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

Trial Summary

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 data supports the idea that Employment Reinforcement Strategies for HIV/AIDS is an effective treatment?

The available research shows that Employment Reinforcement Strategies, also known as Contingency Management, can be effective for people with HIV/AIDS. In one study, participants who received this treatment were more likely to achieve viral load suppression, which means the amount of HIV in their blood was reduced. Another study at an HIV drop-in center found that using this treatment increased attendance and activity completion rates. Although there are fewer studies specifically on HIV, similar strategies have been successful in helping people with substance use disorders by encouraging drug abstinence and improving treatment attendance. This suggests that the treatment can be beneficial for managing HIV-related behaviors as well. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Activity Contracting, Contingency Management for Activity Completion, Contingency Management, Reinforcement Therapy for HIV/AIDS?

Research shows that contingency management (CM) can effectively improve behaviors related to HIV management, such as medication adherence and attendance at health appointments. Studies have also demonstrated that CM can enhance outcomes in substance use treatment and vocational rehabilitation by providing incentives for meeting specific goals, suggesting its potential effectiveness in supporting employment and health behaviors in individuals with HIV/AIDS. ^{1 2 3 4 5}

What safety data exists for Employment Reinforcement Strategies for HIV/AIDS?

The research indicates that Contingency Management (CM), which is related to Employment Reinforcement Strategies, is an evidence-based intervention primarily used for substance use disorders. It has been shown to be effective in reducing drug use and HIV risk behaviors. CM has been applied to reinforce non-drug-related activities, including employment-related tasks, and has been integrated into multi-target interventions for HIV-positive individuals. While the studies focus on efficacy, they do not explicitly address safety concerns, suggesting that CM is generally considered safe as it involves positive reinforcement strategies. ^{1 6 7 8 9}

Is contingency management safe for humans?

Contingency management (CM) has been used safely in various studies to encourage positive behaviors, such as abstaining from drug use and attending health appointments. It involves providing rewards for meeting specific goals and has been integrated into different treatment programs without reported safety concerns. ^{1 6 7 8 9}

Is the treatment Activity Contracting, Contingency Management for Activity Completion a promising treatment for helping people with HIV/AIDS return to work?

Yes, the treatment is promising because it focuses on helping people with HIV/AIDS reenter the workforce, which can improve their health and social outcomes. Employment is a key factor in better health and preventing HIV transmission, and this treatment aims to support people in achieving these benefits. ^{10 11 12 13 14}

How does the treatment 'Activity Contracting, Contingency Management for Activity Completion' differ from other treatments for HIV/AIDS?

This treatment is unique because it focuses on using employment reinforcement strategies, such as setting goals and providing rewards for completing activities, to help people with HIV/AIDS reenter the workforce, which is different from traditional medical treatments that primarily focus on managing the virus itself. ^{10 11 12 13 14}

What is the purpose of this trial?

Many persons living with HIV/AIDS (PLWHA) are unemployed, with estimates indicating rates as high as 60%. This study will examine the efficacy of reinforcing job-acquisition activities for improving employment outcomes in PLWHA who desire to return to the workforce in part- or full-time capacity. In total, this study will randomly assign 144 unemployed PLWHA to one of two interventions. All participants will 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 will involve that same treatment plus chances to win prizes for engaging in job-related activities each week. Participants will receive study treatments for 16 weeks and complete follow-up evaluations throughout 18 months. The hypothesis is that participants reinforced for completing job-related activities will transition to employment at higher and faster rates and work more often than those who are not reinforced for job-related activities.

Research Team

Carla Rash, Ph.D.

Principal Investigator

UConn Health

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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) 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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Contingency management in group treatment: a demonstration project in an HIV drop-in center. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Contingency management for treatment of substance abuse. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Contingency management interventions for HIV-related behaviors. [2019]

6. England 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. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Reinforcing compliance with non-drug-related activities. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Contingency management: utility in the treatment of drug abuse disorders. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Helping people with HIV/AIDS return to work: a randomized clinical trial. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. [2019]

12. Netherlands 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. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

A cross-lagged longitudinal investigation of the relationship between stigma and job effectiveness among employees with HIV. [2023]

14. England 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. [2019]