Skip to main content
Download PDF
Download ePub

Readiness to implement contingency management to promote PrEP initiation and adherence among people who inject drugs: results from a multi-site implementation survey

Addiction Science & Clinical Practice volume 19, Article number: 97 (2024) Cite this article

Abstract

Background

Contingency management (CM), an incentive-based intervention to encourage target behaviors, effectively promotes medication adherence. However, efforts to extend CM to HIV pre-exposure prophylaxis (PrEP) have been lacking. As part of a randomized clinical trial to promote HIV Prevention among people who inject drugs (PWID), we examined the readiness of staff in community-based organizations serving PWID to implement CM for PrEP uptake and adherence in this population.

Methods

From April to August 2022, we conducted a survey of staff from four community-based organizations providing HIV testing, harm reduction, and outreach services in the northeastern United States. We assessed knowledge and attitudes regarding PrEP for PWID on five-point Likert scales (e.g., Poor to Excellent, Not at all to Extremely). Using a modified version of the Contingency Management Beliefs Questionnaire, we assessed the degree to which attitudes about CM for HIV prevention influenced interest in its adoption on a scale from “1-No influence at all” to “5-Very strong influence”. We explored endorsement patterns, along with average values of individual items and subscale scores.

Results

Among 271 staff invitations, 123 (45.4%) responded. The majority (88.6%) of respondents reported prior PrEP awareness, with a mean self-rated knowledge of 2.98 out of 5 (SD = 1.1). Attitudes towards PrEP, including its relevance to and importance for clients (both means = 4.3), efficacy (mean = 4.5), and safety (mean = 4.2), were positive. Items related to practicality and confidence in providing PrEP-related care had relatively lower ratings. Respondents endorsed influential generalized (mean = 2.1) and training-related (mean = 2.5) CM implementation barriers less frequently than positive attitudes towards CM (mean = 3.6). Staff favored adding CM to existing services (mean = 3.8), and highly endorsed it as “useful for targeting HIV prevention with PrEP” (mean = 3.7).

Conclusions

Respondents generally supported the use of CM to promote HIV prevention among PWID and favored adding it to their existing services. Though respondents understood the value of both PrEP and CM to support HIV prevention activities, findings corroborate research citing relative lack of knowledge and confidence regarding PrEP management among clients, potentially detracting from implementation readiness.

Trial Registration Number

NCT04738825.

Background

Pre-exposure prophylaxis for HIV prevention (PrEP) is recommended for people who inject drugs (PWID), who remain at elevated risk for contracting HIV as highlighted by multiple HIV outbreaks occurring in this group in the past decade [1, 2]. Despite moderate-to-high interest in PrEP among this group [3], engagement in PrEP remains extremely low for a variety of individual, institutional, and structural reasons [4,5,6,7]. Integration of PrEP linkage interventions in a variety of substance use service and treatment settings has been identified as a key strategy for increasing PrEP implementation among PWID [8].

Contingency management (CM), the use of incentives to promote verifiable behavior change, has been utilized across the HIV care continuum [9], with demonstrated success in improving HIV-related healthcare visit attendance, increasing adherence to HIV antiretroviral therapy, and maintaining suppressed HIV viral load [10,11,12,13,14]. Among people who use drugs, CM decreases substance use [15,16,17], and has been used effectively to promote treatment of opioid use disorder and infectious disease (including HIV) [18, 19], but has low rates of implementation outside of research settings [20, 21]. However, CM has not, to our knowledge, been applied to the uptake of and sustained adherence to PrEP among PWID, which remains an area of ongoing research [22, 23]. Progress towards achieving PrEP adherence can be verified in several ways, including documentation of an appointment with a clinician; evidence of laboratory testing needed prior to starting PrEP; evidence of medication fill; evidence of tenofovir metabolites in urine; and documentation of receipt of injectable PrEP.

