Alcohol Use Reduction in Methadone Individuals with HCV

描述（由申请人提供）：在全国范围内，聚乙二醇化干扰素和利巴铁治疗hcv感染患者取得了重大进展；然而，在美沙酮维持（MM）治疗中，这些药物与hcv感染的阿片类药物维持（OM） IDUs的使用是有问题的。此外，由于许多感染丙型肝炎病毒的OM客户继续饮酒，持续的肝纤维化以及酒精使用和滥用的其他社会和行为后果仍在继续。尽管事实上，简短的动机访谈（Ml）已经证明了有效性，但这些计划并没有在MM治疗环境中进行。此外，在减少酒精使用方面，与一对一提供Ml相比，集体提供Ml的有效性尚不清楚。在这个两阶段的探索性R21的第一阶段，将对40名普通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，按性别和改变酒精使用的意愿等分，与这些客户探讨：1)影响获得减少酒精使用和健康促进服务以及HAV/HBV免费疫苗接种的因素；2) MM员工可以用来帮助客户寻求服务的策略。MM诊所的工作人员亦会探讨提供这些服务的可行性。在第二阶段，我们计划对250名接受MM治疗的符合条件的hcv感染、饮酒的OM客户进行减少酒精使用和肝脏健康促进干预试验。两个干预组（包括Ml）将通过一对一交付（Mi-Single）或小组交付（Mi-Group）向参与者提供现场简短的Ml（3次）咨询。此外，每个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会议，转介到社区12步酒精门诊项目，并提供免费的HAV/HBV筛查，以及HAV/HBV疫苗系列，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，常规护理（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会议健康促进咨询，而不是Ml。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。长期目标是帮助了解在为hcv阳性患者服务的MM诊所环境中促进与酒精相关的健康寻求和治疗完成行为，以便制定针对人群的干预策略。

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.