Improved Adherence with Contingency Management

Abstract

Contingency management (CM) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged populations. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidenced suboptimal adherence during a baseline assessment were randomly assigned to 16 weeks of weekly CM-based counseling or supportive counseling, followed by 16 additional weeks of data collection and adherence feedback to providers. The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening (MEMS) and brief substance abuse counseling. CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence. Potential total earnings averaged $800. Mean MEMS-measured adherence to the reinforced medication increased from 61% at baseline to 76% during the 16-week treatment phase and was significantly increased relative to the supportive counseling group (p = 0.01). Furthermore, mean log-transformed viral load was significantly lower in the CM group. However, by the end of the 16-week follow-up phase, differences between groups in adherence and viral load were no longer significantly different. Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase. A brief CM-based intervention was associated with significantly higher adherence and lower viral loads. Future studies should evaluate methods to extend effects for longer term benefits.

Internet-based incentives increase blood glucose testing with a non-adherent, diverse sample of teens with type 1 diabetes mellitus: a randomized controlled Trial

“…This procedure, known as Bcontingency management^(CM), has been used to treat substance abuse [8], increase asthma and HIV medication adherence [9][10][11], increase physical activity levels and facilitate weight loss [12,13], and improve diabetes self-management in children and adolescents [14][15][16]. Contingency management has also been shown to be more effective when combined with other psychosocial interventions, such as motivational interviewing (MI) [17].…”

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

“…Contingency management approaches, for example, that use tangible rewards for successful completion of a behavioral target (such as a negative CO test) have been shown to directly reduce cigarette smoking in numerous challenging populations. 67 This intervention, which is typically used as an adjunct to other behavioral or medication approaches, has also been used to improve attendance to group therapy 68 and ART medication compliance 69 among PLWHA. Thus, contingency management may demonstrate efficacy for improving both initial quit rates as well as adherence to treatment if tested in HIV+ smokers.…”

Interventions for Enhancing Adherence to Antiretroviral Therapy (ART): A Systematic Review of High Quality Studies

“…The effects of interventions are summarized in Table 1 46,48,54,62,64,[66][67][68]73,81 Details of the latter studies serve to illuminate the most potent interventions among the studies in this review. Chung and colleagues 66 conducted a randomized controlled factorial design trial in 361 treatment naïve HIV-infected adults in Nairobi, Kenya initiating ART.…”

“…Five of the 30 (17%) studies with an explicit theoretical framework were successful in improving both adherence and clinical outcomes. 46,48,54,66,81 Effects by use of technology. Five studies used technology-based interventions (interactive computers assisted sessions, phone calls, text messaging, and pagers).…”