Though issues of low PrEP initiation and adherence among PWID [24,25,26,27,28] may be directly addressable with CM, attitudes of clinical and non-clinical staff toward the use of CM for this purpose are poorly understood and represent potential implementation barriers. Consistent with a hybrid type 1 effectiveness-implementation approach [29], we sought to identify implementation barriers and facilitators of promoting PrEP for PWID by assessing baseline PrEP-related knowledge and attitudes among both clinical and non-clinical staff, in conjunction with their beliefs about CM for this population.

Methods

From April to August 2022, we conducted a confidential survey of staff and clinicians from four community-based organizations participating in a randomized clinical trial of a stepped care intervention including CM and navigation services (“PrEP adherence and support services”) to promote HIV prevention with PrEP among PWID. This survey was conducted during the first year after launch of the parent randomized clinical trial (details have been published previously) [30].

Drawn from validated measures and previous surveys [31, 32], items for this survey were developed with interdisciplinary input and pilot tested prior to implementation.

Participants and setting

Sites were intentionally selected because of their varying experiences participating in research, missions, and diversity in services. All four of the participating organizations provide on-site HIV testing, harm reduction, and outreach services; three of the organizations offer onsite medications to treat OUD; and two of the organizations house on-site PrEP care [30].

Each site-based Principal Investigator or designee identified a list of eligible staff – including administrative staff, frontline service providers, and leadership – to generate the final sample. To be considered eligible for the study, participants needed to be: (1) currently employed at one of the participating sites and engaged in directly or supervising service delivery; and (2) willing to complete the survey. For this survey, participants were given basic definitions of CM (that it “used rewards or prizes to incentivize behavior change”) and activity contracting (referring to the practice of working with clients to determine targeted behavior and respective source of verification that will be completed to earn CM rewards). This survey was administered as a baseline assessment of attitudes and beliefs, and most staff had not yet received extensive training on CM or PrEP as part of the parent trial [30].

Measures

Participant characteristics

We assessed both sociodemographic (e.g., gender, race, HIV status) and professional (e.g., job type, experience at organization, HIV certification) characteristics. For potentially sensitive items such as HIV status, we included a ‘prefer not to answer’ option. Both organizational and total experience items were collapsed to ‘0–2 years’, ‘2–5 years’, and ‘5 + years’, to better understand employment status. Respondent sociodemographic and professional characteristics are presented in Tables 1 and 2, respectively.

Table 1 Respondent sociodemographic characteristics (n = 123)
Full size table
Table 2 Respondent PrEP knowledge and professional characteristics (n = 123)
Full size table

PrEP knowledge and attitudes

PrEP knowledge was measured by respondent report of ever having heard of PrEP—a “yes/no” question—and self-rated knowledge of PrEP on a five-point Likert scale from “1 – Poor” to “5 – Excellent” (Table 2). Staff opinions about PrEP’s overall effectiveness, safety, and relevance; the appropriateness and practicality of PrEP-related care in respondents’ roles and at their organization; and their confidence about PrEP adoption and management with their specific clients were also captured in five-point Likert responses.

Contingency Management beliefs questionnaire

We collected information about respondent attitudes towards CM using an adapted version of the 32-item Contingency Management Beliefs Questionnaire (CMBQ). The CMBQ consists of three subscales focused on generalized barriers, training-related barriers, and support for CM [31]. We added 15 items related to its use to promote PrEP and medications for opioid use disorder. All items are statements with a 5-item Likert scale for response options, assessing the degree of influence each item had on the interest (or lack of interest) in implementing CM interventions for HIV prevention. The responses ranged from “No influence at all” (rating = 1) to “Very strong influence” (rating = 5). All items were reviewed by the interdisciplinary research team for clarity and relevance before being submitted to the IRB for approval. The data collection instrument can be found as supplementary material in the protocol paper for the larger study [30].

Data collection

The web-based survey was sent to the emails of identified staff and administered via REDCap (Research Electronic Data Capture) [33, 34] and supplemented by paper versions as preferred. The survey was administered after a single staff person from each site had all been trained on the intervention and its components (i.e., CM, PrEP navigation) and enrollment in the parent randomized control trial had commenced. Staff who did not complete the survey after two weeks were sent a reminder every two weeks until they completed the survey or the collection period ended.

