Usual care included established psychosocial treatments, such as cognitive behavioral therapy and relapse prevention, as well as encouragement to participate in 12-step programs.

As part of the contingency management, subjects earned the chance to win prizes each time they tested negative, with the chances increasing with each consecutive period of abstinence. The reinforcers were plastic chips, half of which could be exchanged for prizes, most of which were worth $1 to $5, although a few were worth $20 or $100. The number of chips individuals could take increased with each week of negative samples, but was reset to one after a missed or positive sample.

Participants in the contingency management group submitted significantly more stimulant-negative samples than those in the usual care group (13.9 versus 9.9, retrospectively. This group also had longer periods of documented continuous abstinence (approximately 4.6 weeks versus 2.8 weeks; and was more likely to remain abstinent throughout the entire trial (17.6 percent versus 6.5 percent).

Roll's team observed no difference between groups at 3- and 6-month follow-up. However, they report, "regardless of group assignment, providing all negative samples during the last 4 weeks of treatment significantly increased the likelihood of providing a stimulant-negative urine sample at the 3-month follow-up time."

They conclude that showing that contingency management works "in a 'real world' setting demonstrates the actual clinical utility of the intervention."

SOURCE: American Journal of Psychiatry, November 2006.

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AIDS experts convene ahead of World AIDS Day

Last Updated: 2006-11-29 16:18:08 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - Ahead of World AIDS Day, Friday, December 1, nearly 300 medical, government, and community HIV/AIDS experts have gathered in Washington, D.C. for a 2-day summit in which they will examine ways to expand HIV testing in the United States and assess the impact that an increased number of individuals diagnosed with the disease will have on the health care system.

It's estimated that some 40,000 new HIV infections continue to occur each year in the United States. "It is humbling," said summit co-chair Dr. John G. Bartlett, "that the rate of new infections has not changed in 16 years despite such great progress in other facets of the disease."

"It is unacceptable that we have so many new cases of an entirely preventable disease every year in this country," added Bartlett who is from Johns Hopkins University School of Medicine in Baltimore.

"Equally troubling," Bartlett noted, is the fact roughly 250,000 Americans are living with HIV but are unaware of their infection. These individuals "are not benefiting from life-extending treatments and may unknowingly be transmitting HIV to other people."

"There are a number of preventive strategies that are now available and only need to be implemented," Bartlett said. In September, the CDC recommended that all Americans between the ages of 13 and 64 years be tested for HIV as part of routine medical care.

Scaling up HIV testing, prevention and care is the key to ending the country's HIV/AIDS epidemic, added summit co-chair Dr. Kenneth H. Mayer from Brown University, Providence, Rhode Island, noting that HIV screening rates remain low in doctors' offices, emergency rooms and sexually transmitted disease/family planning clinics.

A recent study found that more than 60 percent of people with regular access to health care who were newly diagnosed with HIV were in an advanced stage of disease, suggesting that prior opportunities for diagnosis had been missed.

"If voluntary, routine HIV testing is to become a reality in doctors' offices, emergency rooms and other health care settings around the country, we need to address a number of social, economic, and logistical issues," Mayer said.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.