HIV InfectionIncentives-2NCT01488942
Use of Incentives to Retain Drug Users in HIV Therapy
A study testing monetary reinforcer in people with HIV Infection, run by University of British Columbia at 1 site in Canada.
Trial summary
In many urban centres including Vancouver's Downtown Eastside, there is a high rate of HIV infection among users of illicit drugs. Among drug users who present to care and start highly active antiretroviral therapy (HAART), retention in care and adherence to their treatment regimen may be less than optimal. Read more about this study
- Who is it for?
- Ages 19 years and older
- Conditions the study is for
- HIV Infection
- What is being tested?
- monetary reinforcer
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 139 participants
- Where
- 1 siteCanada
- Study dates
- Dec 2012to 31 Mar 2018
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 19 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adults at least 19 years of age.
- Have used illicit drugs (heroin, cocaine, cocaine/heroin combinations, methamphetamines, injectable morphine and codeine, but excluding isolated marijuana use) at least once in the past three months.
- Eligible for, and willing to initiate HAART. To be eligible for HAART, participants must have CD4 count at or below 350 cells/mm3 at the HAART eligibility screening visit and/or significant co-morbidities identified in current international guidelines (hepatitis B/C co-infection, HIV associated nephropathy, high risk for cardiovascular disease)
Who cannot join
- No history of active drug use as defined above.
- Pregnant women.
- Receipt of HAART for more than 6 months within the preceding 12 months.
- Persons in recovery from gambling addiction (due to the element of chance in the CM intervention).
- Persons acutely intoxicated at time of consent.
Trial locations and contacts
1 site in 1 country.
Canada1 site
St. Paul's Hospital, VIDUS and Incentives study office site, 611 Powell St.
Vancouver, British Columbia
About this study
Official title: A Randomized Clinical Trial Evaluating the Role of Contingent Reinforcement in the Engagement of and Retention of Drug Users in HAART Programs
In many urban centres including Vancouver's Downtown Eastside, there is a high rate of HIV infection among users of illicit drugs. Among drug users who present to care and start highly active antiretroviral therapy (HAART), retention in care and adherence to their treatment regimen may be less than optimal. Given the known benefits of HAART on both the individual and populational levels, new strategies are required to help retain HIV-infected drug users on HAART.
Contingency management (CM) is a strategy to affect behaviour by providing a reward (e.g. money) to reinforce the desired behaviour. CM has been used with success in other areas of medicine (e.g. smoking cessation, weight loss) and in the drug using population, but has not been established as a means to improve retention in HAART programs.
Read more
The proposed research primarily seeks to assess the effectiveness of monetary-based CM in retaining HIV-infected drug users in HAART programs. 240 HAART-eligible subjects will be randomized in a 2:1 ratio to either receive (n=160) the reinforcer or to a control arm (n=80). All subjects will receive HAART and standard care, and those randomized to the reinforcer arm will receive escalating reinforcement initially for attendance at each clinic visit (until month 6 after starting HAART) and subsequently (until month 12 after starting HAART) will receive an escalating variable reinforcer for each month in which a plasma viral load less than or equal to 100 copies/mL is maintained.
Our hypotheses are that drug users initiating HAART and randomly selected to receive a reinforcer for attending clinic visits then maintaining monthly virologic suppression during the first 52 weeks after HAART initiation will be significantly more likely to achieve virologic suppression at 52 weeks, will have a significantly longer duration of sustained virologic suppression during the first 52 weeks, and will be significantly more likely to maintain virologic suppression at 72 weeks after HAART initiation, than those not offered a reinforcer.
