***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Contingency management ( CM ) rapidly reduces cocaine use , but its effects subside after treatment . Cognitive-behavioral therapy ( CBT ) produces reductions months after treatment . Combined , the 2 might be complementary . One hundred ninety-three cocaine-using methadone-maintained out patients were r and omly assigned to 12 weeks of group therapy ( CBT or a control condition ) and voucher availability ( CM contingent on cocaine-negative urine or noncontingent ) . Follow-ups occurred 3 , 6 , and 12 months posttreatment . Primary outcome was cocaine-negative urine ( urinalysis 3 times/week during treatment and once at each follow-up ) . During treatment , initial effects of CM were dampened by CBT . Posttreatment , there were signs of additive benefits , significant in 3- versus 12-month contrasts . Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment BACKGROUND Injection drug use directly or indirectly accounts for nearly half the annual human immunodeficiency virus ( HIV ) infections in the United States . Prospect i ve studies that investigate both sexual and parenteral HIV risks among injection drug users ( IDUs ) are needed . We studied factors for HIV seroconversion among male and female IDUs in Baltimore , Md. METHODS The HIV-negative IDUs ( 1447 male and 427 female ) were recruited into a prospect i ve study from 1988 to 1989 or in 1994 . Participants underwent semiannual HIV tests and surveys through December 1998 . Poisson regression was used to identify risk factors for HIV seroconversion , stratified by sex . Behaviors were treated as time-dependent covariates that varied at each semiannual period . RESULTS Subjects were primarily African American ( 91 % ) , and median age at enrollment was 35 years .  Incidence of HIV was 3.14 per 100 person years ( 95 % confidence interval , 2.78 - 3.53 ) and did not significantly differ by sex . Younger age independently predicted HIV seroconversion for both men and women . Among men , factors that independently predicted HIV seroconversion were the following : less than a high school education , recent needle sharing with multiple partners , daily injection , and shooting-gallery attendance . The incidence of HIV was double for men recently engaging in homosexual activity and cocaine injection . Among women , the incidence of HIV was more than double for those recently reporting sexually transmitted diseases . CONCLUSIONS The incidence of HIV remained high among IDUs in Baltimore over the past decade . Risk factors for HIV seroconversion differed markedly by sex . Predominant risks among men included needle sharing and homosexual activity ; among women , factors consistent with high-risk heterosexual activity were more significant than drug-related risks . Human immunodeficiency virus interventions aim ed at IDUs should be sex-specific and incorporate sexual risks A r and omized trial was conducted to test the effectiveness of couple-based HIV counseling and testing ( CB-HIV-CT ) and  women-only relationship-focused HIV counseling and testing ( WRF-HIV-CT ) in reducing HIV risk compared to the National Institute on Drug Abuse HIV-CT st and ard intervention . Substance using HIV-negative women and their primary heterosexual partner ( N = 330 couples ) were r and omized to 1 of the 3 interventions . Follow-up assessment s measuring HIV risk behaviors and other relevant variables were conducted at 3- and 9-months postintervention . Repeated measures generalized linear mixed model analysis was used to assess treatment effects . A significant reduction in HIV risk was observed over the 9-month assessment in the CB-HIV-CT group compared to that of the control group ( b = −0.51 , t[527 ] = −3.20 , P = 0.002 ) and compared to that of the WRF-HIV-CT group ( b = −0.34 , t[527 ] = −2.07 , P = 0.04 ) , but no significant difference was observed between WRF-HIV-CT and controls ( b = −0.17 , t[527 ] = −1.09 , P = 0.28 ) . A brief couple-based HIV counseling and testing intervention design ed to address both drug-related and sexual risk behaviors among substance using women and their primary male partners was shown to be more effective at reducing overall HIV risk compared to a st and ard HIV-CT intervention in an urban setting Background : There is a lack of effective behavioral interventions for HIV-positive injection drug users ( IDUs ) . We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population . Methods : HIV-positive IDUs ( n = 966 ) recruited in 4 US cities were r and omly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention ( control condition ) . Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month ( no blood ) , 6-month , and 12-month follow-ups . Results : Overall retention rates for r and omized participants were 87 % , 83 % , and 85 % at 3 , 6 , and 12 months , respectively . Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors , but there were no significant differences between conditions . Participants in both conditions reported no change in medical care and adherence , and there were no significant differences between conditions . Conclusions : Both interventions led to decreases in risk behaviors but no changes in medical outcomes . The characteristics of the trial that may have contributed to these results are examined , and directions for future research are identified OBJECTIVES We evaluated the efficacy of a peer-mentoring behavioral intervention design ed to reduce risky distributive injection practice s ( e.g. , syringe lending , unsafe drug preparation ) among injection drug users with hepatitis C virus ( HCV ) infection . METHODS A r and omized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities . Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups . RESULTS Compared with the control group , intervention-group participants were less likely to report distributive risk behaviors at 3 months ( odds ratio [OR]=0.46 ; 95 % confidence interval [CI]=0.27 , 0.79 ) and 6 months ( OR=0.51 ; 95 % CI=0.31 , 0.83 ) , a 26 % relative risk reduction , but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending . Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months . Peer mentoring and self-efficacy were significantly increased among intervention-group participants , and intervention effects were mediated through improved self-efficacy . CONCLUSIONS This behavioral intervention reduced unsafe injection practice s that may propagate HCV among injection drug users Background We evaluated brief combination interventions to simultaneously reduce sexual and injection risks among female sex workers who inject drugs ( FSW-IDUs ) in Tijuana and Ciudad Juarez , Mexico during 2008–2010 , when harm reduction coverage was exp and ing rapidly in Tijuana , but less so in Juarez . Methods FSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month participated in a r and omized factorial trial comparing four brief , single-session conditions combining either an interactive or didactic version of a sexual risk intervention to promote safer sex in the context of drug use , and an injection risk intervention to reduce sharing of needles/injection paraphernalia . Women underwent quarterly interviews and testing for HIV , syphilis , gonorrhea , Chlamydia and Trichomonas , blinding interviewers and assessors to assignment . Poisson regression with robust variance estimation and repeated measures ordinal logistic regression examined effects on combined HIV/STI incidence and receptive needle sharing frequency . Findings Of 584 initially HIV-negative FSW-IDUs , retention was ≥90 % . After 12 months , HIV/STI incidence decreased > 50 % in the interactive vs. didactic sex intervention ( Tijuana : AdjRR:0.38,95 % CI:0.16–0.89 ; Juarez : AdjRR:0.44,95 % CI:0.19–0.99 ) . In Juarez , women receiving interactive vs. didactic injection risk interventions decreased receptive needle-sharing by 85 % vs. 71 % , respectively ( p = 0.04 ) ; in Tijuana , receptive needle sharing declined by 95 % , but was similar in active versus didactic groups . Tijuana women reported significant increases in access to syringes and condoms , but Juarez women did not . Interpretation After 12 months in both cities , the interactive sexual risk intervention significantly reduced HIV/STI incidence . Exp and ing free access to sterile syringes coupled with brief , didactic education on safer injection was necessary and sufficient for achieving robust , sustained injection risk reductions in Tijuana . In the absence of exp and ing syringe access in Juarez , the injection risk intervention achieved significant , albeit more modest reductions , suggesting that community-level interventions incorporating harm reduction are more powerful than individual-level interventions . Trial Registration clinical trials.gov Active injection drug users ( IDUs ) who are also hazardous alcohol users are at particularly high risk for HIV transmission due to sharing of injection equipment . We recruited AUDIT-positive injectors from the Providence , RI needle exchange program for a r and omized clinical trial testing the effect of a brief motivational intervention ( MI ) on frequency of injection-related HIV risk behavior ( IRRB ) . HIV drug risk behavior was measured as the number of days on which subjects reported sharing works using the 30-day Timeline Followback Method . Overall , 109 subjects reported a mean reduction of IRRB days of 9.1 days from baseline to 6-month follow-up ( p < .001 ) . When compared to controls , there was a trend in reduction of IRRB days to zero at follow-up for MI subject ( OR = 2.1 ; 95 % CI = 0.9 - 4.5 ) , and strongly significant reductions in IRRB days across a range of alternative improvement thresholds . Results from this study demonstrate that MI reduces drug-related HIV risk behaviors among active IDUs . As a brief intervention , MI may be a useful adjunct to existing services intended to reduce harm AIM Contingency management ( CM ) is efficacious in reducing drug use . This study examined whether CM also reduces human immunodeficiency virus ( HIV ) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment . DESIGN Data were analyzed from a subset of participants in a combined data set of three published r and omized controlled trials of CM treatments . SETTING A community-based methadone maintenance clinic . PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients . INTERVENTION Participants received either st and ard methadone treatment or st and ard methadone treatment with CM for 3 months . MEASUREMENTS The HIV Risk Behavior Scale ( HRBS ) was administered prior to r and omization to a study condition and 3 months after the study treatments ended . The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment . FINDINGS Relative to those assigned to st and ard care , participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors .  CM participants also achieved longer duration s of consecutive cocaine and opioid abstinence during treatment . Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores . CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients The authors conducted a preliminary study of the 4-session Holistic Health for HIV ( 3H+ ) , which was adapted from a 12-session evidence -based risk reduction and antiretroviral adherence intervention . Improvements were found in the behavioral skills required to properly adhere to HIV medication regimens . Enhancements were found in all measured aspects of sex-risk reduction outcomes , including HIV knowledge , motivation to reduce sex-risk behavior , behavioral skills related to engaging in reduced sexual risk , and reduced risk behavior . Improvements in drug use outcomes included enhancements in risk reduction skills as well as reduced heroin and cocaine use . Intervention effects also showed durability from post-intervention to the follow-up assessment point . Females responded particularly well in terms of improvements in risk reduction skills and risk behavior . This study suggests that an evidence -based behavioral intervention may be successfully adapted for use in community-based clinical setting s where HIV-infected drug users can be more efficiently reached Injection drug use is a leading transmission route of HIV and STDs , and disease prevention among drug users is an important public health concern . This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women .  Cost-effectiveness analysis was conducted from societal and provider perspectives for r and omized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions : ( 1 ) NIDA ’s st and ard intervention ( SI ) ; ( 2 ) SI plus a well woman exam ( WWE ) ; and ( 3 ) SI , WWE , plus four educational sessions ( 4ES ) . Trial results indicate that 
    Output:
    
Exposure to information on improving injecting techniques did not encourage riskier injecting practice s or injecting frequency , and benefits were reported among attendees .
The intervention has the potential to positively influence BBV prevention .
FUTURE WORK The intervention did not meet the complex needs of some PWID , more tailoring may be needed to reach PWID who are more frequent injectors , who are homeless and female .
LIMITATIONS Intervention delivery proved more feasible in London than other locations .
Non-attendance at the York trial site substantially influenced the results .