James A. Peck

The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study

Background:The association between methamphetamine use and HIV seroconversion for men who have sex with men (MSM) was examined using longitudinal data from the Multicenter AIDS Cohort Study. Methods:Seronegative (n = 4003) men enrolled in 1984 to 1985, 1987 to 1991, and 2001 to 2003 were identified. Recent methamphetamine and popper use was determined at the current or previous visit. Time to HIV seroconversion was the outcome of interest. Covariates included race/ethnicity, cohort, study site, educational level, number of sexual partners, number of unprotected insertive anal sexual partners, number of unprotected receptive anal sexual partners, insertive rimming, cocaine use at the current or last visit, ecstasy use at the current or last visit, any needle use since the last visit, Center for Epidemiologic Study of Depression symptom checklist score >16 since the last visit, and alcohol consumption. Results:After adjusting for covariates, there was a 1.46 (95% confidence interval [CI]: 1.12 to 1.92) increased relative hazard of HIV seroconversion associated with methamphetamine use. The relative hazard associated with popper use was 2.10 (95% CI: 1.63 to 2.70). The relative hazard of HIV seroconversion increased with the number of unprotected receptive anal sexual partners, ranging from 1.87 (95% CI: 1.40 to 2.51) for 1 partner to 9.32 (95% CI: 6.21 to 13.98) for 5+ partners. The joint relative hazard for methamphetamine and popper use was 3.05 (95% CI: 2.12 to 4.37). There was a significant joint relative hazard for methamphetamine use and number of unprotected receptive anal sexual partners of 2.71 (95% CI: 1.81 to 4.04) for men with 1 unprotected receptive anal sexual partner, which increased in a dose-dependent manner for >1 partners. Conclusions:Further examination of the mechanisms underlying the synergism of drug use and sexual risk behaviors on rates of HIV seroconversion is necessary for the development of new targeted HIV prevention strategies for nonmonogamous drug-using MSM.

Sustained reductions in drug use and depression symptoms from treatment for drug abuse in methamphetamine-dependent gay and bisexual men.

Methamphetamine abusers often complain of feelings of depression that can complicate accurately diagnosing these individuals during treatments for methamphetamine abuse. This article presents an examination of temporal associations between documented methamphetamine use and reported ratings of depression among 162 gay and bisexual male methamphetamine abusers who participated in a 16-week randomized clinical trial of four behavioral therapies for methamphetamine abuse. Methamphetamine use was measured using thrice-weekly urine samples analyzed for drug metabolite. Self-reported depressive symptoms were collected weekly using the Beck Depression Inventory (BDI). At treatment entry, 73.2% of participants rated their depressive symptoms as mild or higher in severity (BDI≥10), with 28.5% reporting BDI scores in the moderate to severe range (BDI≥19). All participants reported significant decreases in depressive symptoms from baseline through the end of treatment, regardless of treatment condition, HIV status, or mood disorder diagnosis. A mixed regression model showed methamphetamine use for up to 5 days prior to the BDI score strongly predicted depressive symptoms (F1,968=18.6, P<.0001), while BDI scores had no significant association with subsequent methamphetamine use. Findings show that behavioral methamphetamine abuse treatment yields reductions in methamphetamine use and concomitant depressive symptom ratings that are sustained to 1 year after treatment entry.

Contingency management among homeless, out-of-treatment men who have sex with men

Homeless men who have sex with men are a particularly vulnerable population with high rates of substance dependence, psychiatric disorders, and HIV prevalence. Most need strong incentives to engage with community-based prevention and treatment programs. Contingency management (CM) was implemented in a community HIV prevention setting and targeted reduced substance use and increased health-promoting behaviors over a 24-week intervention period. Participants in the CM condition achieved greater reductions in stimulant and alcohol use (χ(2) = 27.36, p < .01) and, in particular, methamphetamine use (χ(2) = 21.78, p < .01) and greater increases in health-promoting behaviors (χ(2) = 37.83, p < .01) during the intervention period than those in the control group. Reductions in substance use were maintained to 9- and 12-month follow-up evaluations. Findings indicate the utility of CM for this high-risk population and the feasibility of implementing the intervention in a community-based HIV prevention program.

