Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial.

BACKGROUND: Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS: PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS: The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS: gov identifier: NCT03089320.

Escalating schedules of incentives increase physical activity with no differences between deposit and no-deposit groups: A systematic replication.

Physical inactivity has increasingly affected public health in the United States during the COVID-19 pandemic as it is associated with chronic diseases such as arthritis, cancer, and heart disease. Contingency management has been shown to increase physical activity. Therefore, the present study sought to evaluate the effects of an escalating schedule of monetary reinforcement with a reset contingency on physical activity, as compared between 2 counterbalanced groups in which a monetary deposit of $25 was either required (deposit group) or not (no-deposit group). Twenty-five adults wore Fitbit accelerometers to monitor step counts. An ABA reversal design was used; in the 2 baseline phases, no programmed contingencies were in place for step counts. During intervention, step goals were set using a modified 70th percentile schedule with a 7-day window: Reaching the first goal would result in $0.25, and incentives increased by $0.25 for each subsequent day in which the goal was met. Failure to reach a goal resulted in a reset of the monetary incentive value to $0.25. Ten out of 12 participants from the deposit group were determined to be responders to intervention, whereas 8 out of 13 participants from the no-deposit group were determined to be responders to intervention. Overall, there were no significant differences between the groups' step counts. However, the deposit group's intervention was cheaper to implement, which suggests that deposit contracts are a viable modification for physical activity interventions.

Incentivizing Pregnant Women to Quit Smoking in the Real World-A Community-Based Pilot Intervention.

Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes. Financial incentives interventions yield quit rates of approximately 30% during pregnancy, versus ~4% in traditional smoking cessation programs. This pilot study assessed the feasibility of translating an efficacious University of Vermont research-based intervention into a rural community setting delivered by the Vermont Department of Health. Pregnant women using tobacco products were recruited from the Women, Infants and Children program and Rutland Women's Healthcare. Women were provided in-person tobacco cessation counseling during regularly scheduled meetings and received gift cards throughout pregnancy and 3 months postpartum contingent upon biochemically verified smoking abstinence. Cessation counseling and abstinence monitoring began with high frequency (three visits per week), tapering through postpartum to biweekly visits. Gift card values began at $15, increasing by $5 for consecutive negative samples, to $40 maximum. Participants completed three surveys (enrollment, 4-6 weeks postpartum, 6-12 months postpartum) assessing smoking habits, and barriers and facilitators of treatment engagement and success. From 2018 to 2020, we enrolled 20 pregnant women, of whom six self-reported quitting tobacco at some point during the intervention. At study completion, three reported sustained abstinence. Results suggest that it is feasible to translate a research-based smoking cessation program into a community setting. This article discusses the challenges faced and the lessons learned when implementing research in a rural community setting, recruiting and retaining participants, and adapting protocols during the Covid-19 pandemic.

Technology-based contingency management for walking to prevent prolonged periods of workday sitting.

Sedentary behavior is an emerging public health issue. Frequent, brief bouts of walking are recommended by experts to reduce the health risks correlated with physical inactivity and prolonged sedentary periods. The purpose of the current study was to extend the literature by evaluating a remote, technology-based contingency management (CM) intervention that reinforced frequent, brief bouts of walking to decrease prolonged periods of sitting during the workday. A packaged intervention consisting of a contingency contract, monetary incentives, goal setting, textual prompts, and performance feedback was implemented with individuals with sedentary job responsibilities working from home during the COVID-19 pandemic. The intervention increased the number of physically active intervals to mastery for 4 participants, thereby disrupting prolonged periods of sedentary time. For 2 participants, the intervention did not meaningfully increase the number of physically active intervals. Results suggest that a remote, digital CM intervention can decrease sedentary behavior in home office environments.

Contingency Management and SARS-CoV-2 Testing Among People Who Inject Drugs.

OBJECTIVES: People who inject drugs (PWID) are especially vulnerable to morbidity and mortality as a result of SARS-CoV-2 infection because of social and physical health vulnerabilities. Routine testing for SARS-CoV-2 is critical to reduce transmission. Contingency management-the provision of tangible rewards to reinforce positive behavior-can promote the use of health services among PWID. Evidence is scarce on the utility of contingency management to promote SARS-CoV-2 testing. The objective of this study was to evaluate the effectiveness of contingency management to increase testing among PWID. METHODS: SARS-CoV-2 testing was implemented at 9 syringe exchange program sites in partnership with an Oregon-based nonprofit organization for 5 weeks without contingency management and for 6 weeks with contingency management (a $10 financial incentive for testing) from February 1 through mid-April 2021. We measured rates of testing among syringe exchange program clients before and after implementation of contingency management. RESULTS: Before contingency management, SARS-CoV-2 testing occurred during approximately 131 of 1410 (9.3%) client encounters, and 123 of 997 (12.3%) unique clients were tested. During contingency management, testing occurred during approximately 571 of 1756 (32.5%) client encounters, and 407 of 1151 (35.4%) unique clients were tested. Rates of testing increased from 0.04 (SD, 0.04) before contingency management implementation to 0.25 (SD, 0.15) after implementation (t8 = -3.88; P = .005; Cohen d = 1.46). CONCLUSIONS: Contingency management facilitated uptake of SARS-CoV-2 testing among PWID. Contingency management may be an effective strategy for improving communicable disease testing beyond testing for SARS-CoV-2 and for improving vaccine uptake among PWID and warrants additional research.

Sustainment of Contingency Management within Opioid Treatment Programs: COVID-Related Barriers and Innovative Workflow Adaptations.

Introduction: Contingency Management (CM) is one of the most effective interventions for persons with opioid use disorder, but one of the least available interventions in community settings, including opioid treatment programs. Project MIMIC is a NIDA-funded cluster randomized trial that is measuring CM implementation and sustainment across 30 opioid treatment programs in the New England region of the United States. The advent of the COVID-19 pandemic occurred in the midst of Project MIMIC's first cohort of eight opioid treatment programs, presenting a natural opportunity to document and analyze novel challenges to CM sustainment. Utilizing both quantitative and qualitative data collection, we aimed to identify both COVID-related barriers to CM sustainment and innovative workflow strategies to mitigate these barriers. Methods: Quantitative analysis was conducted using data collected from a study-specific CM tracker tool on various CM implementation metrics over three distinct, successive time intervals: prior to COVID-19 social distancing orders with active support; during COVID-19 social distancing orders with active support; and during COVID-19 social distancing orders after removal of support. Semi-structured qualitative interviews were conducted with a representative from each of the eight opioid treatment programs. Using a reflexive team approach, transcripts were coded by independent raters to identify both COVID-related barriers to sustainment and innovative workflow adaptations. Results: Quantitative data revealed a substantial decrease in the number of CM encounters following social distancing orders from 31.8 encounters weekly across eight programs to 6.9 encounters weekly across five programs. A further decline to 1.8 weekly encounters across three programs was observed after implementation support was removed. Four COVID-related barriers were identified via thematic analysis: fear of contagion; difficulty engaging patients remotely; challenges re-defining the CM attendance target due to changing regulations; and staff shortages. Potential adjustments discussed to help address one or more of these barriers included an electronic prize generator; use of technology to promote engagement; brief individual remote check-ins; and expansion of training to non-counseling staff. Conclusion: Although CM implementation challenges emerged during the pandemic, associated workflow adaptations also emerged. The feedback solicited in this study will inform multi-level strategies to aid with CM sustainment post-pandemic.

Comparison of Healthcare Resource Utilization Between Patients Who Engaged or Did Not Engage With a Prescription Digital Therapeutic for Opioid Use Disorder.

BACKGROUND: A prescription digital therapeutic (PDT) (reSET-O®) may expand access to behavioral treatment for patients with opioid use disorder (OUD) treated with buprenorphine, but long-term data on effectiveness are lacking. OBJECTIVE: To compare real-world healthcare resource utilization (HCRU) among patients who engaged with reSET-O and buprenorphine compared to similar patients in recovery treated with buprenorphine who did not fill their reSET-O script or engage with the PDT beyond week one. METHODS: A retrospective analysis of facility and clinical service claims data was conducted in adults with PDT initiation and between 12 weeks and 9 months of continuous enrollment in a health plan after initiation. Patients who filled their prescription and engaged with the therapeutic were compared to patients who filled the prescription but did not engage beyond week one (NE), and patients who did not fill the prescription (NR) (the latter two groups combined into one group hereafter referred to as "non-engagers"). Comparisons were analyzed using a repeated-measures negative binomial model of encounters/procedures, adjusted for number of days in each period. Associated cost trends assessed using current Medicare reimbursement rates. RESULTS: A total of 444 patients redeemed a prescription and engaged with the PDT (mean age 37.5 years, 63.1% female, 84% Medicaid), and 64 patients did not engage with the PDT (mean age 39.5 years, 32.8% female, 73.4% Medicaid). Total cost of hospital facility encounters was $2693 for engaged patients vs $6130 for non-engaged patients. Engaged patients had somewhat higher rates of certain clinician services. Total facility and clinician services costs for engaged vs non-engaged patients were $8733 vs $11,441, for a net cost savings over 9 months of $2708 per patient who engaged with reSET-O. CONCLUSION: Patients who engaged with an OUD-specific PDT had a net cost reduction for inpatient and outpatient services of $2708 per patient over 9 months compared to patients who did not engage with the PDT, despite similar levels of buprenorphine adherence.

Mixed-methods trial of a phosphatidylethanol-based contingency management intervention to initiate and maintain alcohol abstinence in formerly homeless adults with alcohol use disorders.

