Harm reduction in practice: baseline cohort description and early engagement trends in an incentive-based program for PWUD.

Background: Contingency management (CM) has been used to reinforce abstinence in the treatment of substance use disorders (SUD). Novel applications of CM in people who use drugs (PWUD) have been used to facilitate other desirable behaviors. Objective: Describe and assess preliminary outcomes of a program intended to reduce risk for HIV and related infections in a population of PWUD through increased healthcare engagement. Design: Patients receiving care for SUD at a collocated clinic receive shaping CM-based incentives for risk assessment, testing, and clinic attendance. Methods: Baseline cohort characteristics are assessed, and engagement in clinical care during the early period of the program is described. Results: Participants are majority African American, female, and meet criteria for experiencing financial resource strain. During the first year of the program, no significant changes in clinic appointment attendance were observed. Conclusion: Patient-centered CM-based incentivization implemented in a low-barrier, harm-reduction setting may facilitate incremental health behavior changes to reduce infection-related comorbid risk. There is a need to expand approaches to those with high risk and barriers.