The objective of this study is to assess whether modafinil treatment promotes abstinence and reduces highrisk sexual behavior associated with HIV seroconversion (HRSB) in women who are addicted to cocaine.Preventing the heterosexual transmission of AIDS is arguably the greatest challenge that currently confrontsthe medical community. Women addicted to cocaine are at great risk of HIV seroconversion when theyengage in HRSB (e.g., trading sex for cocaine, having unprotected sex with multiple partners) to obtaincocaine, which is readily available within urban communities. An effective means of identifying and treatingthese women should reduce HRSB that jeopardizes them, their sexual partners, and their partners' partners.This project will utilize a mobile outreach van (MOV) that places our research team in the center of WestPhiladelphia neighborhoods where cocaine is heavily trafficked and consumed, allowing us to identifywomen in urgent need of education and addiction treatment. After informed consent and a comprehensivemedical/psychiatric screening, qualifying subjects will receive HIV testing with pre-test and post-testcounseling designed to provide effective education regarding HIV transmission. Subjects will then berandomized to modafinil (300 mg/day) or placebo treatment for a period of 8 weeks with study medicationsdispensed and monitored in the MOV to optimize subject convenience and medication adherence. Modafinilis a promising agent that blocks cocaine-induced euphoria under controlled conditions, and was recentlyreported to promote cocaine abstinence in a controlled pilot study. Psychosocial treatment will involveTelephone Monitoring and Adaptive Counseling (TMAC), an innovative and cost-effective approach thatprovides a feasible means of treatment delivery to the target population. Cocaine abstinence will bemeasured objectively with twice weekly urine testing and HRSB will be measured with the Risk AssessmentBattery (RAB). Follow-up assessments will be scheduled 3 and 6 months after randomization to furtherassess cocaine abstinence and HRSB. Subjects will be genotyped to assess genetic vulnerability to cocainedependence and pharmacogenetic factors associated with their response to modafinil. Thus, this projectemploys innovative means of identifying, treating, and characterizing a target population in need of effectivetreatment designed to promote recovery and prevent HRSB.
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