The Staying Safe Intervention: Preventing HCV among Young Opioid Injectors

保持安全的干预措施：预防年轻阿片类药物注射者丙型肝炎病毒

• 批准号: 9919265
• 负责人: HONORIA M GUARINO
• 金额: $ 66.12万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919265
• 关键词: Address; Age; Antibodies; Attention; Behavior Therapy; Behavioral; Behavioral Mechanisms; Biological; Blood; Car Phone; Chronic; Country; Disease Outbreaks; Drug usage; Effectiveness; Epidemic; Equipment; Frequencies; Generations; Gossypium; HIV Antibodies; HIV risk; HIV/HCV; Health; Hepatitis C; Hepatitis C Antibodies; Hepatitis C Incidence; Hepatitis C Prevalence; Hepatitis C Transmission; Hepatitis C virus; Heroin; Individual; Infection; Injecting drug user; Injections; Intake; Intervention; Lead; Measures; Mediating; Modeling; Motivation; Needle Sharing; Opioid user; Outcome; Outcome Measure; Participant; Patient Self-Report; Pharmaceutical Preparations; Pharmacotherapy; Population; Practice Management; Prevention; Preventive Intervention; Public Health; Randomized Controlled Trials; Reporting; Research; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Self Efficacy; Shares syringes; Social Behavior; Social Conditions; Social support; Structure; Telephone; Testing; Theoretical model; Time; Training; Water; Youth; base; behavior change; behavioral outcome; career; cooking; design; disorder prevention; follow-up; group intervention; heroin use; high risk; injection drug use; innovation; intervention effect; novel; novel strategies; opioid injection; opioid use; opioid withdrawal; pediatric trauma; post intervention; prescription opioid; prescription opioid misuse; prevent; protective behavior; public health relevance; skills; smartphone Application; social; social stigma; sociodemographics; success; theories; trend; young adult

Project Summary/Abstract HCV infection is the most common chronic blood-borne infection in the U.S., with the overwhelming majority of new HCV infections occurring among people who inject drugs (PWID). Sharing syringes and other injection equipment is the primary risk factor for HCV transmission. HCV prevalence is extremely high in most U.S. PWID populations (typically ranging from ~40-70%). Research shows that young PWID (under age 30) engage in particularly high rates of risky injection, and that HCV incidence is highest in the first 3-5 years of an individual's injection career. The national significance of this public health problem is heightened by the recent epidemic of prescription opioid (PO) misuse in youth which has evolved into widespread heroin use and injection drug use, creating a new generation of young injectors at risk for HCV and HIV. These trends demonstrate the urgent need for innovative new approaches to HCV prevention tailored to the growing population of young PWID. To date, no behavioral intervention has been sufficiently potent to produce significant reductions in HCV incidence in at-risk groups of PWID. To address this critical gap, our team developed Staying Safe (Ssafe), an innovative, strengths-based, socio-behavioral HCV prevention intervention for young PWID. Ssafe addresses multi-level “upstream” determinants of risk that occur relatively early in the causal chain of risk, including eco-social conditions, social relations and risk situations, in addition to directly targeting risky injection practices. Ssafe trains and motivates PWID to better manage drug use in order to avoid situations and practices that promote risky injection (e.g., “binging” on drugs), and to implement health- protective behaviors (e.g., promoting risk-reduction norms in injection networks). In preliminary research we found Ssafe to be highly acceptable and feasible, with strong indications of efficacy. In this study we propose to conduct a randomized, controlled trial to assess the effectiveness of the Ssafe intervention (with a mobile phone-delivered booster application) in reducing injection-related risk behavior and HCV incidence among 18- 29 year-olds (n=456) who inject opioids (heroin and/or POs) and test HCV and HIV antibody-negative at baseline. We hypothesize that Ssafe will significantly reduce injection risk behaviors and HCV infections relative to a time- and attention-matched control intervention. We will also examine whether Ssafe's effects are mediated by (a) drug use management practices (injection frequency, drug intake, opioid withdrawal episodes); (b) individual-level mechanisms of behavior change (motivation/self-efficacy, planning skills); and (c) key upstream socio-structural and network-level determinants of risk (social support, skills to avoid PWID- associated stigma, drug treatment and SEP utilization, injection network size and risk norms). The proposed trial promises to significantly advance our ability to prevent HCV infection in the growing population of young, PO-initiated injectors.

项目总结/摘要 HCV感染是美国最常见的慢性血液传播感染，与绝大多数 新的HCV感染发生在注射毒品的人群中（PWID）。共用注射器和其他注射 设备是HCV传播的主要危险因素。HCV在美国大部分地区的流行率非常高。 PWID人群（通常范围约为40-70%）。研究表明，年轻的PWID（30岁以下） 尤其是在高风险注射率，和HCV发病率最高是在头3-5年， 个人的职业生涯。这一公共卫生问题的国家重要性因最近的 青少年滥用处方阿片类药物（PO）的流行已演变为广泛使用海洛因， 注射毒品，创造了新一代的年轻注射者，有感染HCV和HIV的风险。这些趋势 证明迫切需要针对日益增长的 年轻的PWID。迄今为止，还没有任何行为干预措施足以产生 PWID高危人群中HCV发病率显著降低。为了解决这一关键差距，我们的团队 开发了保持安全（Ssafe），这是一种创新的，基于力量的，社会行为的HCV预防干预措施 年轻的PWID Ssafe解决了多层次的“上游”风险的决定因素，发生在相对较早的 风险的因果链，包括生态社会条件、社会关系和风险状况，以及直接的 针对危险的注射行为Ssafe培训和激励PWID更好地管理药物使用， 避免促进危险注射的情况和做法（例如，“沉迷”毒品），并实施健康- 保护行为（例如，在注射网络中推广降低风险规范）。在初步研究中， 发现Ssafe是高度可接受的和可行的，具有强烈的疗效指征。在这项研究中，我们建议 进行随机对照试验，以评估Ssafe干预（使用移动的 在18岁以下人群中， 29岁（n=456）注射阿片类药物（海洛因和/或PO）并在以下时间检测HCV和HIV抗体阴性的患者 基线。我们假设Ssafe将显著降低注射风险行为和HCV感染 相对于时间和注意力匹配的控制干预。我们还将研究Ssafe的影响是否 （a）药物使用管理做法（注射频率、药物摄入、类阿片戒断发作）; (b)个人层面的行为改变机制（动机/自我效能、规划技能）;以及（c）关键 上游社会结构和网络层面的风险决定因素（社会支持，避免PWID的技能， 相关的耻辱，药物治疗和SEP利用，注射网络规模和风险标准）。拟议 这项试验有望显著提高我们在不断增长的年轻人中预防HCV感染的能力， PO启动的注射器。