Alcohol Use Reduction in Methadone Individuals with HCV

描述（由申请人提供）：在全国范围内，使用聚乙二醇干扰素和利巴韦龙治疗 HCV 感染患者已取得重大进展；然而，在美沙酮维持 (MM) 治疗中，将这些药物与 HCV 感染的阿片类药物维持 (OM) 注射吸毒者一起使用是有问题的。此外，由于许多感染 HCV 的 OM 患者继续饮酒，持续的肝纤维化以及饮酒和滥用酒精的其他社会和行为后果仍在继续。尽管简短的动机访谈 (MI) 已证明有效，但这些计划并非在 MM 治疗环境中进行。此外，与一对一递送相比，M1的团体递送在减少酒精使用方面的有效性是未知的。在这个两阶段探索性 R21 的第一阶段，将对 40 名 OM HCV 感染成年人、20 名中度饮酒者和 20 名重度饮酒者进行定性评估，按性别和改变饮酒意愿进行平均分配，与这些客户一起探讨：1) 影响获得减少饮酒和健康促进服务以及免费 HAV/HBV 疫苗接种的因素； 2) MM 员工可以用来协助客户寻求服务的策略。多发性骨髓瘤诊所的工作人员也会探讨提供这些服务的可行性。在第二阶段，我们计划对 250 名符合条件、感染 HCV 且饮酒且接受 MM 的 OM 客户进行试点，以减少饮酒和促进肝脏健康干预。纳入 M1) 的两个干预小组将使用一对一交付 (Mi-Single) 或团体交付 (Mi-Group) 方式向参与者提供现场简短的 M1（3 次会议）咨询。此外，每个团体还将接受肝脏健康促进 (LHP) 计划，其中包括 30 分钟的健康促进教育课程、转介社区 12 步酒精门诊计划、免费筛查 HAV/HBV 以及 HAV/HBV 疫苗接种系列（如果符合条件）（定义为 HAV 和/或 HBV 血清阴性）。所有这些服务将整合到参与者通常的 MM 诊所现场服务中。第三组，通常护理（UC）组将接受与干预组相同的组成部分，除了时间平衡的现场简短的 3 次健康促进咨询（与 M1 不同）。拟议研究的短期目标是完善可以在大规模干预试验中进行充分测试的策略。长期目标是在为 OM HCV 阳性客户服务的 MM 诊所环境中提供有关促进与酒精相关的健康寻求和治疗完成行为的知识，以便制定针对特定人群的干预策略。

DESCRIPTION (provided by applicant): Nationwide, major strides have been made in treatment for HCV-infected patients using pegylated interferon and ribaviron; however use of these medications with HCV-infected opioid maintained (OM) IDUs in methadone maintenance (MM) treatment is problematic. Further, as many HCV-infected OM clients are continuing to drink alcohol, ongoing liver fibrosis and other social and behavioral consequences of alcohol use and abuse continue. Despite the fact that brief Motivational Interviewing (Ml) has demonstrated effectiveness, these programs are not conducted in MM treatment settings. Moreover, the effectiveness of group delivery, as opposed to one-on-one delivery, of Ml is unknown in terms of alcohol use reduction. In Phase I of this two-phased exploratory R21, a qualitative assessment will be conducted with 40 OM HCV-infected adults, 20 moderate alcohol users and 20 heavy alcohol users, equally divided by gender and readiness to change alcohol use, to explore with these clients: 1) factors impacting access to alcohol use reduction and health promotion services and free vaccination for HAV/HBV; and 2) strategies that MM staff can use to assist their clients in seeking services. Staff of a MM clinic will also explore the feasibility of providing these services. In Phase II, we plan to pilot an alcohol use reduction and liver health promotion intervention with 250 eligible, HCV-infected, alcohol-using OM clients receiving MM. Two intervention groups incorporating Ml) will provide on-site brief Ml (3 sessions) counseling to participants using either one-on-one delivery (Mi-Single) or the group-delivery (Mi-Group). In addition, each group will be offered the Liver Health Promotion (LHP) program, which includes a 30-minute health promotion education session, referral to a community 12-Step alcohol outpatient program, and an offer for free screening for HAV/HBV, and the HAV/HBV vaccination series, if eligible (defined as being HAV and/or HBV seronegative). All these services will be integrated within participants' usual MM clinic onsite services. A third group, the Usual Care (UC) group will receive the same components offered to the intervention groups except for a time balanced on-site brief 3 session health promotion counseling as opposed to the Ml. The short-term goals of the proposed study are to refine strategies that can be fully tested in a large-scale intervention trial. The long-term goals are to contribute to knowledge about promoting alcohol-related health-seeking and treatment completion behaviors in MM clinic settings that serve OM HCVpositive clients, so that population-specific intervention strategies can be developed.