Project RETAIN: Integrated Care for Cocaine-Using Individuals with HIV
Overview
Project RETAIN evaluated an integrated intervention combining patient navigation and substance use treatment to improve viral suppression among cocaine-using people with HIV (PWH). Despite increased substance use treatment participation and reduced psychological distress in the intervention group, viral suppression rates did not differ significantly between intervention and usual care groups over 12 months.
Background
Cocaine use, especially crack cocaine, is associated with poor HIV outcomes and virologic suppression due to factors including stigma, marginalization, and co-occurring mental health disorders. Effective treatments for stimulant use disorders are limited, and integrating behavioral therapies like cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) with HIV care has shown mixed results. Patient navigation (PN) can improve retention in HIV care but has limited impact among cocaine-using PWH. Project RETAIN aimed to address these challenges by testing a combined CBT-MET plus PN intervention in high HIV prevalence regions.
Data Highlights
Outcome
Intervention Group
TAU Group
P-value
Viral Suppression at 6-12 months
15.6%
17.1%
0.897
Participation in Substance Use Treatment
87.0%
7.2%
<0.001
Severe Psychological Distress at 6 months
16.1%
24.5%
0.0492
Decrease in Oxycodone Use
Greater decrease
Less decrease
Significant
Key Findings
No significant difference in viral suppression rates between intervention (15.6%) and treatment as usual (17.1%) groups at 6- and 12-month follow-up.
Intervention participants had substantially higher engagement in substance use treatment (87.0%) compared to TAU (7.2%).
Both groups showed significant reductions in stimulant use, but oxycodone use decreased more in the intervention group.
Severe psychological distress declined more in the intervention group at 6 months (16.1%) versus TAU (24.5%).
Despite increased treatment participation, substance use reductions were similar across groups.
The intervention improved psychological distress but did not translate into improved viral suppression.
Clinical Implications
Integrated interventions combining patient navigation and behavioral therapies can enhance engagement in substance use treatment and reduce psychological distress among cocaine-using PWH. However, these improvements may not be sufficient to increase viral suppression rates. Clinicians should consider multifaceted approaches addressing complex medical and psychosocial needs to improve HIV outcomes in this vulnerable population.
Conclusion
Project RETAIN demonstrates that while integrated care can reduce psychological distress and increase substance use treatment participation, achieving viral suppression among cocaine-using PWH remains challenging. Future interventions must address broader barriers to retention and adherence to improve HIV outcomes.
References
Project RETAIN Study (2024) -- Enhancing Integrated Care for Cocaine-Using Individuals Living with HIV
by Lisa R Metsch, Daniel J Feaster, Lauren K Gooden, Yue Pan, Carrigan L Parish, Drenna Waldrop, Allan Rodriguez, Jonathan A Colasanti, Pedro C Castellón, Wendy S Armstrong, Michael Miller, Christin Root, Margaret R Pereyra, Carlos del Rio
