Contextual compatibility of three empirically supported behavior therapies for cART adherence among patients with substance use disorders

ABSTRACT

Though substance use disorders complicate adherence to combination antiretroviral therapy (cART), cognitive–behavioral therapy (CBT), contingency management (CM), and motivational interviewing (MI) each demonstrate efficacy to improve cART adherence among substance-using patients. To inform dissemination of these therapies, this mixed-method study was undertaken involving a full-day site visit to each of four HIV care settings. At each setting, an initial administrator interview elicited setting data. Paired focus groups with setting staff and patients then served as forums for open discussion and live polling of the therapies’ respective contextual compatibility. Focus group recordings were subjected to a phenomenological narrative analysis by multidisciplinary investigators, and staff/patient compatibility ratings were analyzed via generalized linear models. Findings include: (1) emergent themes among staff of adaptability, patient-centeredness, and mission-congruence as desired therapy attributes, (2) emergent themes among patients of intrinsic motivation, respect for patient autonomy in illness management, and fairness among service recipients as desired therapy attributes; and (3) comparatively stronger staff perception of compatibility for MI than CBT or CM, and a similar albeit less robust or reliable pattern among patients. Collective findings support MI as a behavior therapy of choice for broad dissemination to HIV care settings to improve cART adherence of patients with substance use disorders.

KEYWORDS:

• Substance use disorders
• behavior therapy
• cART adherence
• HIV/AIDS

Acknowledgements

Dr Hartzler drafted the initial version of the manuscript, and Drs Dombrowski and Donovan contributed revisions to the submitted version of the manuscript. The authors thank Chris Perry for his transcription efforts, the participating settings for opening their doors, and the setting personnel and patients for sharing their opinions. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by R03DA039719 (Informing Dissemination of Behavior Therapies to Enhance HIV Care Among Substance Abusers, Hartzler PI).