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Use of Incentives to Engage Drug Users in HIV Therapy (Incentives-1)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01526421
Recruitment Status : Completed
First Posted : February 3, 2012
Last Update Posted : December 20, 2012
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
University of British Columbia

Brief Summary:

Highly active antiretroviral therapy (HAART), the current standard of care for treatment of HIV infection, is highly effective when taken appropriately. Before starting this treatment, a person must be aware of their HIV status and present to a clinic for medical care. They then undergo screening procedures (medical assessment and laboratory tests) to determine whether they are eligible to receive HAART, i.e. whether HIV treatment is necessary and safe for them.

In many urban centres including Vancouver's Downtown Eastside, there is a high rate of HIV infection among users of illicit drugs. However, HIV-infected drug users often do not present to the medical system and complete the process necessary to start HAART. Given the known benefits of HAART, new strategies are required to increase rates of HAART initiation in this group. Contingency management (CM) is a strategy to affect behaviour by providing a reward (e.g. money) to reinforce the desired behaviour. CM has been used with success in other areas of medicine (e.g. smoking cessation, weight loss) and in the drug using population, but has not been established as a means to improve HAART uptake.

The proposed research primarily seeks to assess the effectiveness of monetary-based CM in engaging HIV-infected drug users in HAART programs. Drug users identified through outreach will be randomized in a 1:1 ratio to one of two arms; participants in one arm will be offered a monetary-based reinforcer to participate (n=150) and participants in the second arm will be offered no reinforcer (n=150). Participation involves reporting to the study site for formal study of eligibility screening, consisting of clinical evaluation, medical history and laboratory testing required to determine eligibility to receive HAART. Participants randomized to the reinforcer arm will receive gift cards at the completion of screening procedures.

Our hypothesis is that drug users offered a monetary-based reinforcer will be significantly more likely to complete HAART eligibility screening than those not offered a reinforcer.

Condition or disease Intervention/treatment Phase
HIV Infection Other: monetary reinforcer Not Applicable

Detailed Description:

HAART eligibility screening entails presenting to the study site within 2 weeks of pre-screening, undergoing laboratory testing and providing a medical history, and returning for results within the subsequent four weeks. Any potential subjects who appear to be acutely intoxicated will be asked to return the next day or at a later date or time of their choosing. All participants will be asked to return for their results within four weeks after screening. Subjects will have 70 mL of whole blood collected by venipuncture by a trained study nurse. Laboratory tests will include HIV confirmatory testing (antibody and Western blot), CD4 cell count and plasma HIV-1-RNA level (plasma viral load; pVL), Hepatitis A, B and C serology, pregnancy test for women of child-bearing potential, complete blood count (CBC) with differential and platelet count, chemistry profile (creatinine, urea and electrolytes), and transaminase levels (ALT, AST). All participants will also have a medical history taken and undergo a physical examination. Recorded data will include subject gender, age, ethnicity, race, area of residence and living arrangement (categorized as homeless/on the street, unstable [defined as living primarily in a single room occupancy hotel, boarding room, or transition house] or stable). Additional features which will be recorded will include nature and frequency of illicit substance use, and participation in other cohort studies or methadone maintenance programs. All clinical past medical history and co-morbidities and laboratory data will be recorded for assessment of subject HAART eligibility.

All subjects who return for the results, whether HAART-eligible or not, will have their laboratory results explained to them and will be counseled as to a recommended course of clinical care by the study nurse. Those eligible for HAART will be offered enrollment into Part II of the study. Those not eligible for HAART will be invited to re-evaluate their eligibility for antiretroviral therapy at yearly intervals through the study site. Once 150 subjects have been randomized to each of the two study arms (total n=300), recruitment will be temporarily halted and statistical analysis will determine whether the reinforcer resulted in a significant and clinically relevant increase in the proportion of subjects who complete HAART eligibility screening.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 301 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Screening
Official Title: A Randomized Clinical Trial Evaluating the Role of Contingent Reinforcement in the Engagement of and Retention of Drug Users in HAART Programs - Part 1
Study Start Date : February 2012
Actual Primary Completion Date : September 2012
Actual Study Completion Date : September 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Drug Abuse HIV/AIDS

Arm Intervention/treatment
Experimental: monetary reinforcer Other: monetary reinforcer
Participants randomized to the reinforcer arm will receive gift cards at the completion of screening procedures.
Other Name: contingency management

No Intervention: no reinforcer

Primary Outcome Measures :
  1. the proportion of drug users undertaking clinical and laboratory screening to determine eligibility for highly active antiretroviral therapy (HAART). [ Time Frame: 6 weeks ]
    HAART eligibility screening entails presenting to the study site within 2 weeks of pre-screening, undergoing laboratory testing and providing a medical history, and returning for results within the subsequent four weeks.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   19 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age 19 years or older
  2. Self-reports as having used illicit drugs within last 3 months
  3. Self-reports known or at-risk for HIV infection.

Exclusion Criteria:

  1. Unable to provide informed consent due to severe mental or physical illness, or substance intoxication at the time of interview
  2. Has lived in the greater Vancouver area for three months or less (as a means to enhance participant retention)
  3. Pregnancy
  4. Receipt of antiretroviral therapy within the last 12 months
  5. Known history of gambling addiction.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01526421

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Canada, British Columbia
St. Paul's Hospital, VIDUS study office site, 342 East Hastings
Vancouver, British Columbia, Canada
Sponsors and Collaborators
University of British Columbia
National Institute on Drug Abuse (NIDA)
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Principal Investigator: Mark Hull, MD University of British Columbia
Principal Investigator: Julio SG Montaner, MD University of British Columbia
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Responsible Party: University of British Columbia Identifier: NCT01526421    
Other Study ID Numbers: H11-00592
H11-00592 ( Other Identifier: UBC/Providence Health Care REB )
1R01DA031043-01 ( U.S. NIH Grant/Contract )
First Posted: February 3, 2012    Key Record Dates
Last Update Posted: December 20, 2012
Last Verified: December 2012
Keywords provided by University of British Columbia:
Antiretroviral therapy, highly active
Additional relevant MeSH terms:
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HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases