Low-Barrier

Stimulant use and associated sequelae have been rising, representing not only a public health crisis in of itself but also a major barrier to successful control of the HIV epidemic. Stimulant use (including methamphetamine and cocaine) is associated with poor adherence to antiretroviral therapy for HIV, and female-identifying people living with HIV who use drugs have amongst the lowest rates of HIV viral suppression compared to other demographic groups. As such, we propose a trial of contingency management (providing incentives for behavioral change) targeting both reduced stimulant use and improved adherence to HIV medications. With the goal of scaling up treatment for stimulant use disorder and providing synergistic support for HIV medication adherence, we will utilize real-time, point-of-care urine assays for assessing both medication adherence and stimulant use in a contingency management program embedded into HIV primary care. We will study feasibility and acceptability of this program to participants and staff, and will also study hair levels as a quantitative outcome for reduction in stimulant use.