HIV-positive Substance Users Research Articles

Effectiveness of an Intervention for Improving Treatment Adherence, Service Utilization and Viral Load Among HIV-Positive Adult Alcohol Users.

This study evaluates whether a group intervention that included cognitive remediation improved ART adherence, service utilization, and viral load among HIV-positive adults with a history of alcohol abuse. HIV-seropositive adults (n=243), recruited from community-based organizations were randomized to the Holistic Health Recovery Program (HHRP-A) or a comparison condition. Both conditions included eight group sessions; outcomes (adherence, service utilization, and viral load) and processes (social support and stress) were measured. Data were collected at baseline, immediately post-intervention, 3months, and 6months follow-up. Participants were ≥ 18 and ≤ 60 ([Formula: see text] years old), 71% male, and 79.6% black. Participants randomized to HHRP-A were more likely to report adequate ART adherence and to report an undetectable viral load at 6months post-intervention. Participants in the HHRP-A condition showed significantly greater improvement in social support than the comparison group. Providing comprehensive health promotion interventions that incorporate cognitive remediation strategies, could improve health outcomes for HIV-positive substance users.

Clinical and Sociobehavioral Prediction Model of 30-Day Hospital Readmissions Among People With HIV and Substance Use Disorder: Beyond Electronic Health Record Data.

Under the Affordable Care Act, hospitals receive reduced reimbursements for excessive 30-day readmissions. However, the Centers for Medicare and Medicaid Services does not consider social and behavioral variables in expected readmission rate calculations, which may unfairly penalize systems caring for socially disadvantaged patients, including patients with HIV. Randomized controlled trial of patient navigation with or without financial incentives in HIV-positive substance users recruited from the inpatient setting at 11 US hospitals. External validation of an existing 30-day readmission prediction model, using variables available in the electronic health record (EHR-only model), in a new multicenter cohort of HIV-positive substance users was assessed by C-statistic and Hosmer-Lemeshow testing. A second model evaluated sociobehavioral factors in improving the prediction model (EHR-plus model) using multivariable regression and C-statistic with cross-validation. The mean age of the cohort was 44.1 years, and participants were predominantly males (67.4%), non-white (88.0%), and poor (62.8%, <$20,000/year). Overall, 17.5% individuals had a hospital readmission within 30 days of initial hospital discharge. The EHR-only model resulted in a C-statistic of 0.65 (95% confidence interval: 0.60 to 0.70). Inclusion of additional sociobehavioral variables, food insecurity and readiness for substance use treatment, in the EHR-plus model resulted in a C-statistic of 0.74 (0.71 after cross-validation, 95% confidence interval: 0.64 to 0.77). Incorporation of detailed social and behavioral variables substantially improved the performance of a 30-day readmission prediction model for hospitalized HIV-positive substance users. Our findings highlight the importance of social determinants in readmission risk and the need to ask about, adjust for, and address them.

Substance use, anxiety, and self-management efficacy in HIV-positive individuals: A mediation analysis

ABSTRACTContext: In China, the social stigma of both substance use and HIV remains major barrier. HIV-positive individuals have been demonstrated to have higher psychosocial distress in the literature. To ensure quality of life among HIV-positive Chinese individuals, self-efficacy in HIV-related management including substance use and anxiety is the key to suppress viral load and maintain healthy lives. Objectives: We examine the mediation relationship among substance use, anxiety, and self-management efficacy. Method: A cross-sectional study design was used. In total, 137 HIV-positive individuals were recruited from two premier Chinese hospitals: Beijing’s Ditan Hospital and Shanghai’s Public Health Clinic Center (SPHCC). Results: HIV-positive substance users had significantly lower HIV-management efficacy and higher anxiety scores. About a third of the relations between substance use and anxiety were mediated by HIV-management self-efficacy. Those who used substances in the previous week had higher anxiety levels suggesting the presence of a recency effect. Their higher levels of anxiety could be largely explained by their lower HIV-management efficacy. Conclusion: It is useful for healthcare providers to assess substance use behaviors in HIV-positive individuals as well as provide support in managing anxiety in this population. Meanwhile, enhancing self-management efficacy to ensure healthy lifestyles may support achieving optimal lives with HIV.

Stigma in the Dutch Health Care Sector: HIV-Positive Substance Users’ Experiences and Health Care Providers’ Perspectives

We explored 15 HIV-positive substance users’ experiences with health care alongside theperspectives of 14 health professionals. Substance users with HIV reported positive and negative experiences.Positive experiences included equal treatment, receiving social support and extra care, and good continuityof care. Negative experiences included being met with fear and apprehension, excessive or differentialprecautions, unnecessary referrals, outright care refusal, confidentiality breaches, and poor care provision.Health professionals reported limited experience caring for substance users with HIV. Most spoke generallyabout substance users, claiming that they can be difficult clients who are demanding, impatient,unpredictable, and untrustworthy. Also, health professionals indicated that substance users can be shoppersin search of unnecessary prescriptions or avoiders of health care. Efforts to improve interactions shouldencourage positive contact, and should focus on combating attributions of personal responsibility, creatingan awareness of behaviors that are stigmatizing, and improving knowledge of occupational risks for HIV.