Read the detailed description
Once HAART has been initiated, participants will be expected to be assessed at weeks 1,2,3,4,6,8,10,12,14, and 16. Detailed adherence and dispensing records for all antiretroviral medications for each participant will be maintained. Adherence will be assessed primarily on the basis of pharmacy refill records, as well as self-report. Subsequently participants will attend monthly clinical follow-up visits at weeks 20, 24, 28, 32, 36, 40, 44, 48, and 52. Standard laboratory monitoring will be performed at that time, and will include complete blood count (CBC), differential, basic chemistry, liver and kidney profile, as well as CD4 cell count and plasma HIV-1-RNA level, consistent with current care guidelines. All patients will also undergo urine toxicology screens at baseline and quarterly (weeks 12, 24, 36, and 52) in order to assess any effects of engaging in HAART programs on substance use. Follow-up will also include an adverse events assessment (ADE) from a standardized list of signs and symptoms noted by either the patient or practitioner or identified through laboratory testing. At baseline and each quarterly visit, participants will complete the Center for Epidemiologic Studies Depression Scale (CES-D) where a score of 16 correlates with risk of depression. This tool has been validated in our population in a prior study. Participants will also complete the Addiction Severity Index questionnaire, a validated instrument used to examine severity of psychosocial problems in seven domains including drug and alcohol use . Composite scores are derived, and higher scores reflect greater problems. Past 3-month versions of the HIV Risk Behavior Scale will also be administered at baseline and at quarterly visits. This scale assesses injection drug use and sexual behaviors, and responses are coded on a 6-point scale with higher values indicating higher risk.
Participants who are randomized to receive a reinforcer for clinic follow-up will receive the reinforcer at the end of each clinic visit. When the reinforcer is linked to plasma viral load, subjects in the reinforcer arm will be notified within a week of the plasma viral load result, and of any reinforcement earned. Subjects can elect to come in at any time to receive the reinforcement, or they can wait until their next monthly appointment and receive the earnings at that time.
For participants who do not present for laboratory and clinical follow-up within two weeks on either side of their scheduled quarterly visit, an extensive investigation into the client's whereabouts through street outreach as well as a search of hospital records for hospitalization and the provincial vital statistics database for possible deaths will be prompted. Those who discontinue therapy or who are lost to follow-up at or before 52 weeks will be considered therapy failures in the analyses.
A final visit 24 weeks after the week 52 visit will be performed. This will involve the same procedures as the quarterly study visits during the first year, including standard laboratory tests and urine toxicology, ADE assessments, and CES-D, Addiction Severity Index and HIV Risk Behavior Scale questionnaires. Participants who fail to present for laboratory and clinical follow-up within 2 weeks of the expected date of this visit will be sought as described above.
- Conditions
- HIV Infection
- Being tested
- monetary reinforcer
- Keywords
- HIV, reinforcement, medication adherence, patient compliance, antiretroviral therapy, highly active
- Medical subject headings
- HIV Infections, Medication Adherence, Patient Compliance
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
monetary reinforcerOther
Also called contingency management
The protocol will follow an escalating schedule of reinforcements tied to clinic visit attendance for the first 24 weeks, after which the reinforcers will take the form of an escalating variable reinforcement schedule in the form of fishbowl prize draws linked to maintenance of suppressed viral load for the remainder of the 52-week study period. In addition, a reset function will be incorporated by which the reinforcer will be rolled back to an initial lower value if clinic visits or viral load targets are not met. This will be rapidly scaled up again once targets are met.
| Study group | Role | What they receive |
|---|---|---|
| monetary reinforcer | Experimental | Subjects randomized to this arm will receive an escalating reinforcer initially for attendance at each clinic visit (until month 6 after starting HAART) and subsequently (until month 12 after starting HAART) will receive an escalating variable reinforcer for each month in which a viral load at or below 100 copies/mL is maintained Receives: Other: monetary reinforcer |
| no reinforcer | No intervention | All subjects will receive HAART and standard medical care, but subjects in the control arm will not receive monetary reinforcers. |
What is being measured
The primary outcome is the main question the study is designed to answer.
proportion of subjects achieving virologic suppression (plasma viral load less than or equal to 100 copies/mL) at 52 weeks after HAART initiation.
Measured: 52 weeks after HAART initiation.
Secondary outcomes (2)
duration of sustained virologic suppression during the first 52 weeks after HAART initiation.
Virologic response will be defined as the percentage of follow-up time with plasma viral load less than or equal to 100 copies/mL.
Measured: during the first 52 weeks after HAART initiation.
proportion of subjects achieving virologic suppression (plasma viral load less than or equal to 100 copies/mL) at 72 weeks after HAART initiation.
Measured: 72 weeks after HAART initiation.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Dec 2011 (estimated)
- Study startDec 2012
- Primary completion31 Mar 2018
- Study completion31 Mar 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for HIV InfectionStudies of the same condition, open and under way.
