The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Wednesday, May 10, 2006
251

Positive Reinforcement Opportunity Project (PROP): New treatment for MSM who use Methamphetamine

Frank V. Strona1, Jacqueline McCright2, Stephen Tierney3, Katherine Ahrens2, Steven Gibson4, C. Bradley Hare5, Michael Siever6, Jim Kahn7, Steven Shoptaw8, Cathy Reback8, Jeff Dang9, Bob Cabaj10, John Stansell5, Jeffrey D. Klausner2, and William D. King11. (1) STD Prevention & Control Services, San Francisco Department Of Public Health, 1360 Mission St, Suite 401, San Francisco, CA, USA, (2) STD Prevention and Control Services, San Francisco Department of Public Health, 1360 Mission St, Suite 401, San Francisco, CA, USA, (3) San Francisco AIDS Foundation, 995 Market Street, Suite 200, San Francisco, CA, USA, (4) Magnet, 4122 18th street, San Francisco, CA, (5) Ward 84, San Francisco General Hospital, 995 Potrero Avenue, UCSF Box 0881, San Francsico, CA, USA, (6) The Stonewall Project, San Francisco, CA, USA, (7) UCSF, Positive Health Practice, San Francisco, CA, USA, (8) Friends of Research Institute, Inc, 11075 Santa Monica Blvd. Suite 200, Los Angeles, CA, USA, (9) UCLA Integrated Substance Abuse Programs, UCLA, Los Angeles, CA, USA, (10) San Francisco Department of Public Health, San Francisco, CA, USA, (11) UCLA Department of Infectious Diseases, Los Angeles, CA


Background:
Methamphetamine use continues to be a growing problem among men who have sex with men (MSM) and is associated with increased rates of HIV and STDs.

Objective:
To use contingency management (positive reinforcement) in 200 MSM, currently using methamphetamine. To evaluate the treatment effect on drug use.

Method:
The pilot program was a collaboration between the San Francisco Department of Public Health (STD Prevention & Control Services, HIV Prevention Section, Behavioral Health), the Positive Health Program, Magnet, Continuum, UCLA Integrated Substance Abuse Programs and the Friends Research Institute, Inc.
Project recruitment was through street based contact and provider referrals, and clients could participate anonymously. PROP operated sites in two locations for 2 hours each, three times a week. PROP included a behavioral risk intake process and observed urine testing of participants Mondays, Wednesdays and Fridays for 12 weeks, offering increasing incentives for each negative methamphetamine test. Upon a positive methamphetamine test result, staff would encourage the participant to return and try again. If a participant remained negative for 36 visits, they could earn a total of $453.75. No other therapies or support were offered with the exception of a community referral guide.


Result:
211 men have participated in the initial intake process during December 1, 2004 – December 6, 2005. 162 (77%) of the men initiated treatment. Of 149 men eligible to complete, 90 (60.4 %) completed four weeks, 72 (48.3%) completed eight weeks, and 44 (29.5%) completed treatment (12 weeks).

Conclusion:
Contingency management is a feasible, low cost, minimally staffed strategy to reduce methamphetamine use in MSM. Further evaluation is currently being performed.

Implications:
PROP is potentially a low cost, culturally appropriate treatment option for those not motivated to seek other treatment methods.

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