Data analysis

We used R version 4.3.1 to generate descriptive statistics for all demographic and professional background variables. We calculated the average rating for each item and subscale of the modified CMBQ as well as all PrEP practice and attitude-related assessments. No analyses of association were conducted as the sample size did not offer sufficient power.

Results

Participant characteristics

Among 271 invitations, we received 123 (45.4%) complete responses. Respondents primarily identified as female (75.6%), White (61.8%), and not Hispanic or Latinx (83.7%) (Table 1). Over one in five identified as a person in recovery (21.1%) while just under one in ten identified as having or at risk for HIV (8.1%). In terms of their professional role and background, respondents most commonly identified as mental health providers (25.2%), nurses (24.4%), or some other direct service provider (19.5%). Most respondents had been in their current profession (74.8%) and at their respective organization (79.7%) for over two years (Table 2).

PrEP knowledge and attitudes

One hundred nine (88.6%) respondents indicated having awareness of PrEP before taking the survey. Of the respondents who had prior PrEP awareness, self-rated knowledge ranged from 1.0 to 5.0, with an average rating of 2.98. When asked directly about their opinion, staff endorsed PrEP as relevant and important for clients (mean scores = 4.3), efficacious (mean score = 4.5), and safe (mean score = 4.2). Based on a five-point Likert scale from “Strongly Disagree – 1” to “Strongly Agree – 5”, respondents generally agreed that clients had access to PrEP within their organization (mean score = 4.5) and disagreed that PrEP-related care was impractical due to competing priorities (mean score = 2.7) or not within the confines of their role (mean score = 2.6).

While respondents reported confidence in knowing where to refer their clients for PrEP (mean score = 4.0), they were less confident that they knew enough about best practices (mean score = 2.8) and having the skills and knowledge necessary to assist clients in taking PrEP (mean score = 2.7). Findings suggested concerns with client capacity as well, with lower confidence in client motivation (mean score = 2.5) and ability to adhere to and cover the cost of PrEP (mean scores = 2.8 and 2.3, respectively). General response breakdowns are presented in Fig. 1a, 1b, 1c and item-by-item response breakdowns as well as means are presented in Table 3.

Table 3 Respondent PrEP attitude breakdown
Full size table
Fig. 1a
figure 1

PrEP opinions among community-based staff (n = 123). The % statistics at each end of the X axes for Figs. 1a–1c represent cumulative positive or negative valence. For example, the left-aligned statistic is the proportion of respondents who either answered “1” or “2”; the middle statistic is the proportion of respondents who answered “3”; and the right-aligned statistic is the proportion of respondents who answered “4” or “5”. The percentages are rounded to the nearest whole number

Full size image
Fig. 1b
figure 2

PrEP practicality attitudes among community-based staff (n = 123). The % statistics at each end of the X axes for Figs. 1a–1c represent cumulative positive or negative valence. For example, the left-aligned statistic is the proportion of respondents who either answered “1” or “2”; the middle statistic is the proportion of respondents who answered “3”; and the right-aligned statistic is the proportion of respondents who answered “4” or “5”. The percentages are rounded to the nearest whole number

Full size image
Fig. 1c
figure 3

PrEP confidence among community-based staff (n = 123). The % statistics at each end of the X axes for Figs. 1a–1c represent cumulative positive or negative valence. For example, the left-aligned statistic is the proportion of respondents who either answered “1” or “2”; the middle statistic is the proportion of respondents who answered “3”; and the right-aligned statistic is the proportion of respondents who answered “4” or “5”. The percentages are rounded to the nearest whole number

Full size image

CMBQ overall responses

Respondents endorsed influential generalized (mean score = 2.1) and training-related (mean score = 2.5) implementation barriers less frequently than they indicated positive attitudes towards adopting CM (mean score = 3.6). Average responses to the individual items on the CMBQ and item-by-item response breakdowns are presented in Table 4.

