Pre-Chemotherapeutic Care of HCV Infected Drug Users

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DESCRIPTION (provided by applicant): The care of chronic hepatitis C (HCV) infection among drug users, many of whom are co-infected with HIV, is an important public health problem. For drug users with chronic HCV infection, alcohol and active drug abuse, high rates of depression, susceptibility to hepatitis A and B infections, and HIV co-infection are only a few of the variables that affect engagement in and outcome of HCV chemotherapy. Attention to these "pre-chemotherapeutic" factors prepares drug users for future and possibly more efficacious HCV chemotherapy. However, little is known about whether these "pre-chemotherapeutic" factors are successfully addressed in the context of chronic HCV management. The candidate proposes the following specific aims: 1) To determine rates of engagement in pre-chemotherapeutic care among drug users with chronic HCV infection. 2) To determine factors associated with awareness and acceptance of interventions other than specific chemotherapy for reducing the progression of chronic HCV infection and preparing for future chemotherapy. The candidate proposes a five-year prospective study of engagement in and factors associated with pre-chemotherapeutic care for hepatitis C infection, among HCV-infected drug users participating in two ongoing cohort studies of men and women with or at risk for HIV. Participants will be screened and enrolled at a semi-annual research visit for the parent studies. At each semi-annual research visit, study participants will undergo standardized interviews to gather data on demographics, sexual and drug-using behaviors and medical history, including symptoms of and treatment for hepatitis. In addition, blood will be drawn for laboratory assays including HCV antibody and HCV RNA levels. The purpose of this K23 grant proposal is to support this candidate as she develops her clinical research career and undertakes studies in HCV-infected drug users with or at risk for HIV, under the mentorship of experienced investigators.