Employment Reinforcement Strategies for HIV/AIDS

Overseen By Ruth Fetter

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: UConn Health

Disqualifiers: Condition hindering participation

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 16 weeks

144 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to assist people living with HIV/AIDS in finding jobs by testing two different support strategies. All participants will receive standard job-seeking assistance, while some will have the opportunity to win prizes for completing job-related activities, a method known as Contingency Management for Activity Completion. The researchers aim to determine if offering rewards helps participants secure jobs faster and work more frequently. Individuals with HIV who are not currently employed and wish to return to the workforce may find this trial suitable. As an unphased trial, it provides a unique opportunity to explore innovative job support strategies tailored for individuals with HIV/AIDS.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that these employment reinforcement strategies are safe for persons living with HIV/AIDS?

Research has shown that using rewards, known as contingency management, has been safely applied to people with HIV, particularly those with substance use issues. This method has shown promise in helping individuals adhere to their medication regimen without major safety concerns.

Although specific safety data on using activity contracting in clinical settings is limited, this trial emphasizes behavioral strategies like setting goals and earning rewards, rather than drug treatments. This suggests a low risk of negative effects.

In summary, both activity contracting and contingency management are non-invasive and generally well-tolerated. These methods aim to encourage positive behaviors, providing participants with confidence in their safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these new approaches—activity contracting and contingency management—for treating HIV/AIDS because they focus on behavioral strategies to improve employment outcomes, which is an innovative angle compared to traditional medical treatments. Unlike standard care that primarily addresses the physical symptoms and viral load, these strategies aim to enhance the quality of life and socioeconomic stability for individuals living with HIV/AIDS. By providing structured activity plans and rewards for completing job-related tasks, these methods could help individuals maintain employment, boost their mental health, and potentially improve adherence to medical treatments. This holistic approach addresses a critical yet often overlooked aspect of living with HIV/AIDS, enhancing overall well-being and independence.

What evidence suggests that this trial's treatments could be effective for improving employment outcomes in PLWHA?

Research has shown that having a job can improve both physical and mental health for people living with HIV/AIDS. In this trial, participants may receive job activity contracting, which focuses on job-related tasks and may lead to better job opportunities. Studies have found that participating in job training services is linked to better health for people with HIV.

Another treatment arm in this trial involves reinforcement for completing activities, known as contingency management. This method, which provides rewards for completing certain tasks, has effectively encouraged healthy habits. By offering rewards, this approach helps participants stay focused on activities like job hunting and has shown promise in improving health behaviors among people with HIV. ^{6 7 8 9 10}

Who Is on the Research Team?

Carla Rash, Ph.D.

Principal Investigator

UConn Health

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are HIV positive and currently unemployed, not participating in the formal economy. It's designed to help them get back into work. People with conditions that could interfere with their participation in the study cannot join.

Inclusion Criteria

not working in the formal economy

HIV positive

Exclusion Criteria

You have a medical condition that could make it difficult for you to participate in the study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive usual unemployment services with an emphasis on specific issues related to HIV/AIDS, plus encouragement for completing activities geared toward employment readiness and acquisition. The enhanced intervention includes chances to win prizes for engaging in job-related activities each week.

16 weeks

Follow-up

Participants complete follow-up evaluations to assess employment outcomes, quality of life indices, physical and cognitive functioning, psychological symptoms, viral loads, and drug use and risk behaviors.

18 months

What Are the Treatments Tested in This Trial?

Interventions

• Activity Contracting
• Contingency Management for Activity Completion

Trial Overview

The study tests two methods to improve job acquisition for people living with HIV/AIDS. Everyone gets standard unemployment services plus encouragement for job readiness activities. One group also gets chances to win prizes as extra motivation for completing these activities.

How Is the Trial Designed?

Group I: Reinforcement for completing activities Experimental Treatment 2 Interventions

Standard services plus job activity contracting plus reinforcement for completing job-related activities

Group II: Job activity contracting Active Control 1 Intervention

Standard services plus job activity contracting

Who Is Running the Clinical Trial?

UConn Health

Lead Sponsor

Trials

218

Recruited

59,100+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Published Research Related to This Trial

The group-based contingency management intervention at an HIV drop-in center significantly increased attendance from an average of 0.7 clients per session during the baseline phase to 7 clients during reinforcement phases over 35 weeks.

The intervention also improved the completion of treatment-related activities, rising from 25% during baseline to 65% during reinforcement phases, demonstrating its effectiveness in promoting engagement in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management in group treatment: a demonstration project in an HIV drop-in center. Petry, NM., Martin, B., Finocche, C.[2021]

Employment is identified as a crucial social determinant of health that can potentially improve health outcomes for people living with HIV (PLHIV) and aid in the prevention of HIV transmission.

The review highlights significant gaps in current research regarding the employment challenges faced by populations disproportionately affected by HIV, emphasizing the need for targeted interventions and responsive policies to address these issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. Conyers, LM., Richardson, LA., Datti, PA., et al.[2019]

Vocational rehabilitation services significantly contribute to the goals of the National HIV/AIDS strategy, helping individuals living with HIV/AIDS access healthcare and employment services.

