Clinical Scorecard: Project RETAIN: Enhancing Integrated Care for Cocaine-Using Individuals Living with HIV

At a Glance

Key Highlights

• Integrated intervention increased participation in substance use treatment but did not improve viral suppression compared to treatment as usual.
• Both intervention and control groups showed decreases in stimulant use; oxycodone use decreased more in the intervention group.
• Psychological distress declined more in the intervention group at 6 months.

Guideline-Based Recommendations

Diagnosis

• Identify PWH who use cocaine and assess virologic suppression status (<200 copies/mL).
• Screen for co-occurring mental health disorders and psychological distress.

Management

• Implement integrated behavioral treatments including cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET) alongside patient navigation to support engagement in care.
• Provide evidence-based behavioral interventions such as contingency management where feasible.
• Address complex medical and psychosocial needs including housing, food security, and mental health.

Monitoring & Follow-up

• Regularly monitor viral load to assess suppression status at 6 and 12 months.
• Track substance use patterns and psychological distress over time.
• Evaluate retention in HIV care and adherence to antiretroviral therapy.

Risks

• High risk of poor virologic suppression among PWH who use cocaine despite interventions.
• Structural and social determinants such as stigma, poverty, and unstable housing may impede treatment success.
• Limited availability of effective medication-assisted treatments for cocaine use disorder.

Patient & Prescribing Data

Cocaine-using PWH who are not virologically suppressed

Integrated behavioral interventions increased substance use treatment participation but did not significantly improve viral suppression; psychological distress was reduced post-intervention.

Clinical Best Practices

• Use patient-centered motivational approaches combined with CBT to enhance engagement and coping skills.
• Incorporate patient navigation to improve linkage and retention in HIV care.
• Address co-occurring mental health disorders and trauma to optimize HIV treatment outcomes.
• Recognize and mitigate structural barriers such as stigma and social marginalization.
• Consider contingency management as an adjunct behavioral intervention where resources allow.

References

• Project RETAIN graphical abstract and summary