HBV Prevention for Homeless at Risk for HBV/HCV/HIV

描述（由申请人提供）：由于注射吸毒和无保护的性行为的高发率，无家可归的成年人是乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和艾滋病毒感染的高危人群。我们的nida资助的RO1奖使我们能够实施一项成功的干预措施，旨在评估对无家可归的成年人进行HBV疫苗接种干预的有效性。我们的研究结果显示，与没有跟踪的标准计划相比，随机分配到护士病例管理加激励和跟踪组的无家可归成年人完成了HAV/HBV疫苗系列的比例更高。无家可归者最不可能完成疫苗系列接种的是年轻人（<40岁）和男男性行为者（MSM）；这些年轻人中有相当一部分还报告使用甲基苯丙胺（MA）和可卡因/快克。包括MA和可卡因/快克在内的兴奋剂通常被无家可归的男男性行为者使用，他们的生活混乱，失业，很少获得卫生和社会服务；因此，乙肝疫苗接种在这一人群中尤其具有挑战性。HAV/HBV疫苗接种和有效的行为治疗是减少SA高危人群中HBV感染的两个最重要的策略。根据我们的社区合作伙伴的建议，他们已经成功治疗了使用sa的同性恋和双性恋男性（GBM），我们将把应急管理纳入我们的疫苗接种完成计划，该计划在年轻人和男同性恋者中完成率较低。因此，在这个竞争更新中，我们提出了一个随机的、实验性的、两组设计来评估护士病例管理计划的有效性，其中包括专门的教育和应急管理和跟踪（NCCMT），以及一个标准计划，包括简短的教育、应急管理和跟踪（SCMT），对500名无家可归的年轻人（18-39岁），使用sa的GBM，完成twinrixhav /HBV疫苗，其次，降低肝炎和艾滋病毒的风险。这项研究的创新之处在于，它将使我们能够看到增强的病例管理和应急管理程序与标准应急管理程序的效果。这项拟议的研究结合了接近、参与和干预隐藏和高风险人群的最佳策略，以评估干预措施的可行性和有效性，这些干预措施可能证明对预防乙型肝炎和甲型肝炎感染有益。我们还将根据完成甲型肝炎/乙型肝炎疫苗接种系列来评估这些规划的相对成本。由于磺胺类药物的使用有可能加剧无家可归者接触甲肝病毒和乙型肝炎病毒的风险，特别是在可能尚未感染乙型肝炎病毒的年轻使用者中，因此针对这一群体进行治疗的研究至关重要，直到他们得到适当的乙型肝炎病毒保护。

DESCRIPTION (provided by applicant): Homeless adults are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Our NIDA-funded RO1 award has enabled us to implement a successful intervention designed to evaluate the effectiveness of a HBV vaccination intervention with homeless adults. Our findings revealed that a greater percent of homeless adults randomized to the Nurse Case Managed Plus Incentive and Tracking group completed the HAV/HBV vaccine series compared to a Standard program without tracking. Homeless persons least likely to complete the vaccine series were young (<40), and were men having sex with men (MSM); a significant number of these young adults also reported methamphetamine (MA) and cocaine/crack use. Stimulants (SAs), including MA and cocaine/crack are commonly used by homeless MSM, who contend with disorganized lives, unemployment, and little access to health and social services; thus, HBV vaccination is particularly challenging in this population. HAV/HBV vaccination and effective behavioral treatment are two of the most important strategies for reducing HBV infection among this at-risk group of SA users. Based upon advice from our community partners who have successfully treated SA-using gay and bisexual men (GBM), we will incorporate contingency management into our vaccination completion program, which had lower completion rates among young adults and MSMs. Thus, in this competitive renewal, we propose a randomized, experimental, two-group design to evaluate the effectiveness of a Nurse Case Managed Program, which includes specialized education and Contingency Management and Tracking (NCCMT), with a Standard Program, including brief education, Contingency Management and Tracking (SCMT) with 500 homeless, young (18-39), SA-using GBM, on completion of theTwinrixHAV/HBV vaccine and, secondarily, on reduction of risk for hepatitis and HIV. This study is innovative in that it will allow us to look at the effect of an enhanced case management and contingency management program versus a standard contingency management program. The proposed study combines optimal strategies to approach, engage and intervene with a hidden and high- risk population to assess the feasibility and efficacy of interventions that may prove beneficial in preventing HBV and HAV infections. We will also assess the relative cost of these programs in terms of completion of the HAV/HBV vaccination series. As use of SAs threatens to intensify homeless persons' risk of exposure to HAV and HBV, particularly among young users who may not yet be HBV-infected, research targeted to engage this group in treatment, until they are suitably protected from HBV, is critical. PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA and Friends Community Center will work together in designing a program to assist young homeless stimulant-using gay and bisexual homeless men to complete the hepatitis vaccine and in reducing drug and sexual activity. Using nurse case management strategies, found successful with homeless adults as well as contingency management strategies, found successful with gay and bisexual homeless adults by our community partners, we will evaluate the effectiveness of a program that combines both strategies. As Stimulant use threatens to increase homeless persons' risk of exposure to hepatitis A and B viruses, particularly among young users who may not yet be HBV-infected, this research is targeted to engage this group in treatment, until they are suitably protected from HBV, and hopefully reduce risk for HCV and HIV as well.