Contingency management among homeless, out-of-treatment men who have sex with men

Abstract

Homeless men who have sex with men (MSM) are a particularly vulnerable population with high rates of substance dependence, psychiatric disorders, and HIV prevalence. Most need strong incentives to engage with community-based prevention and treatment programs. Contingency Management (CM) was implemented in a community HIV prevention setting and targeted reduced substance use and increased health-promoting behaviors over a 24-week intervention period. Participants in the CM condition achieved greater reductions in stimulant and alcohol use (χ2 = 27.36, p<.01) and, in particular, methamphetamine use (χ2 = 21.78, p<.01), and greater increases in health-promoting behaviors (χ2 = 37.83, p<.01) during the intervention period than those in the control group. Reductions in substance use were maintained to 9- and 12-month follow-up evaluations. Findings indicate the utility of CM for this high-risk population and the feasibility of implementing the intervention in a community-based HIV prevention program.

A Systematic Review of Behavioral and Treatment Outcome Studies Among HIV-Infected Men Who Have Sex with Men Who Abuse Crystal Methamphetamine

“…Contingency management (CM) interventions have also been used to treat crystal meth abuse [63][64][65][66][67][68][69] ; however, there is conflicting evidence regarding CM's efficacy. CM is a psychotherapy that provides rewards (e.g., cash or vouchers exchangeable for goods) for the achievement of specific treatment goals (e.g., abstinence from drug use or treatment session attendance).…”

“…In a similar study, CM was implemented in a community HIV prevention setting in a sample of 131 homeless, substance-dependent MSM (28% HIV-infected). 66 Over the course of the 24-week intervention, both the control and the CM group received points for participating in HIV adherence activities. However, the CM arm also received points for crystal meth abstinence and health-promoting behaviors.…”

Clinical Aspects of HIV‐Related Neurocognitive Disorders

“…Following initiation of cART, these changes can normalize although they may lag behind the rise in CD4 cell count and fall in CSF HIV viral load. MRS abnormalities are also reported in milder forms of HAND, in patients with possible ARV neurotoxicity and in cART-naive patients starting ARVs [34][35][36].…”

“…The major limitation of CM is that behavioural changes are typically not sustained after the reinforcement schedule is terminated [36]. A recent negative pilot RCT [37] also demonstrated the limits of this approach in methamphetamineusing MSM in nontreatment settings.…”

Delay-discounting among homeless, out-of-treatment, substance-dependent men who have sex with men

“…Participants were a subset of 20 homeless, S-D MSM enrolled in a NIDA-funded, randomized, controlled trial (N = 131) investigating the effects of a contingency management (CM) intervention among individuals participating in a low-intensity HIV health education/risk reduction program (16), and 20 matched volunteer controls. Participants were matched on age and ethnicity using propensity-scoring techniques.…”