Metsch Lisa R, Feaster Daniel J, Gooden Lauren K, Pan Yue, Parish Carrigan L, Waldrop Drenna, Rodriguez Allan, Colasanti Jonathan A, Armstrong Wendy S, Root Christin, Del Rio Carlos, Castellón Pedro C, Miller Michael, Pereyra Margaret R
Department of Sociomedical Sciences, Columbia University, New York, New York, USA.
Department of Public Health Sciences, University of Miami, Miami, Florida, USA.
Open Forum Infect Dis. 2025 Mar 3;12(4):ofaf104. doi: 10.1093/ofid/ofaf104. eCollection 2025 Apr.
People with HIV (PWH) who use cocaine are less likely to achieve virologic suppression (<200 copies/mL) because of poor engagement in care. We tested the efficacy of an integrated substance use treatment and outpatient HIV care intervention on improving viral suppression in nonsuppressed PWH who use cocaine.
Project RETAIN recruited 360 cocaine-using PWH who were not virologically suppressed in Miami, FL, and Atlanta, GA. Patients were randomized to treatment as usual (TAU) or the intervention, which included patient navigation and substance use treatment with motivational enhancement therapy and cognitive-behavioral therapy. The primary outcome assessed viral suppression at 6- and 12-month follow-up.
There was no difference in viral suppression by group (TAU = 17.1%, intervention = 15.6%, = .897). The intervention group had significantly more participation in substance use treatment (87.0%) than TAU (7.2%, < .001). There were significant decreases in stimulant use in both groups, but oxycodone use decreased more in the intervention group. Severe psychological distress (32% of the baseline sample) declined differentially at 6 months (TAU = 24.5%, intervention = 16.1%, = .0492).
Only a minority of PWH who used cocaine became virally suppressed over the 12-month study, with no effect of the integrated intervention. Patients in the intervention did have reduced psychological distress postintervention. Despite more substance use treatment in the intervention, both groups declined equally in substance use. Interventions that improve retention in care and viral suppression are needed for this vulnerable population, including those that address their other complex medical and psychosocial needs.
NCT01614106.
使用可卡因的艾滋病毒感染者（PWH）由于护理参与度低，实现病毒抑制（<200拷贝/毫升）的可能性较小。我们测试了一种综合物质使用治疗和门诊艾滋病毒护理干预措施对改善使用可卡因的未实现病毒抑制的PWH的病毒抑制效果。
RETAIN项目招募了360名在佛罗里达州迈阿密和佐治亚州亚特兰大未实现病毒学抑制的使用可卡因的PWH。患者被随机分配到常规治疗（TAU）或干预组，干预措施包括患者导航以及采用动机增强疗法和认知行为疗法的物质使用治疗。主要结局评估了6个月和12个月随访时的病毒抑制情况。
两组之间的病毒抑制情况没有差异（TAU = 17.1%，干预组 = 15.6%，P = 0.897）。干预组参与物质使用治疗的比例（87.0%）显著高于TAU组（7.2%，P < 0.001）。两组的兴奋剂使用均显著减少，但干预组的羟考酮使用减少更多。严重心理困扰（基线样本的32%）在6个月时差异下降（TAU = 24.5%，干预组 = 16.1%，P = 0.0492）。
在为期12个月的研究中，只有少数使用可卡因的PWH实现了病毒抑制，综合干预没有效果。干预组的患者在干预后心理困扰有所减轻。尽管干预组接受了更多的物质使用治疗，但两组在物质使用方面的下降程度相同。对于这一弱势群体，包括那些解决其其他复杂医疗和心理社会需求的人群，需要采取能够提高护理保留率和病毒抑制率的干预措施。
NCT01614106。
