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Pfund RA, Ginley MK, Boness CL, Rash CJ, Zajac K, Witkiewitz K. Contingency Management for Drug Use Disorders: Meta-Analysis and Application of Tolin's Criteria. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:136-150. [PMID: 38863566 PMCID: PMC11164545 DOI: 10.1037/cps0000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Several professional organizations and federal agencies recommend contingency management (CM) as an empirically supported treatment for drug use disorder. However, the release of the "Tolin criteria" warrants an updated recommendation. Using this methodology, five meta-analyses (84 studies, 11,000 participants) were reviewed. Two meta-analyses were rated moderate quality, and three were rated low or critically low quality. Comparator conditions included active treatment, placebo, treatment as usual, and no treatment. The primary outcome was abstinence. Considering only the moderate quality meta-analyses, the effect of CM versus control on posttreatment abstinence was d = 0.54 [0.43, 0.64] and follow-up abstinence was d=0.08 [0.00, 0.16]. A "strong" recommendation was provided for CM as an empirically supported treatment for drug use disorder.
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Affiliation(s)
- Rory A. Pfund
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
| | | | | | - Carla J. Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Thrul J, Yusuf H, Devkota J, Owczarzak J, Ohene-Kyei ET, Gebo K, Agwu A. Accuracy of Provider Predictions of Viral Suppression Among Adolescents and Young Adults With HIV in an HIV Clinical Program. J Int Assoc Provid AIDS Care 2024; 23:23259582241252587. [PMID: 38794860 PMCID: PMC11128167 DOI: 10.1177/23259582241252587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/09/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Providers caring for adolescents and young adults with HIV (AYA-HIV) mostly base their adherence counseling during clinical encounters on clinical judgment and expectations of patients' medication adherence. There is currently no data on provider predictions of viral suppression for AYA-HIV. We aimed to assess the accuracy of provider predictions of patients' viral suppression status compared to viral load results. METHODS Providers caring for AYA-HIV were asked to predict the likelihood of viral suppression of patients before a clinical encounter and give reasons for their predictions. Provider predictions were compared to actual viral load measurements of patients. Patient data were abstracted from electronic health records. The final analysis included 9 providers, 28 patients, and 34 observations of paired provider predictions and viral load results. RESULTS Provider prediction accuracy of viral suppression was low (59%, Cohen's Kappa = 0.16). Provider predictions of lack of viral suppression were based on nonadherence to medications, new patient status, or structural vulnerabilities (e.g., unstable housing). Anticipated viral suppression was based on medication adherence, history of viral suppression, and the presence of family or other social forms of support. CONCLUSIONS Providers have difficulty accurately predicting viral suppression among AYA-HIV and may base their counseling on incorrect assumptions. Rapid point-of-care viral load testing may provide opportunities to improve counseling provided during the clinical encounter.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Hasiya Yusuf
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kelly Gebo
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allison Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Metrebian N, Carr E, Goldsmith K, Weaver T, Pilling S, Shearer J, Woolston-Thomas K, Tas B, Cooper C, Getty CA, van der Waal R, Kelleher M, Finch E, Bijral P, Taylor D, Scott J, Strang J. Mobile telephone delivered contingency management for encouraging adherence to supervised methadone consumption: feasibility study for an RCT of clinical and cost-effectiveness (TIES). Pilot Feasibility Stud 2021; 7:14. [PMID: 33407950 PMCID: PMC7789356 DOI: 10.1186/s40814-020-00761-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription methadone or buprenorphine enables people with opioid use disorder to stop heroin use safely while avoiding withdrawal. To ensure methadone is taken as prescribed and to prevent diversion onto the illicit market, people starting methadone take their daily dose under a pharmacist's supervision. Many patients miss their daily methadone dose risking withdrawal, craving for heroin and overdose due to loss of heroin tolerance. Contingency management (CM) can improve medication adherence, but remote delivery using technology may be resource-light and cost-effective. We developed an innovative way to deliver CM by mobile telephone. Software monitors patients' attendance and supervised methadone consumption through an internet self-login at the pharmacy and sends reinforcing text messages to patients' mobile telephones. A linked system sends medication adherence reports to prescribers and provides early warning alerts of missed doses. A pre-paid debit card system provides financial incentives. METHODS A cluster randomised controlled trial design was used to test the feasibility of conducting a future trial of mobile telephone CM to encourage adherence to supervised methadone in community pharmacies. Each cluster (drug service/3 allied pharmacies) was randomly allocated to provide patient's presenting for a new episode of opiate agonist treatment (OAT) with either (a) mobile telephone text message CM, (b) mobile telephone text message reminders, or (c) no text messages. We assessed acceptability of the interventions, recruitment, and follow-up procedures. RESULTS Four drug clinics were approached and three recruited. Thirty-three pharmacists were approached and 9 recruited. Over 3 months, 173 individuals were screened and 10 enrolled. Few patients presented for OAT and high numbers were excluded due to receiving buprenorphine or not attending participating pharmacies. There was 96% consistency in recording medication adherence by self-login vs. pharmacy records. In focus groups, CM participants were positive about using self-login, the text messages, and debit card. Prescribers found weekly reporting, time saving, and allowed closer monitoring of patients. Pharmacists reported that the tablet device was easy to host. CONCLUSION Mobile telephone CM worked well, but a planned future trial will use modified eligibility criteria (existing OAT patients who regularly miss their methadone/buprenorphine doses) and increase the number of participating pharmacies. TRIAL REGISTRATION The trial is retrospectively registered, ISRCTN 58958179 .
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Affiliation(s)
- N Metrebian
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK.
| | - E Carr
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - K Goldsmith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - T Weaver
- Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, NW4 4BT, UK
| | - S Pilling
- Research Department of Clinical Health and Educational Psychology, University College London, London, WC1 7HB, UK
| | - J Shearer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - K Woolston-Thomas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - B Tas
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - C Cooper
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - C A Getty
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK
| | - R van der Waal
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - M Kelleher
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - E Finch
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - P Bijral
- Change, Grow, Live Charity, Management Offices, M4 1NA, Manchester, UK
| | - D Taylor
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
| | - J Scott
- University of Bath, BAA2 7AY, Bath, UK
| | - J Strang
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AB, UK.,Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, SE5 8RS, UK
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