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1.
Arch Phys Med Rehabil ; 99(5): 952-959, 2018 05.
Article in English | MEDLINE | ID: mdl-29425697

ABSTRACT

OBJECTIVES: To present initial descriptive findings from the Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRC) Traumatic Brain Injury (TBI) Model Systems (MS) National Database. DESIGN: Prospective cohort study. SETTING: VA PRC TBIMS National Database. PARTICIPANTS: 712 service members and veterans with TBI who consented to participate between January 2010 and June 2015. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, preinjury characteristics, injury characteristics, rehabilitation course, functional outcomes, and discharge disposition by TBI severity level. RESULTS: The study cohort was predominantly male with moderate to severe TBI secondary to vehicular accident or blast injury. Sixty-five percent were active duty service members; one-third had been injured during deployment. One-third reported mental health treatment and/or alcohol use problems in the year predating the index TBI. The median number of days between injury and PRC admission was 42.5. Nearly 25% reported clinical levels of posttraumatic stress disorder; 75% reported mild to moderate neurobehavioral symptomatology. The median length of stay in the PRC was 36 days; those with severe TBI had the longest lengths of stay. Functional independence ratings improved from admission to discharge across all TBI severity levels. A majority were discharged to urban areas to reside with spouses or other residents in private residences or adult homes, with some variability by injury severity. CONCLUSIONS: The VA PRC TBIMS national database is a rich source of information on a unique group of individuals with TBI and promises to complement existing knowledge on TBI in the civilian population.


Subject(s)
Brain Injuries, Traumatic/epidemiology , Occupational Injuries/epidemiology , Rehabilitation Centers/statistics & numerical data , Trauma Severity Indices , Veterans/statistics & numerical data , Adult , Databases, Factual , Female , Humans , Length of Stay , Male , Multiple Trauma , Prospective Studies , United States/epidemiology , United States Department of Veterans Affairs
2.
Rehabil Psychol ; 62(4): 563-570, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28703617

ABSTRACT

OBJECTIVE: Sleep disturbance is a key behavioral health concern among Iraq and Afghanistan era veterans and is a frequent complaint among veterans with a history of mild traumatic brain injury (mTBI). Currently, it is unclear whether sleep disturbance is a core sequelae of mTBI or if it may be related to other behavioral health conditions that are commonly present in postdeployment veterans. The purpose of this study was to determine if history of mTBI is associated with poor sleep quality beyond combat exposure and behavioral health concerns, including posttraumatic stress disorder (PTSD), mood disorders, anxiety disorders, and substance use disorders. RESEARCH METHOD: Participants included 527 veterans who deployed after September 11, 2001, in support of the wars in Iraq and Afghanistan. Participants completed the Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, a structured clinical TBI interview, and the Pittsburgh Sleep Quality Index. RESULTS: Deployment-related mTBI was associated with poor sleep quality independent of combat exposure, PTSD, mood disorders, anxiety disorders, and substance use disorders (B = 1.84, p = .001) an average of 6 years after the injury event. No interaction effects between deployment-related mTBI and combat exposure, PTSD, mood disorders, anxiety disorders, or substance use disorders on sleep quality were detected. CONCLUSIONS: Veterans with a history of mTBI sustained during deployment reported significantly poorer sleep quality than veterans without history of mTBI, even when considering combat exposure and behavioral health issues. Clinicians should consider mTBI as a potential contributor to sleep problems, even years after an injury event. (PsycINFO Database Record


Subject(s)
Brain Concussion/epidemiology , Sleep Wake Disorders/epidemiology , Veterans/psychology , Veterans/statistics & numerical data , Adult , Afghan Campaign 2001- , Aged , Brain Concussion/psychology , Comorbidity , Female , Humans , Interviews as Topic , Iraq War, 2003-2011 , Male , Middle Aged , Neuropsychological Tests , Sleep Wake Disorders/psychology , United States/epidemiology , Young Adult
3.
J Clin Sleep Med ; 13(2): 291-299, 2017 Feb 15.
Article in English | MEDLINE | ID: mdl-27998375

