PROJECT SUMMARY/ABSTRACT The objective of this K23 Mentored Patient-Oriented Research Career Development Award is to assist the candidate in acquiring expertise and methodological skills to become an independent implementation science investigator focused on integrated substance use disorder and HIV care practices. The objective of the candidate’s research is two-fold: to reduce the detrimental impact of methamphetamine use while simultaneously supporting engagement in HIV care. People with HIV who use methamphetamine are susceptible to experiencing gaps at each stage of the HIV care continuum. Contingency management is an effective behavioral therapy for methamphetamine use disorder that is based on operant conditioning principles. Contingency management decreases the reinforcing effects of methamphetamine use by providing immediate, positive reinforcement following abstinence from substance use. Incentive-based interventions based on operant conditioning principles also demonstrate positive effects for improving antiretroviral therapy (ART) adherence. It remains unclear whether a contingency management program that integrates incentives for ART adherence (CM+ART, i.e., dually targeting methamphetamine use and ART adherence) is more acceptable and appropriate to people with HIV than a contingency management program targeting methamphetamine use only. The specific aims of the research plan for the five-year K23 award period are: 1) to identify resources required to implement contingency management programs in settings serving people with HIV, 2) to adapt contingency management to integrate incentives for adherence to ART (CM+ART), and 3) to evaluate whether CM+ART is acceptable and appropriate to people with HIV who use methamphetamine compared to a contingency management program targeting only reductions in methamphetamine use. Dr. Montoya’s mentored training plan, including formal didactics and other activities, aligns with the research aims and career development plans and has four key areas: 1) to deepen knowledge of evidence-based practices implemented at local and national levels to support patient engagement in HIV and substance use disorder care, 2) to apply an implementation science approach to guide adaptation of contingency management to integrate incentives for ART adherence, 3) to acquire advanced methodological skills to design and evaluate mixed-method studies and clinical trials, and 4) to engage in professional development activities geared toward development of a competitive NIDA R01 application and an independent research career. This proposal strongly aligns with NIDA Strategic Plan Objectives 3.1 (“Develop and test novel treatments based on the science of addiction”) and 3.4 (“Develop and test strategies for effectively and sustainably implementing evidence-based treatments”); the NIH Office of AIDS Research priority to address HIV- associated comorbidities such as substance use disorders; and the “Ending the HIV Epidemic: A Plan for America” initiative. The comprehensive training activities and research plan will effectively position the candidate for an independent research career focused on the integration of HIV and substance use disorder care.

PROJECT NARRATIVE Substantial resources have been invested to combat the HIV epidemic; however, methamphetamine use is a persistent and growing concern in the U.S. that contributes to worse patient outcomes and HIV transmission. An integrated treatment that addresses methamphetamine use and adherence to HIV treatment may help advance efforts to end the HIV epidemic. Building from a large body of evidence showing the effectiveness of a behavioral treatment (called contingency management) for treating methamphetamine use disorder, we plan to identify resources required to implement contingency management programs in settings serving people with HIV, as well as to adapt and evaluate a contingency management program that dually targets reductions in methamphetamine use and increased adherence to HIV treatment.