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users

Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.

Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder

We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory--goal-directed activation, positive reinforcement, and environmental punishment--as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.

Isolating Cognitive and Neurologic HIV Effects in Substance-Dependent, Confounded Cohorts: A Pilot Study

Controversy exists as to whether effects of HIV infection can be detected in the cognitive profiles of substance users, with methodological differences in degree of control for confounding factors a major contributor to empirical discrepancies. To address this shortcoming, we conducted a small but well-controlled study aimed at isolating HIV neurocognitive (NC) effects in a group of chronic substance users. Thirty HIV-negative substance users were individually matched to 30 HIV-positive substance users on relevant medical and demographic factors, including reading level and methadone therapy status. Results revealed that reading level, methadone maintenance therapy, and positive urine toxicology each exerted significant influence on NC function, and that HIV status was a significant predictor of learning and speeded processing after these control factors were considered. The HIV-positive group also displayed significantly more neurologically assessed motor impairment (p < .05), which was specifically related to impaired cognition in this group and independent of degree of immunocompromise. These data demonstrate the need for increased attention to clinical/demographic characteristics of groups under study. They also show that with applied methodological rigor, the deleterious effects of HIV on cognition can be parsed from substance use, even in small samples with chronic and active use histories.

Physical Activity, Quality Of Life, And Medical Problems In HIV Positive Substance Users

Physical Activity, Quality Of Life, And Medical Problems In HIV Positive Substance Users

The Influence of Contingency Management on Physical Activity among HIV Positive Substance Users

The Influence of Contingency Management on Physical Activity among HIV Positive Substance Users

Enhanced HIV Testing, Treatment, and Support for HIV-Infected Substance Users

Enhanced HIV Testing, Treatment, and Support for HIV-Infected Substance Users

Assessing the Impact of Substance use and Hepatitis Coinfection on Atazanavir and Lopinavir Trough Concentrations in HIV-Infected Patients During Therapeutic Drug Monitoring

Atazanavir (ATV) and lopinavir (LPV) are widely used HIV-1 protease inhibitors. Like with other protease inhibitors, careful monitoring of potential drug-drug and drug-disease interactions in clinical practice is necessary. The aim of this study was to assess the impact of substance use and hepatitis virus coinfection on plasma ATV and LPV trough concentrations in HIV-positive substance users and nonusers. Individuals established on ATV (300 mg and 100 mg ritonavir daily) or LPV (400 mg and 100 mg ritonavir twice daily)-containing regimens completed two clinical visits (trough and directly observed therapy) during which dosing characteristics, concomitant medication, and substance use were recorded. Trough plasma concentrations (22-26 hours for ATV and 10-14 hours for LPV) were measured using LCMSMS. The influence of substance use was evaluated by Kruskal-Wallis test. Substance use was associated with a marked decrease in trough LPV concentrations during the trough visit (median, 5.536 and 3.791 microg/mL for nonsubstance users and substance users, respectively, P = 0.029). Significantly lower LPV trough levels were also noted among patients with active hepatitis C virus coinfection evaluated as an independent variable (median, 2.253 and 5.927 microg/mL for active and inactive/no hepatitis C virus infection, respectively, P = 0.032). Substance use and hepatitis virus coinfection had limited effects on ATV trough levels. In this cohort, despite the wide interindividual variability of ATV and LPV trough concentrations, significant associations between substance use and active hepatitis C virus infection and low LPV trough concentrations were observed. Further work is needed to assess the optimal dosing regimen when using LPV in HIV-infected substance users.

Sexual Risk Intervention In Multiethnic Drug And Alcohol Users

An estimated 38.6 million persons globally are living with HIV, of whom over 1.1 million reside in Zambia. Of the 2 million cases in the US, 64% of new cases among women are among African Americans. Alcohol and drug use represents a significant risk factor for HIV transmission among both Zambians and African Americans. In addition, gender dynamics in both the US and Zambia promote transmission. This study examines two interventions targeting HIV risk behavior among HIV positive substance users, women in Miami, USA (the New Opportunities for Women (NOW) Project) and men in Lusaka, Zambia (the Partner Project). The study compares the efficacy of these two culturally tailored sexual behavior interventions provided in group and individual session formats. US and Zambian participants increased sexual barrier use and reduced substance-related sexual risk. Comparatively greater gains were made by higher risk Zambian males than US females in both group and individual conditions. Among lower risk participants, women in the group condition achieved and sustained the greatest comparative risk reductions. Results suggest that cost effective group HIV transmission risk reduction interventions for multiethnic individuals can be successfully implemented among both female and male drug and alcohol users in multinational settings.

