Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, 90095, Los Angeles, CA, USA.
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA.
AIDS Behav. 2023 Jun;27(6):1962-1971. doi: 10.1007/s10461-022-03929-6. Epub 2022 Nov 21.
Methamphetamine (MA) use is associated with HIV transmission among men who have sex with men (MSM) and lapses in medication adherence. Contingency Management (CM) is effective in reducing MA use, but studies of CM to support adherence to HIV prevention or treatment are limited. We conducted a pilot trial of a CM intervention to reduce MA use and improve PrEP/ART adherence among MSM prescribed a tenofovir (TFV)-based regimen for HIV prevention or treatment. Participants were randomly assigned to receive escalating incentives for either MA abstinence or TFV adherence (based on point-of-care urine testing), and to a monitoring schedule of either 2 or 3 visits/week for 4 weeks. 19 MSM were randomized to either CM for MA use or CM for PrEP/ART adherence (median age: 38; IQR: 28-46) and 15 were living with HIV. Participants attended 95.7% (67/70) of scheduled visits in the 2x/week arm and 74.8% (74/99) in the 3x/week arm. TFV adherence was higher among participants in the TFV adherence arm with 93.5% (n = 72/77) of urine samples positive for TFV, compared to 76.6% (n = 49/64) in the MA abstinence arm (p = 0.007). Participants in the MA abstinence arm had more urine samples negative for MA metabolites (20.3%, n = 13/64) than those receiving CM for TFV adherence (6.5%, n = 5/77; p = 0.021). A CM model for MA abstinence and PrEP/ART adherence using twice-weekly visits and urine testing for MA and TFV for MSM who use MA is feasible and potentially effective as an integrated harm reduction strategy.
甲基苯丙胺（MA）的使用与男男性行为者（MSM）中的 HIV 传播和药物依从性的中断有关。条件性管理（CM）在减少 MA 使用方面非常有效，但支持 HIV 预防或治疗药物依从性的 CM 研究有限。我们开展了一项关于 CM 干预措施的试点试验，旨在减少 MA 使用，并提高接受基于替诺福韦（TFV）的方案预防或治疗 HIV 的 MSM 人群对 PrEP/ART 的依从性。参与者被随机分配接受 MA 禁欲或 TFV 依从性（基于即时尿液检测）的递增激励，以及为期 4 周的每周 2 或 3 次监测计划。19 名 MSM 被随机分配到 MA 使用的 CM 组或 PrEP/ART 依从性的 CM 组（中位年龄：38；IQR：28-46），其中 15 人患有 HIV。参与者参加了每周 2 次治疗组的 95.7%（67/70）和每周 3 次治疗组的 74.8%（74/99）的预约。在接受 TFV 依从性治疗组中，有 93.5%（n=72/77）的尿液样本中检测到 TFV 阳性，而在 MA 禁欲治疗组中，有 76.6%（n=49/64）的尿液样本中检测到 TFV 阳性（p=0.007）。在 MA 禁欲治疗组中，有更多尿液样本中未检测到 MA 代谢物（20.3%，n=13/64），而在接受 CM 治疗组中，有 6.5%（n=5/77；p=0.021）。对于使用 MA 的 MSM，使用每周 2 次就诊和尿液检测 MA 和 TFV 的 MA 禁欲和 PrEP/ART 依从性的 CM 模型是可行的，并且可能是一种有效的综合减少伤害策略。