ABSTRACT

STUDY OBJECTIVES: Sleep disturbances are well documented in relation to trauma exposure and posttraumatic stress disorder (PTSD), but correlates of such disturbances remain understudied in veteran populations. We conducted a preliminary study of sleep disturbances in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 133; mean [standard deviation] age = 29.8 [4.7] y). METHODS: Veterans were assigned to one of three groups based on responses to the Clinician Administered PTSD Scale: control (no trauma-exposure [TE] or PTSD), TE, and PTSD. Sleep disturbance was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measures of resilience, trauma load, personality, coping, alcohol use, and mild traumatic brain injury were also assessed via self-report. RESULTS: The PTSD group had significantly more disturbed sleep (PSQI global score mean = 8.94, standard deviation = 3.12) than control (mean = 5.27, standard deviation = 3.23) and TE (mean = 5.34, standard deviation = 3.17) groups, but there were no differences between TE and control. The same pattern emerged across most PSQI subscales. Results of linear regression analyses indicated that current smoking, Army (versus other military branches), neuroticism, and using substances to cope were all significant correlates of higher sleep disturbance, whereas post-deployment social support was associated with less sleep disturbance. However, when combined together into a model with PTSD status, only neuroticism and substance use coping remained significant as predictors of more disturbed sleep. CONCLUSIONS: These initial findings suggest that TE itself may not be an independent risk factor for disturbed sleep in veterans, and that neurotic personality and a tendency to cope by using substances may partially explain sleep disturbance, above and beyond a diagnosis of PTSD.


Subject(s)
Adaptation, Psychological/physiology , Personality/physiology , Sleep Wake Disorders/complications , Stress Disorders, Post-Traumatic/complications , Veterans , Adult , Afghan Campaign 2001- , Female , Humans , Iraq War, 2003-2011 , Male , Sleep Wake Disorders/physiopathology , Social Support , Stress Disorders, Post-Traumatic/physiopathology , Surveys and Questionnaires , Young Adult
4.
J Clin Sleep Med ; 12(7): 997-1002, 2016 07 15.
Article in English | MEDLINE | ID: mdl-27070244

ABSTRACT

STUDY OBJECTIVES: This cross-sectional study aimed to characterize sleep patterns, the quality and duration of sleep, and estimate the prevalence of common sleep disorders and posttraumatic stress disorder (PTSD) in a hospital-based Veterans Affairs MOVE! (Managing Overweight Veterans Everywhere) clinic. METHODS: Participants completed five instruments: the Pittsburgh Sleep Quality Index (PSQI), Smith's Measure of Morningness/Eveningness, Restless Legs Syndrome Rating Scale, the STOP Questionnaire, and the Posttraumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-C). RESULTS: Enrolled Veterans (n = 96) were mostly male (78%), African American (49%), mean age 58 (standard deviation [SD] 10.6) years, and mean body mass index (BMI) 38.4 kg/m(2) (SD 8.4). By PSQI, 89% rated sleep quality as "poor" (mean = 11.1, SD = 5.1), consistent with severely impaired sleep. Most were at high risk for sleep disorders including restless leg syndrome (53%), obstructive sleep apnea (66%), and circadian sleep disorders (72%). Forty-seven percent endorsed clinically significant symptoms of PTSD. Hypotheses-generating regression models suggest sleep latency (minutes before falling asleep) was associated with BMI (p = 0.018). Bedtime, getting up time, hours of sleep, waking up in the middle of the night or early morning, having to get up to use the bathroom, inability to breathe comfortably, cough or snore loudly, feeling too cold or too hot, having bad dreams, pain, and frequency of having trouble sleeping, were not significantly associated with BMI. CONCLUSIONS: Our cross-sectional study suggests that sleep difficulties are common among Veterans referred to a weight loss program at a Veterans Affairs Hospital. Controlled studies are needed to investigate whether the results are generalizable and whether obesity among veterans is a risk factor for sleep disorders and PTSD. COMMENTARY: A commentary on this article appears in this issue on page 943.


Subject(s)
Obesity/complications , Obesity/therapy , Outpatients/statistics & numerical data , Sleep Wake Disorders/complications , Stress Disorders, Post-Traumatic/complications , Veterans/statistics & numerical data , Weight Reduction Programs/methods , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , United States , United States Department of Veterans Affairs , Urban Population
5.
Brain Inj ; 29(12): 1400-8, 2015.
Article in English | MEDLINE | ID: mdl-26287761

ABSTRACT

OBJECTIVE: Insomnia and behavioural health symptoms 1 year after traumatic brain injury (TBI) were examined in a clinical sample representative of veterans who received inpatient treatment for TBI-related issues within the Veterans Health Administration. METHODS: This was a cross-sectional sub-study (n = 112) of the Polytrauma Rehabilitation Centres' traumatic brain injury model system programme. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioural health problem and insomnia by injury severity. RESULTS: Participants were primarily male, < 30 years old and high school educated. Twenty-nine per cent met study criteria for insomnia; those with mild TBI were significantly more likely to meet criteria (43%) than those with moderate/severe TBI (22%), χ(2)(1, n = 112) = 5.088, p ≤ 0.05. Univariable logistic regression analyses revealed depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not MTBI. CONCLUSIONS: Veterans with history of TBI, of any severity, and current insomnia symptoms may be at increased risk for depression and anxiety 1 year after TBI.