HIV-Associated Medical, Behavioral, and Psychiatric Characteristics of Treatment-Seeking, Methamphetamine-Dependent Men Who Have Sex with Men

Abstract This paper examines medical and psychiatric symptoms and disorders associated with reported HIV serostatus among methamphetamine-dependent, treatment-seeking men who have sex with men (MSM) in Los Angeles. Baseline data from a NIDA-funded, randomized clinical trial of behavioral drug abuse therapies included medical examinations and behavioral interviews of the 162 randomized participants. Variables identified as significantly associated with HIV infection were entered into a multivariate, hierarchical logistic regression analysis to optimally predict HIV serostatus. The disturbingly high 61% of the sample with reported HIV-seropositive status represents 3-4 times the prevalence for all MSM in Los Angeles County. HIV infection status strongly associated with prior treatment for methamphetamine dependence; unprotected receptive anal intercourse; history of sexually transmitted infections; and health insurance status. Findings demonstrate the powerful connection between methamphetamine dependence and HIV infection, and strongly suggest a need for development of interventions that function as both substance abuse treatment and HIV prevention for this population.

Delay-discounting among homeless, out-of-treatment, substance-dependent men who have sex with men

Background: Impulsivity is associated with substance use; however, to date, impulsivity has not been characterized among a sample of homeless, non-treatment seeking, substance-dependent men who have sex with men (MSM). Objectives: The aim of this study was to utilize the delay-discounting instrument to assess impulsive behaviors among a subsample of homeless, non-treatment seeking, substance-dependent men who have sex with men (S-D MSM) enrolled in a randomized, controlled, contingency management (CM) trial. Methods: Twenty S-D MSM participants from the CM parent study were matched on age and ethnicity to 20 non-substance-dependent, non-homeless control participants using propensity scores (N = 40) and were administered the delay-discounting procedure. Results: Although discounting values decreased rapidly with time in both groups, the S-D MSM participants consistently discounted rewards more steeply than controls (p = .05), particularly at all intermediate measured timeframes. The S-D MSM participants also presented greater median discounting rates (k values) compared with the control group (mS-D MSM = 2.39 (SD = 3.72) vs. mctrl = 1.27 (SD = 3.71), p ≤ .01). Conclusion: This work extends existing findings of increased delay-discounting among substance-dependent individuals to homeless, substance-dependent, non-treatment seeking MSM. Scientific Significance: A better understanding of the prevalence of delay-discounting type behaviors among homeless, substance-dependent MSM can be used to inform the development of tailored substance abuse interventions for this high-risk population.

Lifetime Substance Use and HIV Sexual Risk Behaviors Predict Treatment Response to Contingency Management Among Homeless, Substance-Dependent MSM

Abstract Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance- dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p < .05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p ≤ .05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p < .05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.

Using ECHO Clinics to Promote Capacity Building in Clinical Supervision

INTRODUCTION Project Extension for Community Healthcare Outcomes (ECHO™) is a hub-and-spoke knowledge-sharing network, led by expert teams who use multipoint videoconferencing to conduct virtual clinics with community providers in order to improve the quality of care. For this project, members of the Addiction Technology Transfer Center network applied this model in order to enhance workforce capacity to deliver clinical supervision for the treatment of substance use disorders. METHODS Clinical supervisors (n=66) employed in substance use disorder treatment programs were recruited to participate in this pilot study. The virtual ECHO clinic consisted of 12 total sessions, each lasting 1 hour and comprising a 15-minute mini-lecture on a clinical supervision topic and a 45-minute case presentation and review. All data were collected and analyzed between September 2016 and June 2017. RESULTS Forty-eight staff attended at least one ECHO session (mean=6.38) and results are presented for 20 staff who completed the follow-up survey. Participants were highly satisfied with the overall intervention, organization of the clinic and the facilitation of Hub experts, relevance of the technical assistance to their work, and with the impact of the intervention on their effectiveness as a supervisor. Results also indicate that there were significant self-reported improvements in clinical supervision self-efficacy following participation in the ECHO clinic. CONCLUSIONS Results from this pilot study suggest that ECHO virtual clinics are feasible to implement for the purpose of workforce development, are well liked by participants, and can enhance clinical supervision self-efficacy among participants. Further research should explore the impact of self-efficacy on the effective implementation of clinical supervision practices. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.