Table 4 Contingency management beliefs questionnaire responses (n = 123)
Full size table

Generalized barriers

The generalized barriers with the highest rated influence on implementing CM included: “I think the research evidence about contingency management’s effectiveness does not apply to our everyday clients.” (mean score = 2.9), followed by “I am worried about what happens once the contingencies are withdrawn.” (mean score = 2.8), and “I am concerned clients might sell/trade earned items for drugs.” (mean score = 2.6). The least commonly endorsed barriers included: “I find contingency management distasteful because it is basically paying someone to do what they should do already.” (mean score = 1.7) and “Our clinic rules prevent urine screening for opioid use.” (mean score = 1.8).

Training-related barriers

Looking at training-related barriers, the most endorsed included: “I want more training before implementing contingency management.” (mean score = 3.1) and “I don’t feel qualified or properly trained to administer contingency management interventions.” (mean score = 2.5). The least commonly endorsed training-related barriers were: “My agency / supervisors / administrators do not support contingency management (e.g., do not provide training, resources).” (mean score = 2.0) and “Currently, no one in my facility has the experience to supervise contingency management.” (mean score = 2.2).

Support for CM

The highest rated items indicating support for CM included: “Any source of motivation, including extrinsic motivation, is good if it helps get clients involved and responding to treatment.” (mean score = 3.9), “I think that contingency management is worth the time and effort if it works.” (mean score = 3.8), and “I am in favor of adding contingency management interventions to our existing services.” (mean score = 3.8). The lowest rated items were: “Contingency management is good for the client-counselor relationship.” (mean score = 3.3) and “Contingency management helps clients reduce their opioid use so that they can work on other aspects of treatment.” (mean score = 3.4).

Contingency management to promote PrEP

When reviewing additional items related to the use of CM to promote PrEP initiation and adherence, the highest endorsed items were: “Contingency management is useful for targeting HIV prevention with PrEP.” (mean score = 3.7) and “It is preferable to give clients prizes in choice of goods/supplies/gift cards (rather than cash) for reaching treatment goals.” (mean score = 3.7). Items indicating the lowest influence for implementing CM for HIV prevention included: “I believe it is not right to give rewards for PrEP if clients are not meeting other treatment goals.” (mean score = 1.9); “Our clients will not be interested in prizes for opioid abstinence.” (mean score = 2.0); and “Our clients will not be interested in prizes for PrEP adherence.” (mean score = 2.0).

Discussion

These findings suggest high feasibility and acceptability related to the use of CM to promote PrEP in various service provision settings. Participants generally rated items indicating positive attitudes towards CM more highly than they rated items related to barriers to implementing CM. Compared to other recent studies using the CMBQ, this study observed lower ratings for both generalized and training-related barriers and equal or higher ratings for supportive statements [35, 36]. These scores could be further improved through training and education of organization staff on CM [37].

The most commonly endorsed barriers to CM related to the need for more training on the evidence behind CM and how to implement the components of CM within different settings. Participant responses also indicated a level of concern around how CM participants might use the prizes they earn. These concerns are similar to those observed in other research assessing implementation barriers related to CM [38].

With regard to PrEP itself, participants expressed positive attitudes, strongly endorsing its relevance, importance, efficacy and safety. This finding represents an important departure from the extant literature documenting provider and other non-clinical staff concerns about PrEP [39,40,41], which ultimately interfere with adoption [22]. Despite the favorable regard for PrEP amongst participants, their overall lack of confidence in best practices and discussing PrEP initiation with clients corroborates findings from past studies of provider awareness and comfortability [42,43,44]. This self-reported competency gap, in addition to sustained concerns about client capacity for PrEP (i.e., motivation, adherence, cost), may be notable barriers to the implementation of both PrEP in general as well as CM to support PrEP among PWID (4, 45–46). Trainings around CM for PrEP adherence should directly address CM’s long and robust history of promoting new behavior initiation and adherence over time, as well as highlighting the suitability of PrEP adherence as a behavioral target in CM protocols. For example, CM requires objective and verifiable target behaviors. PrEP offers multiple options of adherence verification, such as direct observation for injections or video verification or urine testing for patients taking daily oral formulations.