Subject(s)
Brain Injuries/rehabilitation , Stress Disorders, Post-Traumatic/rehabilitation , Adult , Anxiety , Behavior , Binge Drinking , Brain Injuries/etiology , Cross-Sectional Studies , Depression/etiology , Depressive Disorder/etiology , Female , Headache , Health , Humans , Male , Prevalence , Rehabilitation Centers , Severity of Illness Index , Sleep Initiation and Maintenance Disorders/therapy , Stress Disorders, Post-Traumatic/epidemiology , United States , United States Department of Veterans Affairs , Veterans/psychology , Young Adult
6.
J Head Trauma Rehabil ; 29(6): 490-7, 2014.
Article in English | MEDLINE | ID: mdl-25370441

ABSTRACT

OBJECTIVE: To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). METHODS: Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. RESULTS: The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. CONCLUSIONS: Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.


Subject(s)
Brain Injuries/complications , Fatigue/etiology , Fatigue/therapy , Brain Injuries/rehabilitation , Cognitive Behavioral Therapy , Exercise Therapy , Humans , Treatment Outcome
7.
Mil Med ; 179(5): 521-8, 2014 May.
Article in English | MEDLINE | ID: mdl-24806497

ABSTRACT

Insomnia is increasingly common among the general population, even more so among veterans. Given the adverse impact of insomnia on both mental and physical health of veterans, it is important to provide effective treatments within the Veterans Health Administration (VHA) system. Group-based cognitive behavioral therapy for insomnia (CBT-I) provides a viable option for treatment. This study reports the feasibility, acceptability, initial effectiveness, and durability of group-based CBT-I in a clinical sample of veterans with comorbid medical and mental health diagnoses; the treatment was provided in a real-world VHA hospital setting using a manualized protocol that was explicitly adapted from the existing 1:1 CBT-I VHA protocol. Overall, we found the treatment to be feasible and acceptable to veterans, as well as effective. We found medium to large effect sizes for both questionnaire and sleep diary measures, including sleep onset latency, awakenings during the night, sleep efficiency, insomnia scores, and dysfunctional beliefs about sleep. Improvements in insomnia symptoms were maintained over 1 month.


Subject(s)
Clinical Protocols , Cognitive Behavioral Therapy , Sleep Initiation and Maintenance Disorders/therapy , Veterans , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged
8.
J Head Trauma Rehabil ; 29(3): E1-7, 2014.
Article in English | MEDLINE | ID: mdl-23835876

ABSTRACT

BACKGROUND: In 2008, the Department of Veterans Affairs Polytrauma Rehabilitation Centers partnered with the National Institute on Disability and Rehabilitation Research to establish a Model Systems program of research that would closely emulate the civilian Traumatic Brain Injury (TBI) Model Systems Centers Program established in 1987. OBJECTIVE: To describe the development of a TBI Model Systems program within the Department of Veterans Affairs Polytrauma System of Care. METHODS: Enrollment criteria and data collection/data quality efforts for the newly established Department of Veterans Affairs sites are reviewed. RESULTS: Significant progress has been made in the establishment of a Model Systems program for the Polytrauma System of Care. Data collection has moved forward and program-specific modifications have been implemented. CONCLUSION: The Veterans Affairs TBI Model System program is established and growing, with many projects underway and a strong working relationship with the civilian TBI Model System programs.


