Evaluation of harm reduction treatment for MSM who use meth
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Recent research has provided consistent evidence that methamphetamine use continues to be an important driver of the HIV epidemic among gay men and other men who have sex with men (G/MSM) in California. HIV-negative G/MSM who use methamphetamine report increased sexual risk taking and are at elevated risk for HIV infection. HIV-positive G/MSM who use methamphetamine report increased HIV transmission risk behaviors and less consistency in taking HIV medications as prescribed which, in combination, could promote the transmission of medication-resistant strains of HIV. Clearly, innovative interventions that can be delivered across the spectrum of HIV prevention and care are needed to address methamphetamine use and the consequences of its use among G/MSM. The purpose of this proposed study is to conduct a systematic program evaluation of the Stonewall Project, an existing HIV prevention intervention that is currently deployed in four community settings in San Francisco. The Stonewall Project, a program of the San Francisco AIDS Foundation, provides integrated substance use, mental health, and HIV counseling from a harm reduction perspective to G/MSM who use methamphetamine. Participants in the Stonewall Project are provided with both weekly individual counseling and group counseling twice weekly and are prescribed psychiatric medications when appropriate. The majority of individuals come in on their own for this 1-year outpatient drug treatment program certified by the California Department of Alcohol and Drug Programs. To date, there has not been a systematic evaluation to determine the effectiveness of the Stonewall Project harm reduction intervention approach. The proposed comprehensive evaluation plan will develop and pilot test an innovative, web-based assessment system (using audio computer-assisted self interviewing technology) that can be implemented in the context of regular clinical care at the Stonewall Project. This system will automate existing self-monitoring activities that participants complete as part of the Stonewall Project and will provide outcome data regarding: HIV risk behavior; the frequency, quantity and patterns of substance use; and the methods of use, e.g., injection, smoking, snorting or other method. Our study team will collect information from key stakeholders (San Francisco AIDS Foundation administrators, Stonewall Project staff, and Stonewall Project participants) to inform the development of this web-based assessment system. Furthermore, we plan to collect information regarding Stonewall Project staff and participant experiences during pilot testing of the web-based assessment system to determine feasibility and acceptability. Based on the information gathered, our study team will further refine the web-based assessment system for use in regular clinical care at the Stonewall Project. Following the implementation of this web-based assessment system, 100 participants in the Stonewall Project will complete 26 weekly assessments of HIV risk and substance use during the 6 months following their intake for services at the Stonewall Project. The information gathered regarding participant responses to the Stonewall Project intervention will be used to examine treatment outcome with respect to HIV risk and substance use. If successful, the proposed study will have important scientific and clinical implications. Although harm reduction programs are being implemented in California and across the United States, there is little or no evidence available that demonstrates whether or not these programs are effective for methamphetamine use treatment. Research demonstrating the effectiveness of harm reduction for methamphetamine users would provide support for alternatives to abstinence-based treatment. From a clinical perspective, developing a web-based assessment system could serve as a “best practices” model for program evaluation of community-based HIV prevention interventions. Furthermore, the Stonewall Project can continue to use the web-based assessment system to evaluate participant responses to treatment as well as long-term outcomes following the conclusion of formal treatment. Research demonstrating the effectiveness of the Stonewall Project’s harm reduction approach would provide some of the evidence necessary to support the implementation of similar harm reduction treatment approaches for methamphetamine users in other settings and communities.