Limitations

These findings should be taken into consideration along with the limitations of the study. All participants were from the northeastern US, based at organizations participating in a clinical trial of a CM intervention. This sample may not be generalizable to other settings. Additionally, given data were collected during the COVID-19 pandemic, responses may differ based on how respondent priorities changed. Finally, we did not calculate associations between CMBQ scores and other variables due to limited power.

Conclusions

Overall, respondents understood the value of CM in motivating clients and thought it would support HIV prevention activities, including PrEP engagement. Positive attitudes towards PrEP signaled increased potential for readiness to implement this intervention with an underserved population. These results suggest staff are favorable towards the use of CM in community-based organizations, though staff competency and concerns about providing PrEP-related care must also be considered. Continued efforts to research and increase utilization of CM in promoting various health behaviors across various settings is needed.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CM:

Contingency management

CMBQ:

Contingency Management Beliefs Questionnaire

MOUD:

Medications for Opioid Use Disorder

PrEP:

Pre–Exposure Prophylaxis for HIV Prevention

PWID:

People Who Inject Drugs

References

  1. Strathdee SA, Kuo I, El-Bassel N, Hodder S, Smith LR, Springer SA. Preventing HIV outbreaks among people who inject drugs in the United States: plus ça change, plus ça même chose. AIDS. 2020;34(14):1997–2005.

  2. US Preventive Services Task Force. Preexposure Prophylaxis to Prevent Acquisition of HIV: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;330(8):736–45.

    Article  Google Scholar 

  3. Ni Z, Altice FL, Wickersham JA, Copenhaver MM, DiDomizio EE, Nelson LE, et al. Willingness to initiate pre-exposure prophylaxis (PrEP) and its use among opioid-dependent individuals in drug treatment. Drug Alcohol Depend. 2021;219:108477.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Pleuhs B, Mistler CB, Quinn KG, Dickson-Gomez J, Walsh JL, Petroll AE, et al. Evidence of potential discriminatory HIV Pre-exposure Prophylaxis (PrEP) prescribing practices for people who inject drugs among a small percentage of providers in the U.S. J Prim Care Community Health. 2022;13:21501319211063999.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mistler CB, Copenhaver MM, Shrestha R. The pre-exposure Prophylaxis (PrEP) Care Cascade in people who inject drugs: a systematic review. AIDS Behav. 2021;25(5):1490–506.

    Article  PubMed  Google Scholar 

  6. Jaiswal J, Griffin M, Hascher K, Cox AB, Dunlap K, Walters S, et al. Logistical facilitators and barriers to PrEP implementation in Methadone Clinic settings: Provider and Staff perspectives. J Addict Med. 2022;16(5):e278–83.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Edelman EJ, Moore BA, Calabrese SK, Berkenblit G, Cunningham C, Patel V, et al. Primary Care Physicians’ willingness to prescribe HIV pre-exposure Prophylaxis for people who inject drugs. AIDS Behav. 2017;21(4):1025–33.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The past, Present, and future of PrEP implementation among people who use drugs. Curr HIV/AIDS Rep. 2021;18(4):328–38.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Andrawis A, Tapa J, Vlaev I, Read D, Schmidtke KA, Chow EPF, Lee D, Fairley CK, Ong JJ. Applying behavioural insights to HIV Prevention and Management: a scoping review. Curr HIV/AIDS Rep. 2022;19(5):358–74. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11904-022-00615-z.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Reback CJ, Kisler KA, Fletcher JB. A novel adaptation of Peer Health Navigation and Contingency Management for Advancement along the HIV Care Continuum among Transgender women of Color. AIDS Behav. 2021;25(Suppl 1):40–51. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10461-019-02554-0.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Alsan M, Beshears J, Armstrong WS, Choi JJ, Madrian BC, Nguyen MLT, Del Rio C, Laibson D, Marconi VC. A commitment contract to achieve virologic suppression in poorly adherent patients with HIV/AIDS. AIDS. 2017;31(12):1765–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/QAD.0000000000001543.

