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Dr. Adam Carrico Presents at the 10th International AIDS Society Conference on HIV Science

Contingency management (CM) – an evidence-based intervention where individuals receive incentives when abstaining from stimulants – decreases stimulant use and achieves short-term reductions in HIV viral load. While CM has shown to be effective, interventions are still needed to address concerns about its durability.

Adam Carrico, Ph.D., associate professor at the University of Miami Miller School of Medicine’s Department of Public Health Sciences, was the lead author on a randomized controlled trial (RCT) that tested the efficacy of positive affect intervention for boosting and extending the effectiveness of CM with HIV-positive, methamphetamine-using men who have sex with men. His team examined whether those randomized to receive the positive affect intervention displayed more durable reductions in HIV viral load.

The study found that individually-led positive affect intervention not only reduced HIV viral load over 15 months but also improved positive affect at six and 12 months. His team has also previously shown that the positive affect intervention reduced methamphetamine craving and stimulant use during three months of CM.

Dr. Carrico presented the findings as a late-breaker abstract at the 10th International AIDS Society Conference on HIV Science, which took place in Mexico City, Mexico. The conference brought together over 6,000 researchers, advocates, policymakers, funders, community leaders, and journalists.

“This trial was the first to observe that behavioral intervention can achieve durable and clinically meaningful reductions in HIV viral load among substance users,” Dr. Carrico noted. 

From 2013 to 2017, 110 participants were recruited for the RCT from a three-month community-based CM program provided by the San Francisco AIDS Foundation. The participants were 43 percent Caucasian, 29 percent were Hispanic/Latino, 16 percent were African American, and 12 percent were ethnic minorities or multiracial. They were from the ages of 24 to 50 years.

Half of these participants were randomized to receive Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS), an individually-delivered, five-session positive affect intervention. ARTEMIS consisted of exercises such as gratitude journaling and mindfulness meditation practices that have been shown to increase positive affect. The other half received attention-control sessions that consisted of face-to-face administration of psychological measures and neutral writing exercises.

“The ARTEMIS intervention focuses on cultivating positive affect to help men cope more effectively with methamphetamine withdrawal and sensitize participants to non-drug-related sources of reward,” Dr. Carrico stated.

Those randomized to receive the ARTEMIS intervention were found to have lower HIV viral load at six, 12 and 15 months than those participating in the attention-control intervention. They were also found to have an unsuppressed HIV viral load over the 15 months, which is typically the period in time when HIV can be sexually transmitted to another person. Participants randomized to receive ARTEMIS also reported improvements in positive affect at six and 12 months.

The study was co-authored by Daniel J. Feaster, Ph.D., associate professor in the Miller School of Medicine’s Department of Public Health Sciences, as well as with researchers from other institutions and the San Francisco AIDS Foundation.

Written by Amanda Torres 
Published on August 5, 2019