An integrated incentive-based treatment to optimize HIV treatment engagement among persons who use methamphetamine

项目摘要/摘要 K23指导患者导向研究职业发展奖的目的是帮助 获得专业知识和方法技能以成为独立实施科学的候选人 调查员专注于综合药物使用障碍和艾滋病毒护理做法。该计划的目标是 Candier的研究有两个方面：减少冰毒使用的有害影响，同时 支持参与艾滋病毒护理。使用甲基苯丙胺的艾滋病毒携带者容易患上 在艾滋病毒护理连续体的每个阶段都存在差距。应急管理是一种有效的行为疗法 甲基苯丙胺使用障碍是基于可操作性条件反射原理的。应急管理 通过提供即时、积极的强化来减少使用甲基苯丙胺的强化效果 在戒除物质使用之后。基于操作性条件反射原理的激励性干预 对改善抗逆转录病毒疗法(ART)的依从性也显示出积极的效果。目前仍不清楚 整合ART坚持激励的应急管理计划(CM+ART，即， 双重针对甲基苯丙胺的使用和抗逆转录病毒药物的坚持)更容易被有 艾滋病毒而不是只针对冰毒使用的应急管理计划。《公约》的具体目标 五年K23奖励期的研究计划是：1)确定实施应急措施所需的资源 为艾滋病毒携带者服务的环境中的管理方案，2)调整应急管理，以整合 对坚持抗逆转录病毒治疗(CM+ART)的激励，以及3)评估CM+ART是否可接受和适当 对于使用甲基苯丙胺的艾滋病毒携带者，与仅针对 减少甲基苯丙胺的使用。蒙托亚博士指导的培训计划，包括正式的教学和其他 活动，与研究目标和职业发展计划相一致，并有四个关键领域：1)深化 了解在地方和国家层面实施的循证实践，以支持患者参与 在艾滋病毒和药物使用障碍护理方面，2)应用实施科学方法指导适应 应急管理，整合对坚持抗逆转录病毒治疗的激励，3)获得先进的方法 设计和评估混合方法研究和临床试验的技能，以及4)从事专业工作 为开发具有竞争力的NIDA R01应用程序和独立的 研究生涯。该建议与NIDA战略计划目标3.1(开发和测试小说 基于成瘾科学的治疗“)和3.4(”制定和测试有效和 可持续地实施循证治疗“)；美国国立卫生研究院艾滋病研究办公室优先处理艾滋病毒-- 相关的合并症，如药物使用障碍；以及“结束艾滋病毒流行：一项 “美国”倡议。全面的培训活动和研究计划将有效地定位候选人 对于专注于艾滋病毒和物质使用障碍综合护理的独立研究生涯。

PROJECT SUMMARY/ABSTRACT The objective of this K23 Mentored Patient-Oriented Research Career Development Award is to assist the candidate in acquiring expertise and methodological skills to become an independent implementation science investigator focused on integrated substance use disorder and HIV care practices. The objective of the candidate’s research is two-fold: to reduce the detrimental impact of methamphetamine use while simultaneously supporting engagement in HIV care. People with HIV who use methamphetamine are susceptible to experiencing gaps at each stage of the HIV care continuum. Contingency management is an effective behavioral therapy for methamphetamine use disorder that is based on operant conditioning principles. Contingency management decreases the reinforcing effects of methamphetamine use by providing immediate, positive reinforcement following abstinence from substance use. Incentive-based interventions based on operant conditioning principles also demonstrate positive effects for improving antiretroviral therapy (ART) adherence. It remains unclear whether a contingency management program that integrates incentives for ART adherence (CM+ART, i.e., dually targeting methamphetamine use and ART adherence) is more acceptable and appropriate to people with HIV than a contingency management program targeting methamphetamine use only. The specific aims of the research plan for the five-year K23 award period are: 1) to identify resources required to implement contingency management programs in settings serving people with HIV, 2) to adapt contingency management to integrate incentives for adherence to ART (CM+ART), and 3) to evaluate whether CM+ART is acceptable and appropriate to people with HIV who use methamphetamine compared to a contingency management program targeting only reductions in methamphetamine use. Dr. Montoya’s mentored training plan, including formal didactics and other activities, aligns with the research aims and career development plans and has four key areas: 1) to deepen knowledge of evidence-based practices implemented at local and national levels to support patient engagement in HIV and substance use disorder care, 2) to apply an implementation science approach to guide adaptation of contingency management to integrate incentives for ART adherence, 3) to acquire advanced methodological skills to design and evaluate mixed-method studies and clinical trials, and 4) to engage in professional development activities geared toward development of a competitive NIDA R01 application and an independent research career. This proposal strongly aligns with NIDA Strategic Plan Objectives 3.1 (“Develop and test novel treatments based on the science of addiction”) and 3.4 (“Develop and test strategies for effectively and sustainably implementing evidence-based treatments”); the NIH Office of AIDS Research priority to address HIV- associated comorbidities such as substance use disorders; and the “Ending the HIV Epidemic: A Plan for America” initiative. The comprehensive training activities and research plan will effectively position the candidate for an independent research career focused on the integration of HIV and substance use disorder care.