Subject(s)
Brain Injuries/rehabilitation , Delivery of Health Care/organization & administration , Military Medicine/organization & administration , Rehabilitation Centers/organization & administration , Veterans , Biomedical Research , Data Collection , Databases, Factual , Hospitals, Veterans , Humans , Program Development , United States , United States Department of Veterans Affairs
9.
Mil Med ; 178(9): 951-6, 2013 Sep.
Article in English | MEDLINE | ID: mdl-24005542

ABSTRACT

OBJECTIVES: This investigation sought to characterize prevalence and factors associated with subjective sleep disturbance (SSD) in a clinical sample of veterans with blast-related mild traumatic brain injury (mTBI). METHODS: Adult veterans with history of blast-related mTBI were enrolled in a cross-sectional study. Data on demographics, injury, and current symptoms, including SSD, were obtained. Descriptive and univariate analyses investigated prevalence of SSD and associated factors. RESULTS: Participants were 114 veterans with blast-related mTBI (96% male; mean age = 31 years, SD = 8; mean number of days since injury =1,044, SD = 538). 78% screened positive for post-traumatic stress disorder and 77% reported SSD. Loss of consciousness at time of injury, current nightmares, depression, headache, fatigue, and positive screen for post-traumatic stress disorder were significantly associated with SSD (p < 0.05). CONCLUSIONS: SSD was pervasive in this clinical sample and was significantly associated with multiple modifiable emotional symptoms as well as headache and fatigue; this is consistent with previous literature including samples with history of nonblast-related mTBI. Future research incorporating objective measurement of SSD and associated symptoms is needed to inform evidence-based screening, assessment, and treatment efforts for veterans with history of mTBI.


Subject(s)
Blast Injuries/epidemiology , Brain Injuries/epidemiology , Sleep Initiation and Maintenance Disorders/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Veterans/psychology , Adult , Cross-Sectional Studies , Depression/epidemiology , Dreams/psychology , Fatigue/epidemiology , Female , Headache/epidemiology , Humans , Male , Prevalence , Young Adult
10.
J Subst Abuse Treat ; 45(4): 335-42, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23810264

ABSTRACT

The previously published randomized controlled trial, EARLY, tested the efficacy of a motivational interviewing (MI) plus feedback condition against a video information (VI) condition and an informational brochure (IB) condition in reducing drinking and/or increasing contraception effectiveness, and found that drinking and rates of effective contraception improved in all conditions. In this reanalysis of the data from EARLY, potential moderating effects of depressive, global distress, and anxiety symptoms in response to the three brief interventions to reduce alcohol exposed pregnancy risk were examined. Women with higher levels of depression at baseline reported greater improvements in the MI plus feedback condition versus the VI and IB conditions with depression moderating both drinking and contraceptive effectiveness. Global distress moderated only drinking behavior in the MI plus feedback but not other groups and anxiety was not a moderator of outcome in any of the intervention groups. Depressed or distressed women at risk for AEP may benefit from an AEP risk reduction intervention that incorporates interaction with a treatment provider versus educational information provided via video or written materials.


Subject(s)
Alcohol Drinking/prevention & control , Depression/psychology , Fetal Alcohol Spectrum Disorders/prevention & control , Motivational Interviewing , Adult , Alcohol Drinking/psychology , Female , Humans , Pregnancy , Risk Reduction Behavior , Treatment Outcome
11.
Telemed J E Health ; 19(8): 597-604, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23763608

ABSTRACT

BACKGROUND: Alcohol-exposed pregnancy (AEP) is a leading cause of birth defects. Effective face-to-face preconception interventions based on motivational interviewing (MI) exist and should be translated into remote formats for maximum public health impact. This study investigated the feasibility and promise of a one-session, remote-delivered, preconception, MI-based AEP intervention (EARLY Remote) for non-treatment-seeking community women. SUBJECTS AND METHODS: This was a single-arm, prospective pilot intervention study. All participants received the intervention via telephone and mail. Feasibility of remote-delivery methods, treatment engagement, treatment credibility, MI treatment integrity, and therapeutic alliance were examined. Outcomes were 3- and 6-month drinks per drinking day (DDD), rate of unreliable contraception, and proportion of women at risk for AEP due to continued risk drinking and no or unreliable contraception use. RESULTS: Feasibility of remote delivery was established; participants were engaged by the intervention and rated it as credible. Integrity to MI and therapeutic alliance were good. Both DDD and rate of unreliable contraception decreased significantly over time. Proportions of women who drank at risk levels, used unreliable or no contraception, and/or were at risk for AEP in the past 90 days decreased significantly from baseline to 6 months. CONCLUSIONS: Remote delivery was feasible, and the translated remote intervention may reduce AEP risk. Refinement of EARLY Remote may facilitate its placement within a spectrum of effective MI-based preconception AEP interventions as part of a stepped-care approach. EARLY Remote may have an important role within a stepped-care model for dissemination to geographically disperse women at risk for AEP. This could result in substantial public health impact through reduction of AEP on a larger scale.