    Article  PubMed  Google Scholar 

  12. Silverman K, Holtyn AF, Rodewald AM, Siliciano RF, Jarvis BP, Subramaniam S, Leoutsakos JM, Getty CA, Ruhs S, Marzinke MA, Fingerhood M. Incentives for viral suppression in people living with HIV: a Randomized Clinical Trial. AIDS Behav. 2019;23(9):2337–46. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10461-019-02592-8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ribeiro A, Pinto DGA, Trevisol AP, Tardelli V, Arcadepani F, Bosso RA, Ribeiro M, Fidalgo TM. Can Contingency Management solve the problem of adherence to antiretroviral therapy in drug-dependent individuals? Health Educ Behavior: Official Publication Soc Public Health Educ. 2023;50(6):738–47. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/10901981221148966.

    Article  Google Scholar 

  14. Stitzer M, Matheson T, Cunningham C, Sorensen JL, Feaster DJ, Gooden L, Hammond AS, Fitzsimons H, Metsch LR. Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study. Addict Sci Clin Pract. 2017;12(1):16. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13722-017-0081-1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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. 2022; Suppl No Pagination Specified-No Pagination Specified.

  16. Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction (Abingdon England). 2006;101(2):192–203.

    Article  PubMed  Google Scholar 

  17. Rash CJ, Stitzer M, Weinstock J. Contingency management: new directions and remaining challenges for an evidence-based intervention. J Subst Abuse Treat. 2017;72:10–8.

    Article  PubMed  Google Scholar 

  18. Herrmann ES, Matusiewicz AK, Stitzer ML, Higgins ST, Sigmon SC, Heil SH. Contingency management interventions for HIV, Tuberculosis, and Hepatitis Control among individuals with Substance Use disorders: a systematized review. J Subst Abuse Treat. 2017;72:117–25.

  19. Bolívar HA, Klemperer EM, Coleman SRM, DeSarno M, Skelly JM, Higgins ST. Contingency management for patients receiving medication for opioid use disorder: a systematic review and Meta-analysis. JAMA Psychiatry. 2021;78(10):1092–102.

    Article  PubMed  Google Scholar 

  20. Scott K, Murphy CM, Yap K, Moul S, Hurley L, Becker SJ. Health Professional Stigma as a barrier to Contingency Management Implementation in Opioid Treatment Programs. Translational Issues Psychol Sci. 2021;7(2):166–76.

    Article  Google Scholar 

  21. Petry NM, Alessi SM, Olmstead TA, Rash CJ, Zajac K. Contingency management treatment for substance use disorders: how far has it come, and where does it need to go? Psychol Addict Behav. 2017;31(8):897–906.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stitzer M, Calsyn D, Matheson T, Sorensen J, Gooden L, Metsch L. Development of a Multi-target Contingency Management Intervention for HIV positive substance users. J Subst Abuse Treat. 2017;72:66–71.

    Article  PubMed  Google Scholar 

  23. Klemperer EM, Evans EA, Rawson R. A call to action: contingency management to improve post-release treatment engagement among people with opioid use disorder who are incarcerated. Prev Med. 2023;107647.

  24. Bazzi AR, Drainoni ML, Biancarelli DL, Hartman JJ, Mimiaga MJ, Mayer KH, Biello KB. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC Public Health. 2019;19(1):31. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12889-018-6314-8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Felsher M, Ziegler E, Amico KR, Carrico A, Coleman J, Roth AM. (2021). PrEP just isn’t my priority: Adherence challenges among women who inject drugs participating in a pre-exposure prophylaxis (PrEP) demonstration project in Philadelphia, PA USA. Social science & medicine (1982), 275, 113809. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.socscimed.2021.113809

  26. Edelman EJ, Moore BA, Calabrese SK, Berkenblit G, Cunningham C, Patel V, Phillips K, Tetrault JM, Shah M, Fiellin DA, Blackstock O. Primary care Physicians’ willingness to prescribe HIV pre-exposure prophylaxis for people who inject drugs. AIDS Behav. 2017;21:1025–33.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Adams LM, Balderson BH. (2016). HIV providers’ likelihood to prescribe pre-exposure prophylaxis (PrEP) for HIV prevention differs by patient type: A short report. AIDS Care. 2016;28(9):1154–1158.

