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林治疗HCV感染患者已取得重大进展;然而，在美沙酮维持治疗（MM）中，HCV感染的阿片类维持（OM）IDUs使用这些药物存在问题。此外，由于许多HCV感染的OM客户继续饮酒，持续的肝纤维化和酒精使用和滥用的其他社会和行为后果继续存在。尽管简短的动机访谈（MI）已经证明了有效性，但这些计划并不是在MM治疗环境中进行的。此外，与一对一递送相比，MI的分组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感染的成年人、20名中度饮酒者和20名重度饮酒者进行定性评估，按性别和改变饮酒习惯的意愿进行平均分配，以探索这些客户：1）影响获得减少饮酒和健康促进服务以及HAV/HBV免费疫苗接种的因素; 2）MM工作人员可以用来帮助他们的客户寻求服务的策略。一间MM诊所的职员亦会研究提供这些服务的可行性。在第二阶段，我们计划对250名合格的、HCV感染的、使用酒精的接受MM的OM客户进行减少酒精使用和肝脏健康促进干预的试点。两个纳入MI的干预组将使用一对一递送（MI-单）或组递送（MI-组）向参与者提供现场简短的MI（3次会议）咨询。此外，每个小组将提供肝脏健康促进（LHP）计划，其中包括30分钟的健康促进教育课程，转介到社区12步酒精门诊计划，并提供免费筛查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）。所有这些服务都将整合到参与者通常的MM诊所现场服务中。第三组，即家庭护理（UC）组将接受提供给干预组的相同组分，除了与MI相反的时间平衡的现场简短3次健康促进咨询。拟议研究的短期目标是完善可以在大规模干预试验中充分测试的策略。长期目标是促进知识，促进酒精相关的健康寻求和治疗完成的行为，在MM诊所设置，服务OM HCV阳性客户，使人群特异性的干预策略可以制定。

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.