Subject(s)
Fetal Alcohol Spectrum Disorders/prevention & control , Motivational Interviewing/organization & administration , Postal Service , Preconception Care , Telecommunications , Adolescent , Adult , Feasibility Studies , Female , Humans , Motivational Interviewing/methods , Pilot Projects , Pregnancy , Prospective Studies , Virginia , Young Adult
12.
J Subst Abuse Treat ; 44(4): 407-16, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23192220

ABSTRACT

Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care.


Subject(s)
Alcohol Drinking/prevention & control , Alcoholism/prevention & control , Fetal Alcohol Spectrum Disorders/prevention & control , Motivational Interviewing , Pregnancy Complications/prevention & control , Adult , Congenital Abnormalities/prevention & control , Contraception , Data Interpretation, Statistical , Female , Follow-Up Studies , Humans , Motivation , Patient Education as Topic , Pregnancy , Research Design , Risk Reduction Behavior , Socioeconomic Factors , Surveys and Questionnaires , Treatment Outcome
13.
Psychooncology ; 21(7): 695-705, 2012 Jul.
Article in English | MEDLINE | ID: mdl-21538678

ABSTRACT

OBJECTIVE: Insomnia is a common complaint among cancer survivors. Fortunately, cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective treatment in this population. However, it is rarely implemented given its limited availability. To address this barrier, we examined the ability of an easily accessible online CBT-I program to improve insomnia symptoms in cancer survivors. METHODS: Twenty-eight cancer survivors with insomnia were randomly assigned to either an Internet insomnia intervention (n = 14) or to a waitlist control group (n = 14). The online program, Sleep Healthy Using The Internet, delivers the primary components of CBT-I (sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention). Pre- and post-assessment data were collected via online questionnaires and daily sleep diaries. RESULTS: Participants in the Internet group showed significant improvements at post-assessment compared with those in the control group in overall insomnia severity (F(1,26) = 22.8; p<0.001), sleep efficiency (F(1,24) = 11.45; P = 0.002), sleep onset latency (F(1,24) = 5.18; P = 0.03), soundness of sleep (F(1,24) = 9.34; P = 0.005), restored feeling upon awakening (F(1,24) = 11.95; P = 0.002), and general fatigue (F(1,26) = 13.88; P = 0.001). Although other group × time interactions were not significant, overall adjusted effect sizes for all sleep variables as well as for fatigue, depression, anxiety, and quality of life ranged from small to large. CONCLUSIONS: CBT-I delivered through an interactive, individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia.


Subject(s)
Cognitive Behavioral Therapy/methods , Internet , Neoplasms/complications , Neoplasms/therapy , Sleep Initiation and Maintenance Disorders/etiology , Sleep Initiation and Maintenance Disorders/therapy , Survivors/psychology , Therapy, Computer-Assisted/methods , Adult , Fatigue/psychology , Fatigue/therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms/psychology , Patient Education as Topic/methods , Quality of Life/psychology , Severity of Illness Index , Sleep Initiation and Maintenance Disorders/psychology , Stress, Psychological , Treatment Outcome
14.
Drug Alcohol Depend ; 116(1-3): 177-87, 2011 Jul 01.
Article in English | MEDLINE | ID: mdl-21306837

ABSTRACT

BACKGROUND: Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skill model to improve HAART adherence and reduce crack cocaine problems. METHODS: Participants were 54 adults with crack cocaine use and HIV with <90% HAART adherence. Most participants were African-American (82%) heterosexual (59%), and crack cocaine dependent (92%). Average adherence was 58% in the past 2 weeks. Average viral loads (VL) were detectable (logVL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (MI+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14-day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measure ANOVA assessed main effects of the interventions and interactions by condition. RESULTS: Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. CONCLUSIONS: A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Cocaine-Related Disorders/epidemiology , Crack Cocaine , HIV Infections/drug therapy , Medication Adherence , Adult , Antiretroviral Therapy, Highly Active/psychology , Antiretroviral Therapy, Highly Active/statistics & numerical data , Behavior Therapy , Cocaine-Related Disorders/psychology , Cocaine-Related Disorders/therapy , Female , HIV , HIV Infections/epidemiology , HIV Infections/psychology , HIV Seropositivity/drug therapy , HIV Seropositivity/epidemiology , HIV Seropositivity/psychology , Humans , Interview, Psychological/methods , Male , Motivation , Patient Compliance/psychology , Pilot Projects , Treatment Outcome , Videotape Recording
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