# Stigma-Treatment Enhanced Incentivized Directly Observed Therapy for People with HIV who Inject Drugs

> **NIH NIH R34** · MASSACHUSETTS GENERAL HOSPITAL · 2022 · $295,870

## Abstract

PROJECT ABSTRACT
People who inject drugs (PWID) are less likely to maintain viral suppression, perpetuating HIV transmission
among PWID over the past two years in Massachusetts. While resource intensive intervention strategies (i.e.,
incentive-based interventions and directly observed therapy (DOT)) have demonstrated effectiveness for
improving ART adherence in the short-term, they do not address underlying barriers to engagement in HIV
care for PWID, such internalized and anticipated stigma. Acceptable, feasible, and scalable intervention
strategies that combine these intervention strategies with an evidence-based cognitive behavioral therapy
(CBT) intervention designed to address internalized and anticipated stigma related to substance use, as well
as other related stigmas (e.g., HIV) and their sequelae (e.g., avoidance behaviors) optimized for PWID may
result in sustained adherence and viral suppression over time. We hypothesize that combining an app-based
video-delivered optimized stigma-focused CBT intervention coupled with app-based video-delivered short-term
incentivized DOT will have longer lasting effects than short-term incentivized DOT alone. To test this
hypothesis, data on the feasibility, acceptability, and scalability of a combined intervention, optimized for PWID,
is needed. In this R34 we will leverage the multiphase optimization strategy (MOST) to facilitate the
optimization of an evidence-based video-delivered stigma-focused CBT intervention for PWID living with HIV in
Massachusetts who are not virally suppressed (aim 1). We will then utilize implementation science strategies in
a Hybrid Type 1 design to simultaneously conduct a pilot randomized controlled trial (RCT) to test the feasibility
and acceptability of the optimized stigma-focused CBT intervention paired with incentivized DOT compared to
incentivized DOT alone, both implemented through a tailored mobile app (emocha®; n=70; aim 2), while
rigorously testing the implementation strategy, including scalability (aim 3). By accomplishing these aims, we
will develop and refine critical components of the intervention, including optimizing the stigma-focused CBT
intervention and assessing the acceptability, feasibility, and preliminary scalability of combined intervention.
This R34 will enable the development and refinement of the infrastructure for a fully powered RCT, which will
be submitted as a subsequent R01 to test the effectiveness of the intervention and scalability. Throughout this
R34 and the subsequent R01, we will work closely with the Massachusetts Department of Public Health, given
their interest in implementing this intervention strategy and platform should it be identified as effective and
scalable.

## Key facts

- **NIH application ID:** 10472519
- **Project number:** 5R34DA053686-02
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Abigail Winston Batchelder
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $295,870
- **Award type:** 5
- **Project period:** 2021-09-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10472519

## Citation

> US National Institutes of Health, RePORTER application 10472519, Stigma-Treatment Enhanced Incentivized Directly Observed Therapy for People with HIV who Inject Drugs (5R34DA053686-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10472519. Licensed CC0.

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