Dr. Carrico | Department of Public Health Sciences | University of Miami

Public Health’s Dr. Adam Carrico to begin a National Institute on Drug Abuse-Funded Project on a mHealth Intervention

In the United States, there is a resurgence of methamphetamine and other stimulant use that fuels the HIV/AIDS epidemic in men who have sex with men. Findings from the Carrico Lab and others demonstrate that people living with HIV who use stimulants experience difficulties navigating the HIV care continuum that fuel elevated viral load, a greater risk of onward HIV transmission, and faster clinical HIV progression.

Adam W. Carrico, Ph.D., associate professor at the Miller School’s Department of Public Health, in collaboration with other researchers, have previously found that behavioral interventions have positive outcomes in methamphetamine-using men who have sex with men. One intervention called Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS) reduced the HIV viral load, increased positive emotions, and decreased stimulant use of the participants. 

While behavioral interventions have shown promise, those who do not reside in major urban centers experience greater difficulty in accessing HIV and substance use disorder services. Because of this, mHealth approaches are needed to optimize the effectiveness of HIV treatment as prevention.

Dr. Carrico, in collaboration with two other principal investigators, will lead a new project funded National Institute on Drug Abuse to test the efficacy of Supporting Treatment Adherence for Resilience and Thriving (START). START is a mHealth intervention that will integrate two theoretically grounded, evidence-based behavioral interventions. Two other PIs who will be responsible for leading this project with Dr. Carrico is Keith Horvath, Ph.D., an associate professor at San Diego State University, and Sabina Hirshfield, Ph.D., an associate professor from the State University of New York - Downstate. 

“Each principal investigator makes important contributions to this team science project. Together, we bring the right mix of expertise that is necessary to successfully complete this ambitious trial of the START mHealth App for sexual minority men living with HIV who use stimulants,” Dr. Carrico said.

Previously, Dr. Horvath and Dr. Hirschfield have worked with this population by testing technology-based interventions and demonstrating the feasibility of obtaining self-collected dried blood spots from people living with HIV.

The aim of the project is two-fold. The first is to test the efficacy of START for achieving a higher proportion of stimulant-using men who have sex with men who are virally suppressed at six months. The results will then be compared to a website with referrals to HIV treatment information and substance use treatment resources, which will be the project’s control condition. The team will analyze the efficacy of the intervention for decreasing stimulant use, sexual risk, as well as whether it increases theory-based psychological processes over 12 months.

Second, relative to the control condition, the team will assess the cost and cost-effectiveness of START in achieving and/or maintaining viral suppression, including net savings with respect to averted health utilization.  Kathryn McCollister, Ph.D., an associate professor in public health, will oversee the cost-effectiveness component of this project. Raymond Balise, Ph.D., an assistant professor in public health, will be the primary statistician on this project. 

“Our goal is to develop a scalable, efficacious, technology-based approach that can optimize adherence to antiretroviral medications, regardless of whether men are seeking formal substance use disorder treatment,” Dr. Carrico added. “We also hope to reach those who reside outside of major urban centers that lack specialized services for sexual minority men living with co-occurring HIV and stimulant use disorder.”

Written by Amanda Torres

Published on October 2, 2019