  28. Shrestha R, Karki P, Altice FL, Huedo-Medina TB, Meyer JP, Madden L, Copenhaver M. (2017). Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment. Drug Alcohol Depend. 2017;173:107–116.

  29. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/MLR.0b013e3182408812.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sung ML, Viera A, Esserman D, Tong G, Davidson D, Aiudi S, et al. Contingency Management and Pre-exposure Prophylaxis Adherence Support services (CoMPASS): a hybrid type 1 effectiveness-implementation study to promote HIV risk reduction among people who inject drugs. Contemp Clin Trials. 2023;125:107037.

    Article  PubMed  Google Scholar 

  31. Blackstock OJ, Moore BA, Berkenblit GV, Calabrese SK, Cunningham CO, Fiellin DA, Patel VV, Phillips KA, Tetrault JM, Shah M, Edelman EJ. A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. J Gen Intern Med. 2016;32(1):62–70.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rash CJ, Petry NM, Kirby KC, Martino S, Roll J, Stitzer ML. Identifying provider beliefs related to contingency management adoption using the contingency management beliefs questionnaire. Drug Alcohol Depend. 2012;121(3):205–12.

    Article  PubMed  Google Scholar 

  33. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.

    Article  PubMed  Google Scholar 

  35. Oluwoye O, Weeks DL, McDonell MG. An unexplored equity factor: differential beliefs and attitudes toward contingency management by providers’ ethnicity. BMC Health Serv Res. 2023;23(1):902.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cowie ME, Hodgins DC. Contingency Management in Canadian addiction treatment: provider attitudes and use. J Stud Alcohol Drug. 2023;84(1):89–96.

    Article  Google Scholar 

  37. Rash CJ, DePhilippis D, McKay JR, Drapkin M, Petry NM. Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort. J Subst Abuse Treat. 2013;45(3):306–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Mitchell SG, Monico LB, Stitzer M, Matheson T, Sorensen JL, Feaster DJ, et al. How patient navigators view the use of financial incentives to influence study involvement, substance use, and HIV treatment. J Subst Abuse Treat. 2018;94:18–23.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Turner L, Roepke A, Wardell E, Teitelman AM. Do you PrEP? A review of primary care provider knowledge of PrEP and attitudes on prescribing PrEP. JANAC. 2018;29(1):83–92.

    PubMed  Google Scholar 

  40. Jaiswal J, Dunlap K, Griffin M, Cox A, Singer SN, Hascher K, LoSchiavo C, Walters SM, Mumba M. Pre-exposure prophylaxis awareness, acceptability and potential stigma among medical and non-medical clinic staff in methadone treatment settings in northern New Jersey: the key role of non-medical staff in enhancing HIV prevention. J Subst Abuse Treat. 2021;129:108371.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Desai M, Gafos M, Dolling D, McCormack S, Nardone A. PROUD study Healthcare providers’ knowledge of, attitudes to and practice of pre-exposure prophylaxis for HIV infection. HIV Med. 2016;17:133–42. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/hiv.12285.

    Article  CAS  PubMed  Google Scholar 

  42. Petroll AE, Walsh JL, Owczarzak JL, McAuliffe TL, Bogart LM, Kelly JA. PrEP awareness, Familiarity, Comfort, and prescribing experience among US Primary Care providers and HIV specialists. AIDS Behav. 2017;21(5):1256–67.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Wood BR, McMahan VM, Naismith K, Stockton JB, Delaney LA, Stekler JD. Knowledge, practices, and barriers to HIV Preexposure Prophylaxis Prescribing among Washington State Medical Providers. Sex Transm Dis. 2018;45(7):452–8.

    Article  PubMed  Google Scholar 

  44. Sell J, Chen R, Huber C, Parascando J, Nunez J. Primary care provider HIV PrEP Knowledge, attitudes, and Prescribing habits: a cross-sectional survey of late adopters in rural and suburban practice. J Prim care Community Health. 2023;14:21501319221147254.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kennedy AJ, Hassan I, Cameron FA, Gobao V, Edelman EJ, Ho K, Fisk S, Hamm M, Merlin JS. Barriers and facilitators to providing HIV Preexposure Prophylaxis among Buprenorphine prescribers: a pilot qualitative study. J Addict Med. 2021;15(3):261–3.

