Employment Reinforcement Strategies for HIV/AIDS
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: UConn Health
No Placebo Group
Trial Summary
What is the purpose of this trial?Many persons living with HIV/AIDS (PLWHA) are unemployed, with estimates indicating rates as high as 60%. This study will examine the efficacy of reinforcing job-acquisition activities for improving employment outcomes in PLWHA who desire to return to the workforce in part- or full-time capacity. In total, this study will randomly assign 144 unemployed PLWHA to one of two interventions. All participants will receive usual unemployment services with an emphasis on specific issues related to HIV/AIDS, plus encouragement for completing activities geared toward employment readiness and acquisition. The enhanced intervention will involve that same treatment plus chances to win prizes for engaging in job-related activities each week. Participants will receive study treatments for 16 weeks and complete follow-up evaluations throughout 18 months. The hypothesis is that participants reinforced for completing job-related activities will transition to employment at higher and faster rates and work more often than those who are not reinforced for job-related activities.
What data supports the idea that Employment Reinforcement Strategies for HIV/AIDS is an effective treatment?
The available research shows that Employment Reinforcement Strategies, also known as Contingency Management, can be effective for people with HIV/AIDS. In one study, participants who received this treatment were more likely to achieve viral load suppression, which means the amount of HIV in their blood was reduced. Another study at an HIV drop-in center found that using this treatment increased attendance and activity completion rates. Although there are fewer studies specifically on HIV, similar strategies have been successful in helping people with substance use disorders by encouraging drug abstinence and improving treatment attendance. This suggests that the treatment can be beneficial for managing HIV-related behaviors as well.
234511Do I have to stop taking my current medications for this trial?
The trial protocol does not specify whether you need to stop taking your current medications.
What safety data exists for Employment Reinforcement Strategies for HIV/AIDS?
The research indicates that Contingency Management (CM), which is related to Employment Reinforcement Strategies, is an evidence-based intervention primarily used for substance use disorders. It has been shown to be effective in reducing drug use and HIV risk behaviors. CM has been applied to reinforce non-drug-related activities, including employment-related tasks, and has been integrated into multi-target interventions for HIV-positive individuals. While the studies focus on efficacy, they do not explicitly address safety concerns, suggesting that CM is generally considered safe as it involves positive reinforcement strategies.
1671011Is the treatment Activity Contracting, Contingency Management for Activity Completion a promising treatment for helping people with HIV/AIDS return to work?
Yes, the treatment is promising because it focuses on helping people with HIV/AIDS reenter the workforce, which can improve their health and social outcomes. Employment is a key factor in better health and preventing HIV transmission, and this treatment aims to support people in achieving these benefits.
89121314Eligibility Criteria
This trial is for adults over 18 who are HIV positive and currently unemployed, not participating in the formal economy. It's designed to help them get back into work. People with conditions that could interfere with their participation in the study cannot join.Participant Groups
The study tests two methods to improve job acquisition for people living with HIV/AIDS. Everyone gets standard unemployment services plus encouragement for job readiness activities. One group also gets chances to win prizes as extra motivation for completing these activities.
2Treatment groups
Experimental Treatment
Active Control
Group I: Reinforcement for completing activitiesExperimental Treatment2 Interventions
Standard services plus job activity contracting plus reinforcement for completing job-related activities
Group II: Job activity contractingActive Control1 Intervention
Standard services plus job activity contracting
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
United Labor AgencyMiddletown, CT
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Who is running the clinical trial?
UConn HealthLead Sponsor
National Institute on Drug Abuse (NIDA)Collaborator
References
Reinforcing compliance with non-drug-related activities. [2019]Contingency management (CM) procedures, that provide incentives for specific behaviors, are efficacious in treating substance use disorders. Typically, CM interventions reinforce submission of urine specimens negative for the targeted drug(s) of abuse, but other behaviors can be reinforced as well, such as compliance with non-drug-related activities. This article describes 1,059 activities chosen by 46 subjects participating in one of two CM studies. The most frequently chosen activities were related to recreational activities (going to movies, library, or church) and sobriety (attending Alcoholics Anonymous meetings, completing worksheets). Over 95% of subjects participated in at least one of these types of activities, and together they accounted for over 70% of the activities selected. Over half the subjects participated in at least one activity related to employment, health, family, and personal improvement, such as applying for a job, attending a medical appointment, taking their child to an event, or creating weekly to-do lists. A detailed description of activity selection and verification procedures may assist in developing consistent approaches across treatment settings, and future research may evaluate further the efficacy of this contingency management approach in treating substance abusers.