The study, which included a diverse sample of respondents, demonstrated that these services are associated with reduced risk of HIV transmission, highlighting their importance in health and prevention efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS. Conyers, L., Boomer, KB.[2019]

Contingency management (CM) is an effective treatment strategy that reinforces positive behaviors, such as drug abstinence and counseling attendance, and shows promise in improving HIV-related behaviors.

CM interventions, including voucher systems and cash incentives, can significantly reduce HIV risk behaviors and enhance adherence to HIV medications, making them versatile tools for both prevention and management in various settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management interventions for HIV-related behaviors. Haug, NA., Sorensen, JL.[2019]

The study is testing the effectiveness of a 5-session intervention called ARTEMIS, which aims to help HIV-positive men who use methamphetamine by enhancing their ability to manage emotions and find rewards outside of drug use, alongside a 12-week contingency management program.

The primary goal of the trial is to assess the impact of ARTEMIS on HIV viral load, with secondary outcomes including sustained viral suppression and psychological adjustment, highlighting its potential to improve both health and substance use outcomes in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. Carrico, AW., Jain, J., Discepola, MV., et al.[2019]

A study involving 246 adolescents living with HIV in Nigeria tested the impact of conditional economic incentives and motivational interviewing on health outcomes over one year, but found no significant improvement in achieving undetectable viral loads or other secondary outcomes.

While the intervention group showed a 10.1% increase in the proportion of participants with undetectable viral loads, this change was not statistically significant compared to the control group, indicating that the incentive scheme did not effectively enhance virologic outcomes or medication adherence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of conditional economic incentives and motivational interviewing on health outcomes of adolescents living with HIV in Anambra State, Nigeria: A cluster-randomised trial. Ekwunife, OI., Anetoh, MU., Kalu, SO., et al.[2022]

The study of 225 employees with HIV revealed that stigma associated with HIV negatively impacts job effectiveness, primarily through feelings of shame rather than fear.

Core self-evaluation (CSE) and CD4 cell count were found to moderate the relationship between HIV stigma and job effectiveness, suggesting that higher self-esteem and better health can help mitigate the negative effects of stigma on work performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A cross-lagged longitudinal investigation of the relationship between stigma and job effectiveness among employees with HIV. Ocampo, ACG., Chen, Y., Restubog, SLD., et al.[2023]

Contingency management (CM) is effective in treating substance use disorders by incentivizing specific behaviors, with 46 subjects in the study selecting from 1,059 activities, primarily focused on recreational and sobriety-related tasks.

Over 95% of participants engaged in activities like attending Alcoholics Anonymous meetings and recreational outings, indicating that CM can promote positive lifestyle changes alongside substance use recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reinforcing compliance with non-drug-related activities. Petry, NM., Tedford, J., Martin, B.[2019]

Contingency management (CM) effectively uses positive reinforcement to enhance treatment outcomes for substance abusers, particularly in achieving sustained abstinence from drugs.

CM is not only beneficial as a direct therapeutic approach but also serves as a valuable tool in clinical trials for testing new medications and improving patient adherence to treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management: utility in the treatment of drug abuse disorders. Stitzer, ML., Vandrey, R.[2019]

Contingency management procedures have been shown to effectively treat substance use disorders by providing rewards, like vouchers, for drug abstinence, particularly in psychosocial and methadone maintenance settings.

Recent adaptations of these procedures include using lower-cost reinforcers and expanding their application to improve treatment attendance, adherence to goals, and medication compliance, highlighting the versatility of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management for treatment of substance abuse. Stitzer, M., Petry, N.[2019]

In a study of 19 veterans undergoing vocational rehabilitation, those who received enhanced financial incentives for meeting clinical goals were more successful in job-search activities and remained abstinent from drugs and alcohol compared to those who did not receive incentives.

Participants in the incentive group not only secured competitive employment more frequently but also earned an average of 68% more in wages, indicating that adding financial rewards can significantly improve rehabilitation outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans. Drebing, CE., Van Ormer, EA., Krebs, C., et al.[2019]

A novel multi-target contingency management (CM) program was developed for HIV positive substance users, integrating various health and behavior targets to improve outcomes over a 6-month period.

The primary goal of the program is to achieve viral load suppression at 12 months, with participants able to earn up to $1160 through completing tasks related to health care visits, medication adherence, and drug use abatement, indicating a comprehensive approach to managing both health and substance use behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. Stitzer, M., Calsyn, D., Matheson, T., et al.[2019]

Contingency management (CM) significantly reduces HIV risk behaviors and injection drug use among cocaine-abusing patients in a methadone maintenance program, based on a study of 165 participants over 3 months.

The effectiveness of CM in reducing these risks is linked to the longest duration of abstinence achieved during treatment, indicating that longer periods of sobriety contribute to safer behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Hanson, T., Alessi, SM., Petry, NM.[2021]

A randomized clinical trial involving 174 individuals with HIV/AIDS showed that a mixed intervention program significantly increased workforce-reentry activities compared to standard care over a 24-month period.

Participants who attended more individual sessions of the intervention were more engaged in job-seeking activities and had better job retention, highlighting the importance of personalized support in helping individuals with HIV/AIDS return to work.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping people with HIV/AIDS return to work: a randomized clinical trial. Martin, DJ., Chernoff, RA., Buitron, M., et al.[2022]

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