- More trials run by University of British ColumbiaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 139 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of British Columbia
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Responsible party
- Principal investigator, Mark Hull, University of British Columbia
- Investigators
- Mark Hull, MD, Principal investigator, University of British ColumbiaJulio SG Montaner, MD, Principal investigator, University of British Columbia
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01488942
- Sponsor's protocol ID
- H11-00514
- Other IDs
- 1R01DA031043-01, H11-00514
- Acronym
- Incentives-2
- Status last verified
- Jul 2019
- First submitted
- 6 Dec 2011
- Last updated
- 15 Jul 2019
- Results posted
- No
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 15 Jul 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Clinical Trial Evaluating the Role of Contingent Reinforcement in the Engagement of and Retention of Drug Users in HAART Programs
- ClinicalTrials.gov ID
- NCT01488942
- Acronym / sponsor ID
- Incentives-2 / H11-00514
- Conditions
- HIV Infection
- Keywords
- HIV, reinforcement, medication adherence, patient compliance, antiretroviral therapy, highly active
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 139 participants (actual)
- Lead sponsor
- University of British ColumbiaUniversity, hospital or other
- Collaborators
- National Institute on Drug Abuse (NIDA)
- Study start
- Dec 2012
- Primary completion
- 31 Mar 2018 (actual)
- Study completion
- 31 Mar 2018 (actual)
- First posted
- 8 Dec 2011 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In many urban centres including Vancouver's Downtown Eastside, there is a high rate of HIV infection among users of illicit drugs. Among drug users who present to care and start highly active antiretroviral therapy (HAART), retention in care and adherence to their treatment regimen may be less than optimal. Given the known benefits of HAART on both the individual and populational levels, new strategies are required to help retain HIV-infected drug users on HAART.
Contingency management (CM) is a strategy to affect behaviour by providing a reward (e.g. money) to reinforce the desired behaviour. CM has been used with success in other areas of medicine (e.g. smoking cessation, weight loss) and in the drug using population, but has not been established as a means to improve retention in HAART programs.
The proposed research primarily seeks to assess the effectiveness of monetary-based CM in retaining HIV-infected drug users in HAART programs. 240 HAART-eligible subjects will be randomized in a 2:1 ratio to either receive (n=160) the reinforcer or to a control arm (n=80). All subjects will receive HAART and standard care, and those randomized to the reinforcer arm will receive escalating reinforcement initially for attendance at each clinic visit (until month 6 after starting HAART) and subsequently (until month 12 after starting HAART) will receive an escalating variable reinforcer for each month in which a plasma viral load less than or equal to 100 copies/mL is maintained.
Our hypotheses are that drug users initiating HAART and randomly selected to receive a reinforcer for attending clinic visits then maintaining monthly virologic suppression during the first 52 weeks after HAART initiation will be significantly more likely to achieve virologic suppression at 52 weeks, will have a significantly longer duration of sustained virologic suppression during the first 52 weeks, and will be significantly more likely to maintain virologic suppression at 72 weeks after HAART initiation, than those not offered a reinforcer.
Detailed description
Once HAART has been initiated, participants will be expected to be assessed at weeks 1,2,3,4,6,8,10,12,14, and 16. Detailed adherence and dispensing records for all antiretroviral medications for each participant will be maintained. Adherence will be assessed primarily on the basis of pharmacy refill records, as well as self-report. Subsequently participants will attend monthly clinical follow-up visits at weeks 20, 24, 28, 32, 36, 40, 44, 48, and 52. Standard laboratory monitoring will be performed at that time, and will include complete blood count (CBC), differential, basic chemistry, liver and kidney profile, as well as CD4 cell count and plasma HIV-1-RNA level, consistent with current care guidelines. All patients will also undergo urine toxicology screens at baseline and quarterly (weeks 12, 24, 36, and 52) in order to assess any effects of engaging in HAART programs on substance use. Follow-up will also include an adverse events assessment (ADE) from a standardized list of signs and symptoms noted by either the patient or practitioner or identified through laboratory testing. At baseline and each quarterly visit, participants will complete the Center for Epidemiologic Studies Depression Scale (CES-D) where a score of 16 correlates with risk of depression. This tool has been validated in our population in a prior study. Participants will also complete the Addiction Severity Index questionnaire, a validated instrument used to examine severity of psychosocial problems in seven domains including drug and alcohol use . Composite scores are derived, and higher scores reflect greater problems. Past 3-month versions of the HIV Risk Behavior Scale will also be administered at baseline and at quarterly visits. This scale assesses injection drug use and sexual behaviors, and responses are coded on a 6-point scale with higher values indicating higher risk.