    Article  PubMed  Google Scholar 

  46. Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and provider perspectives on a Novel, low-threshold HIV PrEP Program for people who inject drugs experiencing homelessness. J Gen Intern Med. 2023;38(4):913–21.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Sherry Aiudi for her invaluable contributions to the CoMPASS Study Team and help with developing the survey tool and data management. Earlier versions of this work were presented at the 2023 College on Problems of Drug Dependence Annual Meeting in Denver, Colorado.

Funding

This work was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA051871 and the Yale Clinical and Translational Science Award UL1TR001863. ML Sung was supported by the Department of Veterans Affairs (VA), Veterans Health Administration, VISN 1 Career Development Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or VA.

Author information

Author notes

  1. Eleanor Pickering and Adam Viera are co-first authors of the article.

Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, 06510, USA

    Eleanor Pickering, Adam Viera & E. Jennifer Edelman

  2. Yale University School of Nursing, 06477, Orange, CT, USA

    Eleanor Pickering

  3. Collaborative Center to Advance Health Services, University of Missouri Kansas City School of Nursing and Health Studies, Kansas City, MO, 64108, USA

    Adam Viera

  4. Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA

    Adam Viera, Daniel Davidson & E. Jennifer Edelman

  5. VA Connecticut Healthcare System, West Haven, CT, 06516, USA

    Minhee L. Sung

  6. Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA

    Minhee L. Sung & E. Jennifer Edelman

  7. Stanley Street Treatment and Resources (SSTAR) Inc, Fall River, MA, 02720, USA

    Genie Bailey

  8. Connecticut Department of Public Health, 06134, Hartford, CT, USA

    Marianne Buchelli

  9. Connecticut Harm Reduction Alliance, 06106, Hartford, CT, USA

    Mark Jenkins

  10. Recovery Network of Programs, Inc, Bridgeport, CT, 06604, USA

    Jennifer Kolakowski

  11. Apex Community Care, 06810, Danbury, CT, USA

    Leah Maier

  12. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06510, USA

    Minhee L. Sung & E. Jennifer Edelman

  13. University of Connecticut School of Medicine, Farmington, CT, 06032, USA

    Carla J. Rash

Authors
  1. Eleanor Pickering
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Adam Viera
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Minhee L. Sung
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Daniel Davidson
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Genie Bailey
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Marianne Buchelli
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Mark Jenkins
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Jennifer Kolakowski
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Leah Maier
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. E. Jennifer Edelman
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Carla J. Rash
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

EJE, DE, DD, MP, CR, MB, JK, MJ, and GB contributed to the design of the study and obtaining grant funding. EJE holds primary responsibility for the conduct of the study and provide oversight for all aspects of the study implementation. All investigators help oversee implementation of the intervention and GB, JK, MJ, and AL oversee study activities as site-PIs at their respective participating sites. AV and EP oversee and hold primary responsibility for conduct of analyses with mentorship from EJE and CR. AV and EP wrote the initial draft of the manuscript. All authors contributed to critical revision of the manuscript.

Corresponding author

Correspondence to Eleanor Pickering.

Ethics declarations

Ethics approval and consent to participate

These research activities have been approved by institutional review boards at Yale University, as well as Connecticut and Massachusetts Departments of Health. These Departments of Public Health do not endorse or assume any responsibility for any analyses, interpretations, or conclusions based on these data. The authors assume full responsibility for all such analyses, interpretations, and conclusions.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pickering, E., Viera, A., Sung, M.L. et al. Readiness to implement contingency management to promote PrEP initiation and adherence among people who inject drugs: results from a multi-site implementation survey. Addict Sci Clin Pract 19, 97 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13722-024-00503-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13722-024-00503-4

Keywords

Addiction Science & Clinical Practice

ISSN: 1940-0640