Association for Behavior Analysis International

The success for pharmacotherapy depends on the patients taking their prescribed medication. Unfortunately, adherence to prescribed medication averages 50% in developed countries (Sabat, 2003). Reasons for non-adherence can include forgetfulness, lack of information, complex regimens, and poor relationships with clinical staff, among others (Osterberg and Blaschke, 2005). A review of 76 medication adherence studies conducted by Claxton, Cramer, and Pierce (2001) found that as number of required doses increased, adherence decreased. Non-adherence can have serious negative health consequences for the individual, which increases the cost of care. Due to the serious health and economic consequences of adherence to pharmacotherapy regimens, evidence-based interventions to increase medication adherence should be a top priority to behavioral scientists. Presentations will feature a smartphone-based approach to reinforcing antiretroviral adherence in HIV+ adults, employment based reinforcement of adherence to an opioid pharmacotherapy that blocks the effects of drugs like heroin, a delay discounting account of pregnancy- and condom-protected sex among methadone-maintained women, and treatment adherence in Multiple Sclerosis patients. The discussant is an eminent scholar in behavior analysis whose broad range of contributions include work in the areas of traffic and pedestrian safety, education, and developmental disabilities. Taken together, audience members can expect a robust overview of behavior analytic research in the area of medication adherence.

Even though antiretroviral therapy (ART) increases the quality of life for those with HIV and reduces the risk of HIV transmission, only 59% of patients with HIV in North America report adherence >90%. Injection drug use and cocaine use are both related to higher risk for HIV transmission and lower adherence. HIV drug users are thus an important population to target for increasing ART adherence. The purpose of the current project was to test the feasibility and acceptability of a smartphone based ART adherence intervention in drug using HIV patients. Participants were randomized to either a treatment-as-usual control group or the SteadyRx treatment group. Those in the SteadyRx group were given a smartphone with the SteadyRx application. Participants used the smartphone application to record themselves taking their medication for six months. $2.00 was deposited to a reloadable debit card for each day videos were correctly submitted, and bonuses were available for 3 day and 29 day consecutive adherence. MEMS caps were used to monitor adherence in both groups. Results indicate that the system is usable and feasible.

Behavioral interventions are needed to improve naltrexone treatment for opioid use disorder. This ongoing study is evaluating employment-based reinforcement for extended-release naltrexone (XR-NTX) adherence and opiate abstinence on decreasing opiate use. After completing an outpatient induction to be eligible for XR-NTX, participants are assigned to a usual care, opiate abstinence, XR-NTX, or opiate abstinence + XR-NTX group. Participants are invited for 24 weeks to the Therapeutic Workplace, a model employment-based program for drug addiction where they can work each weekday. To maintain maximum pay, participants assigned to the opiate abstinence group must provide opiate-negative samples, whereas those assigned to the XR-NTX group must accept naltrexone injections. Both conditions must be met for the opiate abstinence + XR-NTX group. Usual care participants have no contingencies for their pay. Preliminary analyses focusing on the outpatient induction phase show that employment-based reinforcement for opioid abstinence and oral naltrexone adherence was successful getting 58.3% of participants inducted onto naltrexone. Participants coming from longer-term detoxification programs and who were not on parole or probation had more success. Full planned analyses on opiate use during the intervention will provide important information on the separate and combined effects of using incentives for XR-NTX adherence and opiate abstinence.