Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine

Abstract

Introduction In the era of HIV treatment as prevention (TasP), evidence‐based interventions that optimize viral suppression among people who use stimulants such as methamphetamine are needed to improve health outcomes and reduce onward transmission risk. We tested the efficacy of positive affect intervention delivered during community‐based contingency management (CM) for reducing viral load in sexual minority men living with HIV who use methamphetamine. Methods Conducted in San Francisco, this Phase II randomized controlled trial tested the efficacy of a positive affect intervention for boosting and extending the effectiveness of community‐based CM for stimulant abstinence to achieve more durable reductions in HIV viral load. From 2013 to 2017, 110 sexual minority men living with HIV who had biologically confirmed, recent methamphetamine use were randomized to receive a positive affect intervention (n = 55) or attention‐control condition (n = 55). All individual positive affect intervention and attention‐control sessions were delivered during three months of community‐based CM where participants received financial incentives for stimulant abstinence. The 5‐session positive affect intervention was designed to provide skills for managing stimulant withdrawal symptoms as well as sensitize individuals to natural sources of reward. The attention‐control condition consisted of neutral writing exercises and self‐report measures. Results Men randomized to the positive affect intervention displayed significantly lower log10 HIV viral load at six, twelve and fifteen months compared to those in the attention‐control condition. Men in the positive affect intervention also had significantly lower risk of at least one unsuppressed HIV RNA (≥200 copies/mL) over the 15‐month follow‐up. There were concurrent, statistically significant intervention‐related increases in positive affect as well as decreases in the self‐reported frequency of stimulant use at six and twelve months. Conclusions Delivering a positive affect intervention during community‐based CM with sexual minority men who use methamphetamine achieved durable and clinically meaningful reductions in HIV viral load that were paralleled by increases in positive affect and decreases in stimulant use. Further clinical research is needed to determine the effectiveness of integrative, behavioural interventions for optimizing the clinical and public health benefits of TasP in sexual minority men who use stimulants such as methamphetamine.

Posttraumatic growth and well-being among people living with HIV: A systematic review and meta-analysis in recognition of 40 years of HIV/AIDS

“…Also, in the case of PLWH, the promotion PTG is associated with specific goals, including not only enhancing compliance with the rigors of treatment, but also learning to benefit from close relationships [33]. Finally, the access to psychological care for these patients is still very limited and acknowledgement of its meaning for PLWH is still a challenge in the medical care for this patient group [31].…”

“…However, along with the tremendous progress in the treatment of HIV/AIDS and its transformation from a terminal to a chronic and manageable medical problem [31,32], more researchers have started to study the positive side of trauma that accompanies HIV-related PTG [14,26]. However, according to a recent review by Rzeszutek and Gruszczyńska [33], these studies present a very incomplete, thematically heterogonous, and inconsistent picture of growth predictors among PLWH.…”

Feasibility and Acceptability of a Program to Promote Positive Affect, Well-Being and Gender Empowerment in Black Women Living with HIV

“…At ten months post-intervention, participants in the intervention group reported higher past-day positive affect, reductions in intrusive and avoidant thoughts about HIV, and a lower likelihood of being on antidepressants as compared to the control group [ 5 ]. In another randomized trial of the positive affect intervention delivered in-person to men living with HIV (MLWH), the program resulted in durable and clinically meaningful reductions in HIV viral load as well as concomitant improvements in positive affect and reductions in self-reported stimulant use [ 22 ].…”

Sexual Minority Mental Health

“…Other interventions have focused on addressing positive and negative affect in sexual minority men who use substances, particularly crystal methamphetamine, based on data to support the importance of positive affect in active coping and self-efficacy in avoiding triggers and remaining abstinent (Carrico et al, 2013). Carrico and colleagues tested positive affect interventions in community settings in San Francisco (Carrico et al, 2013) and in randomized trials for sexual minority men living with HIV who also use crystal methamphetamine and noted significant improvements in positive affect and ART medication adherence compared to a neutral writing intervention (Carrico et al, 2019).…”