Background: Randomized controlled trials (RCTs) with HIV+ persons who use substances support the short-term effectiveness of contingency management (CM) for reducing HIV viral load. Positive affect interventions that sensitize individuals to natural sources of reward as well as provide skills for managing withdrawal could boost the effectiveness of CM for stimulant abstinence.
Methods: From 2013-2017, 110 HIV+ sexual minority men with biologically confirmed, recent methamphetamine use were enrolled. Participants were randomized to: 1) a five session, individually delivered positive affect intervention (n = 55) - Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS); or 2) an attention-matched control condition (n = 55). ARTEMIS and attention-control sessions were delivered over a three-month period where all participants were receiving thrice-weekly CM for stimulant abstinence. We examined intent-to-treat effects on log10 HIV viral load as the primary outcome. Secondary outcomes included any unsuppressed HIV viral load over 15 months (> 200 copies/mL) and positive affect.
Results: The majority of participants were racial/ethnic minorities (57%), middle-aged (mean = 43.2 years; SD = 8.9), and had a median CD4+ T-cell count of 646 cells/mm3 (Interquartile Range = 428-816). At baseline, 14% had an unsuppressed viral load. We observed a significant group x time interaction for the primary outcome, log10 HIV viral load (p = 0.049). In planned comparisons, men in the ARTEMIS intervention displayed significantly lower log10 HIV viral load at six (Cohen''s d = 0.89), 12 (Cohen''s d = 0.43), and 15 (Cohen''s d = 0.50) months compared to attention-control participants. Men in the ARTEMIS intervention also had significantly lower risk of at least one unsuppressed HIV RNA over 15 months (Risk Ratio = 0.33; 95% CI = 0.15 - 0.69; p < 0.001). Finally, there was a significant group x time interaction for positive affect (p = 0.044) such that men in the ARTEMIS intervention reported significantly higher positive affect at six (Cohen''s d = 0.53) and 12 (Cohen''s d = 0.41) months compared to attention-control participants.
Conclusions: Delivering a positive affect intervention with CM for stimulant abstinence achieved durable virologic suppression in methamphetamine-using sexual minority men.

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