HBV Prevention for Homeless At-Risk for HBV/HCV/HIV

描述（由申请人提供）：全国范围内，无家可归的人口由于不成比例地使用注射毒品，无保护的性活动，卖淫和受害而面临感染艾滋病毒的风险。 无家可归的成年人感染B型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的比例很高，因为他们与艾滋病毒有共同的风险因素。 甲型肝炎病毒（HAV）在易感染HBV、HCV和HIV的人群中也很高，因为HAV的传播方式与HBV、HCV和HIV的传播方式重叠。 因此，HAV、HBV、HCV和HW的教育和筛查计划，结合HAV和HBV的疫苗接种计划，可以显着降低肝炎相关的发病率和死亡率。 然而，无家可归者往往不遵守规定，因为他们中的许多人可能正在与吸毒、酗酒和失业作斗争，并且生活在一个没有组织的世界中，很少有机会获得保健和社会服务。 在这一前瞻性两组准实验设计中，我们将对洛杉矶Skid Row地区约1000名受保护的男性和女性进行评估，以理论为基础的HAV/HBV疫苗接种干预的有效性主要集中在完成Twinrix HAV/HBV联合疫苗接种系列，其次是降低HAV、HBV、HCV和HIV的风险。 我们还将收集这些计划在完成HAV/HBV疫苗接种方面的相对成本数据，提高疫苗接种完成率的成本效益，每个血清保护病例的成本以及预防感染的成本。 一旦确定合格，参与者将被随机分配到两个计划之一：护士案例管理加激励和跟踪（Nurse Case Managed Plus Incentive and Tracking，NCMIT）计划和标准加激励和跟踪（Standard Plus Incentive and Tracking，SIT）计划。 拟议的研究是创新的，因为SIT和NCMIT计划的比较将使我们能够观察标准干预的效果，该标准干预结合了简短的教育，激励和跟踪，类似的干预也包括完成HAV/HBV疫苗接种后的护士病例管理。 两个项目的受试者将在研究诊所接受由经过培训的研究护士进行的为期6个月的3系列疫苗接种，沿着NCMIT或SIT项目。 所有参与者将在基线和六个月和十二个月的随访时使用一系列心理社会、行为、健康和身体状况以及HAV、HBV、HCV和HIV血清状态测量进行评估。 这项拟议的研究支持国家药物滥用研究计划，因为它的重点是评估干预计划的有效性，促进预防HAB，HBV，HCV和HIV在无家可归和吸毒人群中的医疗后果。

DESCRIPTION (provided by applicant): Nationwide, homeless populations are at risk for HIV infection due to disproportionate use of injection drugs, unprotected sexual activity, prostitution and victimization. Infection with the Hepatitis B Virus (HBV) and the Hepatitis C Virus (HCV) is high among homeless adults as they share risk factors with HIV. Hepatitis A Virus (HAV) is also high among populations vulnerable to HBV, HCV, and HIV as modes of transmission for HAV overlap with those of HBV, HCV, and HIV. Thus, education and screening programs for HAV, HBV, HCV, and HW, combined with vaccination programs for HAV and HBV, can significantly decrease Hepatitis-related morbidity and mortality. However, homeless persons, many of whom may be contending with drug and alcohol abuse and unemployment, and live in a disorganized world with little access to health and social services, are often non-compliant. In this prospective two group quasi-experimental design, we will evaluate with approximately 1000 sheltered men and women in the Skid Row area of Los Angeles, the effectiveness of a theoretically-based HAV/HBV vaccination intervention focused primarily on completion of the combined Twinrix HAV/HBV vaccination series and secondarily on risk reduction of HAV, HBV, HCV, and HIV. We will also collect data on the relative cost of each of these programs in terms of completion of HAV/HBV vaccination, the cost effectiveness of improving vaccination completion, the cost per sero-protected case, and the cost per infection prevented. Once determined eligible, participants will be randomized by shelter into one of two programs: a Nurse Case Managed Plus Incentive and Tracking (NCMIT) program and a Standard Plus Incentive and Tracking (SIT) program. The proposed study is innovative in that the comparison of the SIT and NCMIT programs will allow us to look at the effect of a standard intervention combining brief education, incentives and tracking with that of a similar intervention that also includes nurse case management on completion of the HAV/HBV vaccination. Participants in the two programs will receive the 3-series vaccination by trained research nurses at the study clinic over six months, along with either the NCMIT, or the SIT program. All participants will be assessed at baseline and six- and twelve-month follow-up using a battery of psychosocial, behavioral, health and physical status, as well as HAV, HBV, HCV, and HIV sero-status measurements. This proposed study supports the National Drug Abuse Research Initiative as it is focused on assessing the effectiveness of intervention programs promoting the prevention of medical consequences of HAB, HBV, HCV, and HIV in homeless and drug abusing populations.