Contingency management in group treatment: a demonstration project in an HIV drop-in center. [2021]This study describes a contingency management intervention applied in group treatment. In an HIV drop-in center, groups were held on Tuesdays and Thursdays for 35 weeks. An ABB'CA design was used, in which reinforcers were available in non-A phases. In the initial B phase, reinforcers were available only on Tuesdays, and they switched to Thursdays in the B' and C phases. The reinforcer was a drawing that was associated with the possibility of winning a prize. Reinforcers were provided for attending group and completing steps related to treatment goals. The number of drawings escalated with weeks of consecutive attendance and activity completion in the B phases; in the C phase, a fixed number of draws were provided. Overall, the procedure increased attendance, with an average of 0.7 clients (range 0-4) per session in the initial baseline phase to an average of seven clients (range 2-12) during reinforcement phases. The percentage of activities completed also rose from 25% during baseline to 65% during reinforcement phases. These data suggest the feasibility of a group-based contingency management intervention.
The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans. [2019]This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.
Contingency management interventions for HIV-related behaviors. [2019]Contingency management (CM) is a scientifically based treatment approach typically employed in substance abuse treatment settings to reinforce drug abstinence, counseling attendance, completion of activities, or other treatment goals. Although the application of CM to HIV management has few published studies, it shows promise as an intervention for HIV-related behaviors. CM interventions such as voucher reinforcement, prize systems, and cash incentives can be used to reduce HIV risk behaviors and to improve HIV medication adherence. CM programs have wide applicability to HIV prevention and management in clinical and community settings and can be implemented as stand-alone techniques or in combination with other interventions.
Contingency management for treatment of substance abuse. [2019]Clinical research trials demonstrate the efficacy of contingency management procedures in treating substance use disorders. Usually, reinforcement, in the form of vouchers exchangeable for retail goods and services, is provided for drug abstinence in patients treated in psychosocial or methadone maintenance clinics. Recently, the types of reinforcers have been adapted to include lower cost alternatives, and reinforcement is being expanded to alter other target behaviors such as attendance at treatment, adherence to treatment goals, and compliance with medication. This chapter provides an overview of the populations and behaviors to which contingency management approaches have been applied. It also reviews design features that appear critical in the successful adaptation of the techniques. In addition, areas for future research are described.
Contingency management: utility in the treatment of drug abuse disorders. [2019]Contingency management (CM) is a strategy that uses positive reinforcement to improve the clinical outcomes of substance abusers in treatment, especially sustained abstinence from drugs of abuse. Further, CM has been adopted to improve methodology and interpretation of outcomes in clinical trials testing new pharmacotherapies and to improve adherence to efficacious medications in substance abuse patients. Thus, CM has proven to be widely useful as a direct therapeutic intervention and as a tool in treatment development.
Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. [2021]Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment.
Helping people with HIV/AIDS return to work: a randomized clinical trial. [2022]New treatments introduced in the mid-1990s led many people with HIV/AIDS who previously had been disabled by their disease to contemplate workforce reentry; many remain unemployed, and little is known concerning interventions that might help them return to work. We report the results of a randomized clinical trial of an intervention designed to help people with HIV/AIDS reenter the workforce.
Examining the role of vocational rehabilitation on access to care and public health outcomes for people living with HIV/AIDS. [2019]The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? and (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention?
A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men. [2019]Contingency management (CM) is an evidence-based intervention providing tangible rewards as positive reinforcement for abstinence from stimulants such as methamphetamine. Integrative approaches targeting affect regulation could boost the effectiveness of CM in community-based settings and optimize HIV/AIDS prevention efforts.
Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users. [2019]Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.
A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. [2019]A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.
Impact of conditional economic incentives and motivational interviewing on health outcomes of adolescents living with HIV in Anambra State, Nigeria: A cluster-randomised trial. [2022]Adolescents living with HIV (ALHIV) have had worse outcomes compared to adults. They face enormous difficulty in accessing HIV care services. We hypothesize that conditional economic incentives (CEI) and motivational interviewing could increase retention in care, medication adherence and ultimately viral load suppression. Therefore, we evaluated the one-year impact of conditional economic incentives and motivational interviewing on the health outcomes of ALHIV in Anambra State, Nigeria.
A cross-lagged longitudinal investigation of the relationship between stigma and job effectiveness among employees with HIV. [2023]Growing diversity in the workforce has compelled scholars and managers to create inclusive organizational environments for employees who belong to marginalized groups. Yet, little is known about how employees with stigmatized medical conditions manage their job demands. In this article, we examine the role of stigma associated with human immunodeficiency virus (HIV) in shaping the ability of employees with HIV to contribute to their organizations. Drawing on stigma and emotions literatures, we investigate the influence of HIV stigma on job effectiveness (i.e., in-role performance and organizational citizenship behaviors) through the mediated paths of fear and shame. We further examine whether a psychological (i.e., core self-evaluation [CSE]) and a physiological (i.e., CD4 cell count, defined as the biological indicator of HIV severity) factor would moderate these mediating relationships at the first and second stages, respectively. Using a sample of 225 employees with HIV surveyed across three measurement periods with a time lag of 3 months, we found support for the dual-stage moderated mediation model linking HIV stigma and job effectiveness via shame under lower (vs. higher) levels of CSE and CD4 cell count. By contrast, we did not find evidence for the mediating role of fear. Implications of our findings for theory and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).