BACKGROUND: Contingency management (CM) is an intervention where incentives are provided in exchange for biochemically confirmed alcohol abstinence. CM is effective at initiating alcohol abstinence, but it is less effective at maintaining long-term abstinence. Phosphatidylethanol (PEth), collected via a finger-stick, can detect alcohol use for 14-28 days. PEth allows for the development of a CM model that includes increasingly less frequent monitoring of abstinence to assist high risk groups, such as formerly homeless individuals, maintain long-term abstinence. AIMS: Investigate whether PEth-based CM intervention targeting alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is: (1) acceptable and feasible for housing program tenants and personnel; and is associated with increased (2) alcohol abstinence and (3) housing tenure. METHODS: Acceptability and feasibility will be assessed using a QUAL+quant mixed-methods design using qualitative interviews and quantitative measures of satisfaction and attrition. Effectiveness will be evaluated through a randomized pilot trial of 50 study participants who will receive 6 months of either treatment as usual (TAU) including incentives (e.g., gift cards) for providing blood samples (Control Condition) or TAU and incentives for negative PEth results (PEth-CM Condition). Outcomes will be assessed during the intervention and at a three-month follow-up visit. The trial will be conducted via telehealth as a result of COVID-19. DISCUSSION: This protocol seeks to utilize a novel alcohol biomarker to evaluate the acceptability, feasibility, and initial effectiveness of a CM model that encourages long-term abstinence in a high-risk group.

Considerations for remote delivery of behavioral economic interventions for substance use disorder during COVID-19 and beyond.

The response to the COVID-19 crisis has created direct pressure on health care providers to deliver virtual care, and has created the opportunity to develop innovations in remote treatment for people with substance use disorders. Remote treatments provide an intervention delivery framework that capitalizes on technological innovations in remote monitoring of behaviors and can efficiently use information collected from people and their environment to provide personalized treatments as needed. Interventions informed by behavioral economic theories can help to harness the largely untapped potential of virtual care in substance use treatment. Behavioral economic treatments, such as contingency management, the substance-free activity session, and episodic future thinking, are positioned to leverage remote monitoring of substance use and to use personalized medicine frameworks to deliver remote interventions in the COVID-19 era and beyond.

Nosocomial infection control strategy in cabin hospital during the outbreak of COVID-19 / 中华医院管理杂志

The construction of mobile Cabin hospitals is a pioneering effort for the prevention and controlling of the patients with mild symptoms during the outbreak epidemic of Novel Coronavirus Pneumonia. It is a prerequisite and important guarantee for the hospital to manage the hospital infection and prevent the spreading of the epidemic. Our team is located in Dongxihu mobile Cabin hospital, which is one of the first three Cabin hospitals in Wuhan. This article takes the operation process of this hospital as a clue, and discusses aspects of personal protection, environmental sanitation management, item management, occupational exposure disposal, and discharged patient management. It also analyzed common and critical problems in operation. With a view to provide reference for other Cabin hospitals or temporary treatment agencies.

Analysis on the application status of artificial intelligence in COVID-19 / 中华医院管理杂志

Since December 2019, an outbreak of novel coronavirus pneumonia (COVID-19) in Wuhan, Hubei Province, which has caused wide public concern all through the world. Although artificial intelligence is a priority development fields in recent years, there is no study on the application and effect of AI in this epidemic. Based on the application of AI scenarios in typical cases, the research analyzes the practice and effectiveness of AI in epidemic surveillance, clinical diagnose, public health management and other related scientific research. Besides, combined with the current situation of development, some suggestions are put forward in order to better play the role of artificial intelligence in the public health emergency system in China.

Adaptation of contingency management for stimulant use disorder during the COVID-19 pandemic.

The current coronavirus disease (COVID-19) pandemic has rapidly spread across the world. Individuals with stimulant use disorder are a vulnerable population, who are particularly at risk of negative outcomes during this pandemic due to several risk factors, including mental and physical comorbidities, weakened immune responses, high-risk behaviors, and barriers to healthcare access. Engaging patients with stimulant use disorder in regular treatment has become even more difficult during this pandemic, which has resulted in many cuts to addiction treatment programs. The most effective treatment options for stimulant use disorder are psychosocial interventions, which rely heavily on in-person interactions, posing an added challenge during physical distancing. In particular, contingency management (CM) is a behavioral therapy that utilizes tangible reinforcements to incentivize targeted behavior changes, and is an effective treatment intervention used for stimulant use disorder. This paper highlights the treatment challenges for individuals with stimulant use disorder and the importance of adapting CM programs during COVID-19. We present strategies for how CM can be adapted and its role expanded in a safe way during the COVID-19 pandemic to help prevent infection spread, stimulant use relapse, and worsened psychosocial consequences.

Contingency management strategies of the Nursing Department in centralized rescue of patients with coronavirus disease 2019.

OBJECTIVES: This article aims to summarize a series of contingency management strategies of the Nursing Department in the centralized treatment of patients with coronavirus disease 2019 (COVID-19). METHODS: The strategies of the Nursing Department included an early warning for prevention and control, taking functions of vertically commanding and horizontally coordinating, and reasonably allocating nursing workforce, to facilitate centralized treatment work in the in-hospital fever clinic, isolation wards and ICU, and referral and admission of critical patients. Five special groups were established in charge of training and examination, management and supervision, psychological support, logistical support, and reporting and publicity, respectively. RESULTS: It was achieved that no deaths from critical patients and no medical staff, no other patients were infected. CONCLUSION: Through the implementation of these strategies, safe and efficient centralized treatment was ensured timely, orderly and sustainably.