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

基于激励的综合治疗，以优化甲基苯丙胺使用者的艾滋病毒治疗参与度

• 批准号: 10609449
• 负责人: Jessica Lynette Montoya
• 金额: $ 20.57万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609449
• 关键词: Abstinence; Address; Adherence; Area; Behavior Therapy; Biological; Caring; Clinical Trials; Continuity of Patient Care; Development; Development Plans; Effectiveness; Epidemic; Evaluation; Evidence based practice; Evidence based treatment; Five-Year Plans; Goals; HIV; Health Services; Incentives; Individual; Intervention; Investments; Knowledge; Link; Mentored Patient-Oriented Research Career Development Award; Mentors; Methamphetamine use disorder; Methodology; Methods; Modeling; NIH Office of AIDS Research; National Institute of Drug Abuse; Operant Conditioning; Patient-Focused Outcomes; Persons; Positioning Attribute; Positive Reinforcements; Predisposition; Prize; Process; Provider; Public Health; Randomized; Recommendation; Regimen; Reporting; Research; Research Activity; Research Personnel; Research Priority; Research Project Grants; Resources; Science; Strategic Planning; Substance Use Disorder; System; Targeted Research; Testing; Toxicology; Training; Training Activity; Training Programs; Urine; addiction; antiretroviral therapy; career; career development; combat; comorbidity; contingency management; design; effective intervention; effectiveness evaluation; evidence base; experience; falls; health goals; implementation framework; implementation science; improved; improved outcome; incentive-based intervention; methamphetamine effect; methamphetamine use; novel; patient engagement; programs; psychosocial; skills; stimulant use; substance use; success; therapy adherence; transmission process

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.

项目总结/摘要 这个K23指导以患者为导向的研究职业发展奖的目的是帮助 候选人获得专业知识和方法技能，成为一个独立的实施科学 调查人员集中在综合药物使用障碍和艾滋病毒护理做法。的目的 候选人的研究是双重的：减少甲基苯丙胺使用的有害影响，同时 支持参与艾滋病毒护理。使用甲基苯丙胺的艾滋病毒感染者容易经历 艾滋病毒护理连续体每个阶段的差距。应急管理是一种有效的行为疗法， 基于操作性条件反射原理的甲基苯丙胺使用障碍。权变管理 通过提供即时的、积极的强化来减少甲基苯丙胺使用的强化效果 在戒除药物使用之后。基于操作性条件反射原则的激励干预 也显示出对改善抗逆转录病毒疗法（ART）依从性的积极作用。目前还不清楚 整合ART依从性激励的应急管理计划（CM+ART，即， 双重目标甲基苯丙胺的使用和ART坚持）是更容易接受和适当的人， 而不是一个只针对甲基苯丙胺使用的应急管理计划。的具体目标 五年K23奖励期的研究计划是：1）确定实施应急计划所需的资源 在为艾滋病毒感染者服务的环境中实施管理方案，2）调整应急管理， 鼓励坚持ART（CM+ART），3）评估CM+ART是否可接受和适当 与仅针对使用甲基苯丙胺的艾滋病毒感染者的应急管理计划相比， 减少甲基苯丙胺的使用。蒙托亚博士的指导培训计划，包括正式的教学法和其他 活动，符合研究目标和职业发展计划，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）采用科学方法指导 应急管理，以整合ART依从性的激励措施，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 开发活动旨在开发具有竞争力的NIDA R 01应用程序和独立的 研究生涯。该提案与NIDA战略计划目标3.1（“开发和测试新的 和3.4（“制定和测试有效和有效的治疗策略， 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解决艾滋病毒- 相关的合并症，如物质使用障碍;和“结束艾滋病毒流行病： 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 一个独立的研究生涯，专注于艾滋病毒和物质使用障碍护理的整合。