Participants who are randomized to receive a reinforcer for clinic follow-up will receive the reinforcer at the end of each clinic visit. When the reinforcer is linked to plasma viral load, subjects in the reinforcer arm will be notified within a week of the plasma viral load result, and of any reinforcement earned. Subjects can elect to come in at any time to receive the reinforcement, or they can wait until their next monthly appointment and receive the earnings at that time.
For participants who do not present for laboratory and clinical follow-up within two weeks on either side of their scheduled quarterly visit, an extensive investigation into the client's whereabouts through street outreach as well as a search of hospital records for hospitalization and the provincial vital statistics database for possible deaths will be prompted. Those who discontinue therapy or who are lost to follow-up at or before 52 weeks will be considered therapy failures in the analyses.
A final visit 24 weeks after the week 52 visit will be performed. This will involve the same procedures as the quarterly study visits during the first year, including standard laboratory tests and urine toxicology, ADE assessments, and CES-D, Addiction Severity Index and HIV Risk Behavior Scale questionnaires. Participants who fail to present for laboratory and clinical follow-up within 2 weeks of the expected date of this visit will be sought as described above.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| monetary reinforcer | Experimental | Other: monetary reinforcerSubjects randomized to this arm will receive an escalating reinforcer initially for attendance at each clinic visit (until month 6 after starting HAART) and subsequently (until month 12 after starting HAART) will receive an escalating variable reinforcer for each month in which a viral load at or below 100 copies/mL is maintained |
| no reinforcer | No intervention | –All subjects will receive HAART and standard medical care, but subjects in the control arm will not receive monetary reinforcers. |
Who may qualify
- Ages
- 19 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Adults at least 19 years of age.
- Have used illicit drugs (heroin, cocaine, cocaine/heroin combinations, methamphetamines, injectable morphine and codeine, but excluding isolated marijuana use) at least once in the past three months.
- Eligible for, and willing to initiate HAART. To be eligible for HAART, participants must have CD4 count at or below 350 cells/mm3 at the HAART eligibility screening visit and/or significant co-morbidities identified in current international guidelines (hepatitis B/C co-infection, HIV associated nephropathy, high risk for cardiovascular disease)
Key exclusion criteria (5 listed)
- No history of active drug use as defined above.
- Pregnant women.
- Receipt of HAART for more than 6 months within the preceding 12 months.
- Persons in recovery from gambling addiction (due to the element of chance in the CM intervention).
- Persons acutely intoxicated at time of consent.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| monetary reinforcerAlso: contingency managementThe protocol will follow an escalating schedule of reinforcements tied to clinic visit attendance for the first 24 weeks, after which the reinforcers will take the form of an escalating variable reinforcement schedule in the form of fishbowl prize draws linked to maintenance of suppressed viral load for the remainder of the 52-week study period. In addition, a reset function will be incorporated by which the reinforcer will be rolled back to an initial lower value if clinic visits or viral load targets are not met. This will be rapidly scaled up again once targets are met. | Other | monetary reinforcer |
Primary outcome
proportion of subjects achieving virologic suppression (plasma viral load less than or equal to 100 copies/mL) at 52 weeks after HAART initiation.
Time frame: 52 weeks after HAART initiation.
2 secondary outcomes
duration of sustained virologic suppression during the first 52 weeks after HAART initiation.
Time frame: during the first 52 weeks after HAART initiation.
proportion of subjects achieving virologic suppression (plasma viral load less than or equal to 100 copies/mL) at 72 weeks after HAART initiation.
Time frame: 72 weeks after HAART initiation.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jul 2019.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mark Hull, MD principal investigator
University of British Columbia
Julio SG Montaner, MD principal investigator
University of British Columbia
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing monetary reinforcer in people with HIV Infection, run by University of British Columbia at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 Jul 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
proportion of subjects achieving virologic suppression (plasma viral load less than or equal to 100 copies/mL) at 52 weeks after HAART initiation. (time frame: 52 weeks after HAART initiation.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jul 2019.