Ryan White CARE Act Title II Survey: Services for HIV-Positive Substance Users

A national survey was conducted among Ryan White CARE Act-funded providers to determine what types of services are specifically provided for HIV-positive substance users through Title II within the context of the overall delivery system for substance abuse treatment services. There was an 87% return rate on questionnaires representing 47 states. Only 18 of the 47 states reported funding some form of substance abuse services. The results show (1) the types of substance abuse services funded under Title II, (2) what special populations are served by those programs, (3) additional funding sources utilized by those programs, (4) the common systemic barriers to care, (5) the greatest programmatic barriers to care, and (6) gaps in knowledge about unmet needs for HIV-positive substance users. Some states have been quite innovative in targeting resources to support HIV-positive substance users while others report less activity. Although design and implementation of innovative programs for HIVpositive substance users rests with service providers, state agencies responsible for Title II planning are in the best position to identify system strengths and weaknesses.

Ryan White Title I Survey: Services for HIV-Positive Substance Users

People living with HIV/AIDS who are also substance users need primary health care, substance abuse treatment, and support services. They also require care delivery strategies that are comprehensive and innovative. Forty-three of 51 Ryan White Care Act Title I grantees funding 197 substance abuse treatment agencies in the United States participated in this study. Grantees were surveyed to determine (1) use of Title I funding to provide services for HIV-positive substance users, (2) the types of substance abuse services provided, (3) strengths and weaknesses of different metropolitan substance abuse service delivery systems, (4) sources of information used to assess the needs of substance users, (5) gaps in knowledge about substance users and their service needs, and (6) examples of successful strategies within the eligible metropolitan areas. The results of the study demonstrate that most grantees use Title I funds to support some form of substance abuse treatment for people with HIV; however, many do not use the funds to address the barriers to care that they identified. Lack of provider knowledge, expertise, and awareness, were cited as important barriers to care by a majority of the grantees. The availability of harm reduction approaches to care is an area in which there is wide variation. Several Title I programs have supported innovative programs for HIV positive substance users that may be used elsewhere as program models. It is important to find ways to incorporate these issues into the needs assessment and service prioritization process.

Integration of Motivational Interviewing and Cognitive Behavioral Therapy to Improve HIV Medication Adherence and Reduce Substance Use Among HIV-Positive Men and Women: Results of a Pilot Project

Directly addressing HIV medication adherence and substance use together is ideal in light of the research on the complex connections between these two behaviors. This paper describes the development of a pilot program in which a combined motivational interviewing and cognitive behavioral therapy intervention was used to increase adherence to highly active antiretroviral therapy (HAART) and reduce substance use in HIV-infected adults. The main goals of the pilot study were (1) to confirm the ability to recruit HIV-positive substance users taking HAART; (2) to demonstrate the ability to retain participants over the course of an eight-session intervention; and (3) to examine changes in substance use and HAART adherence from pretreatment to posttreatment. Twelve HIV-positive adults with a substance use disorder participated in an 8-week intervention, which consisted of weekly individual sessions with a trained therapist. Results showed that despite the small sample size, there was a significant reduction in substance use from pretreatment to posttreatment. No statistically significant differences were found for changes in HIV medication adherence, but the trends suggest the potential for positive results with a larger sample. Retention for all eight sessions of the treatment was 73.3%. Eighty percent completed the 3-month follow-up assessment. Participants reported high therapeutic alliance reflecting comfort with their therapists and in the treatment. Overall, the pilot demonstrated feasibility and acceptability of the treatment. Furthermore, results suggest that this may, in fact, be an effective intervention to reduce substance use and improve HIV medication adherence.

Analysis of Human Resources and Services Administration-Funded Services for HIV-Positive Substance Users: A Study of Ryan White CARE Act Title III, Title IV, and Special Projects of National Significance Providers

In this study, 175 organizations providing health care and/or social services to HIV-positive substance users responded to a questionnaire to: (1) investigate how programs were configured to serve consumer needs and (2) identify potential innovative strategies to be explored in greater depth in a subsequent study. The results demonstrated wide variability in types of services provided, racial and ethnic diversity, methods of addressing cultural and linguistic needs, accessibility provisions, strategies for engagement and retention, strategies for coordination and integrations of care, most difficult barriers to care, and funding sources.

Analysis of Human Resources and Services Administration-Funded Services for HIV-Positive Substance Users: A Study of Ryan White CARE Act Title III, Title IV, and Special Projects of National Significance Providers

Analysis of Human Resources and Services Administration-Funded Services for HIV-Positive Substance Users: A Study of Ryan White CARE Act Title III, Title IV, and Special Projects of National Significance Providers