# Presentation: 404440

## Treatment Impact on HIV Risk Behavior 

**Valerie Pearce, M.P.H.**
**Rachel Gonzales, Ph.D.**
**Julie Brummer, B.A.**
***UCLA Integrated Substance Abuse Programs***
- May 8, 2007

**Treatment Impact on HIV Risk Behavior **
**Among Methamphetamine Users**

## Does treatment reduce HIV risk behavior? (injection and unsafe sexual practices)

- Does treatment reduce HIV risk behavior? *(injection and unsafe sexual practices)*

**Research Question**

- Changes from Baseline to Treatment-End

## Treatment Data

- The Methamphetamine Treatment Project (MTP)-**AIDS Risk Assessment (TCU/ARU) **Methamphetamine Clinical Trials Group (MCTG) -**HIV Risk Behavior Scale (HRBS) **

**Treatment Data**

**Notes:**
Treatment data comes from two large scale studies. Measures included...

## Study Designs

**MTP**: Multisite 1-year clinical trial (N=978): 16 week treatments (Matrix vs. Treatment-as-usual) in 8 treatment programs within Montana, Hawaii, and California funded by SAMHSA/CSAT.
**MCTG**: Multisite study includes two MA pharmacotherapy trials (N=320) within Texas, Missouri, Iowa, Honolulu, and California (Ondansetron and Bupropion) funded by NIDA. Length of treatment varied per protocol (8 weeks and 12 weeks)

**Notes:**
Briefly, the MTP was a..

## Baseline Demographics

|  | MTP
(N=784) | MCTG
(N=320) |
| --- | --- | --- |
| % Female | 51.1% | 34.4% |
| Average Age | 32.8 (18-60) | 36.0 (18-59) |
| Mean Years Education | 12.2 (sd=1.7) | 12.0 |
| % White | 65.5% | 73.3% |
| Mean Years of MA use | 7.5 (sd=6.0) | 11.2 (sd=7.7) |

- Sample Demographics

## Change in Injection Use

|  | Baseline | Tx-end |
| --- | --- | --- |
| MTP: # of people injected in past 30 days* | 128 (13.1%) | 54 (5.4%) |
| MCTG: # of people injected in past 30 days* | 68 (21.2%) | 24 (10.3%) |

****p<.05***

**Notes:**
Data from both the MTP & MCTG studies indicate that injection within the previous 30 days substantially reduced from baseline to treatment discharge.

## MTP: Change in Injection Practices

| 
Repeated measures on 193 injectors
Past 30 days | Baseline | Tx-end |
| --- | --- | --- |
| Mean # times inject**  | 19.7  | 7.8 |
| Mean # times dirty needles** | 3.9 | 0.91  |
| Mean # times share cooker, cotton, etc.** | 6.5 | 1.4  |

*****p<.01***

**Notes:**
Using the AIDS Risk assessment (TCU/ARU) - results indicate that injection practices significantly reduced after participating in treatment.

## MCTG: Change in Injection Practices

| 
Repeated measures on 44 injectors
Past 30 days | Baseline
(N=44) | Tx-end
(N=24) |
| --- | --- | --- |
| Number of injectors who used needles after someone  | 7(16%) | 0 (0%)  |
| Number of injectors who reused needles  | 22 (50%) | 9 (38%)  |
| Number of injectors who reused needles AND cleaned with bleach every time | 3/22
(14%) | 3/9
(33%) |

**Notes:**
At baseline, 44 injectors reported MA use by injection in the last 30 days. At study discharge, 24 reported injection use, reflecting a 54.5% drop in current IV MA use (n=24).  There were no new injection users from baseline to tx-end.  

Using the HIV Risk Behavior Scale (HRBS) – results indicate that participation in treatment reduced drug sharing practices, and increased harm reduction methods.  

## MTP: Change in Risky Sexual Practices

| 
Repeated measures on 784 MA users
Past 30 days | Baseline | Tx-end |
| --- | --- | --- |
| Mean times had sex w/out condoms | 14.7  | 13.2 |
| Mean # times sex w/out condom w/IV user * | 2.3 | 1.4  |
| Mean # times sex w/out condom w/ MA user** | 6.5 | 1.4  |
| Mean times sex while high*** | 9.1 | 4.9 |
| Mean risk composite (# of times engaged in risky behavior)** | 23.1 | 10.2 |

****p<.05***** *******p<.01******; *********p<.001***

**Notes:**
Using the AIDS Risk assessment (TCU/ARU) - results indicate that sexual risk behaviors significantly reduced after participating in treatment.

## MCTG: Change in Risky Sexual Practices

| 
Repeated measures on 199 MA users
Past 30 days | Baseline | Tx-end |
| --- | --- | --- |
| 
Unsafe sexual behavior mean composite score* | 
5.2 | 
4.4 |

****p<.05***

**Notes:**
Using the HRBS - Of the sample that engaged in sexual activity in the last 30 days at admission (n=199), there was a significant reduction in the unsafe sexual behavior mean composite score (5.28 to 4.4; t=2.544, p<.05). 

## MTP: Long-Term Change Risk Behavior

- Significant reduction in mean # of risky behaviors from baseline to 3 year follow-up among 574 MA users from MTP.

- 23.1

- 17.6

**Notes:**
Using a risk composite scale from the AIDS Risk assessment (TCU/ARU)– results show that there was a significant reduction in mean number of risky behaviors from baseline to 3 year follow-up among heterosexual sample of MA users.

Specifically, the mean # of risky behaviors reduced from 23.1 at baseline to 17.6 at 3 year follow-up.

## MTP: Treatment Impact on  Risky Behavior

- Longer treatment retention is significantly associated with *less risky behavior* (based on sex risk score) among MA users (B=-.043, p<.001).
- Treatment completion is significantly related to *less risky sexual behavior* among MA users (B=-.565, p<.001).
- Significant *reduction in injection behavior* for completers than non-completers (p<.05).

## MCTG: Treatment Impact on  Risky Behavior

- Paired samples t-tests show that treatment completion had a statistically significant impact on _reducing high sex risk_ behavior compared to those who did not complete treatment (p<.01 ).
- Treatment completion was significantly associated with _reducing injection use_ (p<.05):
- Over half of the injectors who completed treatment reported no current injection use at discharge compared to no reduction in injection for non-completers.

## My Sexual Performance is Improved by the use of:

- (Rawson et al., 2002)

## Methamphetamine in RSA*

- The use of methamphetamine (‘tik’) and methcathinone is on the increase in South Africa, especially in Cape Town.
- In treatment centres in Capetown, treatment admission rates for MA have increased from 3% in 2002 to 32.4% in 2005.
- Most of the patients (92%) were Coloured, 7% were White, 0.5 Indian/Asian and 0.5% were Black/African.
- Almost 50% of the patients were younger than 20 years of age (see Figure 2). The ages ranged from 12 to 53 years.
- 90+% report smoking methamphetamine as the preferred route of administration.
- 41% report daily use.
- *Parry et al 2005

## Study Implications

**MA treatment is associated with  substantial reductions in HIV risk behaviors.**
**Retention and treatment completion play a critical role in preventing the escalation of HIV risk behaviors.**

## Acknowledgements

- Investigators of the NIDA  Methamphetamine Clinical Trials Group and the CSAT Methamphetamine Treatment Project
- Funding from NIDA and SAMHSA