposure Prophylaxis (PrEP) Awareness and Use Among Cisgender Men Who Have Sex With Men (MSM) and Use Methamphetamine in Three Western US Cities

Background In the United States, cisgender men who have sex with men (MSM) who use methamphetamine are at substantial risk of HIV and can benefit from pre-exposure prophylaxis (PrEP). Methods We used data from the National HIV Behavioral Surveillance (NHBS) 2017 survey from Seattle, WA; Portland, OR; and Denver, CO to estimate PrEP awareness and use in the past 12 months among MSM who use methamphetamine. We then compared these estimates to participants who do not use methamphetamine but meet other criteria for PrEP use (i.e., condomless anal sex or a bacterial sexually transmitted infection). We explored reasons for not using PrEP and challenges using PrEP. Results Of the 1,602 MSM who participated in the 2017 NHBS survey in Seattle, WA; Portland, OR; and Denver, CO, 881 met inclusion criteria for this study, of whom 88 (10%) reported methamphetamine use in the past 12 months. Most (95%) participants had heard of PrEP, and 35% had used it in the past 12 months. PrEP awareness was lower among MSM who used methamphetamine (p=.01), but use was not different (p=.26). Among those who had not used PrEP, the most common reason for not using it was not thinking one’s HIV risk was high enough (50%). MSM who used methamphetamine were more likely to report that they were not sure PrEP would prevent them from getting HIV (38% vs 19%, p=.002). Conclusions These results highlight the need for continued efforts to educate and promote PrEP uptake among MSM, particularly those who use methamphetamine

Predictors of Having Naloxone in Urban and Rural Oregon Findings from NHBS and the OR-HOPE Study.

Naloxone is an opioid antagonist that can be effectively administered by bystanders to prevent overdose. We determined the proportion of people who had naloxone and identified predictors of naloxone ownership among two samples of people who inject drugs (PWID) who use opioids in Portland and rural Western Oregon

Characterizing Metrics of Sexual Behavior Stigmas Among Cisgender Men Who Have Sex with Men in Nine Cities Across the United States.

Men who have sex with men (MSM) in the United States (US) are stigmatized for same-sex practices, which can lead to risky sexual behavior, potentiating risk for HIV infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to the local surveys of 9 sites of the Centers for Disease Control and Prevention 2017 National HIV Behavioral Surveillance system, which used venue-based, time-sampling procedures to survey cisgender MSM in US metropolitan statistical areas. We performed exploratory factor analytic procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; Virginia Beach-Norfolk, Virginia) and pooled responses to the items. A three-factor solution - stigma from family (α = 0.70), anticipated health-care stigma (α = 0.75), general social stigma (α = 0.66) - best fit the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the US experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking stigma trends over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the US

Additional file 3 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 3: Appendix 3 Figure. Conceptual diagram of multivariable generalized hierarchical linear model combining individual and site factors

Additional file 2 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 2: Appendix Table 2. HIV-specific criminalization laws – National HIV Behavioral Surveillance, 9 U.S. sites, 2017

Additional file 1 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 1: Appendix Table 1. Sexual behavior stigma scale items and responses by associated factors