PROJ 2:UCC:HCV RISK REDUCTION INTERVENTION AS SECONDARY CO-MORBIDITY PREVNT

这个子项目是众多研究子项目之一

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Introduction This project developed and validated a multimedia educational intervention to reduce HCV associated risk behaviors with the ultimate outcome of reducing the rate of co-infection among IDUs. The education and prevention intervention modules consist of four computer based sessions directed at increasing: 1) HCV knowledge; 2) HCV susceptibility perception and disease severity; 3) HCV protective measures efficacy perception; and 4) risk reduction self-efficacy perception. In this second study phase the intervention is being implemented and evaluated in a population of people living with HIV/AIDS (PLWHA). Selection of a cohort of Puerto Rican PLWHA, self reporting injecting drug use, and characterization by HCV knowledge and risk behaviors. Recruitment Currently, and as expected, a total of 200 participants have been recruited for the study. All participants received a HCV prevalence screening, with the aid of HCV qualitative testing, upon study entry. In addition, HCV viral load and a HCV genotype test were performed in all serologically positive blood samples. As a secondary aim, this study will measure the HCV sero-prevalence in this PLWHA cohort b. Characterize the cohort in relation to socioeconomic and HIV/AIDS infection parameters Data related with the socioeconomic parameters and the HIV infection characterizations of the participants (risk factors, morbidity, laboratory finding and treatments) are been collected and evaluated at study entry and very six months. These data are being collected with the help of the common questionnaire and the RRC instruments. HCV infection knowledge and risk behaviors The HCV Knowledge, Risk Behaviors and Barriers questionnaire measured the HCV knowledge and risk behaviors in the cohort. A total o 422 questionnaires were completed by the participants as follows: enrollment 180, eight week visit 124, 83 for the six month visit, and 35 for the one year visit. HCV sero-prevalence As a secondary aim the study measures the HCV sero-prevalence among participants. Until June 2007, a total of 230 HCV qualitative test were performed in the study participants; 185 at study entry and 45 one year later. In additionally, HCV viral load and HCV genotype test were performed in all serologically positive blood samples. Data analysis We continue the process of data analyses, after performing data quality control. Educational and counseling interventions On February 2006 the study began the implementation of the program, designed to improve the HCV knowledge and to diminish the HCV risk behaviors. By June 2007, 92 cases and 50 controls received one or more intervention sessions. The intervention group, received the education and counseling interventions in the first 8 weeks after enrollment; and the control group, received the intervention after the 6th month of follow up. The sessions were delivered on week zero, two, four and eight in the intervened group. A total of 142 participants have received the first intervention, 118 the second, 110 the third and 98 the fourth intervention. Significance of the study HIV/AIDS is one of the most relevant public health problems in Puerto Rico. The AIDS prevalence is among the highest in the United Stated and its territories. Over fifty percent of the PLWHA in Puerto Rico are IDUs, with risk behaviors that significantly increase the probability of HCV co-infection. Additionally, the medical management of HCV in PLWHA is complicated by the high costs, the immune suppression, the potential drug interactions and toxicities. The increasing evidence that emphasizes the synergistic role of HIV-HCV co-infection in the morbidity and mortality of PLWHA has focused our attention in evaluating HIV secondary prevention strategies targeted to reduce their HCV co-infection and their complications. Thus this study is evaluating the prevalence of risk behaviors that could increase the HCV co and super-infection in a cohort of mostly medically indigent Puerto Rican PLWHA. The study is also implementing and evaluating the educational and counseling intervention, directed to decrease the risk of HCV co and super-infection in IDUs PLWHA. Preliminary results Over 92% of the participants reported that the computer based program was easy or very easy to operate in the first intervention. Computer skills increased with the completion of each session: 21% of the participants reported that the computer program was very easy in the initial session compared to 83% after the fourth session. Most of the participants (over 97%) agreed that the audio and video tools facilitated their learning process, this opinion increased throughout the course of the sessions. All participants agreed that the programmed session durations were adequate. Additionally, they reported that the health educator facilitated the process. Accordingly, the majority of the participants reported an increase in knowledge regarding: HIV/HCV co-infection (87%), perception of HCV infection risk (85%), complications associated with HCV (88%), HCV preventive measures (91%), HCV diagnosis process (88%) and HCV therapy (86%). Pre-post test comparisons showed an increased knowledge of the concept of liver function, severity of HCV infection and HCV infection risk factors. All of the participants favored dissemination of the information to other individuals at risk. Despite the low educational level of the group, the program was well received by HIV-infected IDUs and suggests that a multimedia educational HCV prevention intervention is an effective means of information dissemination. This new technology kept the participants attention and interest, while increasing the HIV/HCV co-infection knowledge. Activities conducted between August 2006 and June 2007 Recruitment continues and until June 2007 a total of 200 participants were enrolled for the study. This number participation rates reached the study enrollment expectations. The blood sample collection and processing continues with a total of 230 blood samples. The education and counseling intervention was given to 92 participants on the intervention group. Of the 92 participants in the control group, 50 have received one or more of the intervention sessions. Regular meetings are held with the mentor to evaluate and analyze the education and counseling interventions, to redact of abstracts and presentations and with the research team.