Integrated Treatment of Persons with Co-Occurring HCV and Alcohol Use/Abuse

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DESCRIPTION (provided by applicant): BACKGROUND: For those infected with hepatitis C (HCV), alcohol use has a direct negative impact on the liver, increasing the risk and progression of liver fibrosis and hepatocellular carcinoma, which can lead to liver failure and death. Few studies have systematically examined effective approaches to address co-occurring HCV and alcohol use. Integrated Behavioral Health-Medical models have demonstrated decreases in alcohol use in primary care settings, but have rarely been tested in HCV specialty care settings. Data on integrated models for African American patients with HCV are lacking. Medical providers need data on effective treatments for the spectrum of problem drinking with which their HCV-infected patients present. AIMS: The objective of this R21 is to test the feasibility of implementing a promising integrated treatment model tested among persons with HIV and problem drinking to persons with HCV and problem drinking ranging from hazardous consumption to harmful alcohol use. This R21 proposal will examine a) the feasibility of adapting an integrated intervention designed for alcohol-using HIV populations to an HCV population; b) the impact of this intervention on participation in alcohol treatment, changes in alcohol use, and participation in HCV medical care; and c) the factors associated with outcomes in this sample. RESEARCH DESIGN: Sixty participants will receive the Integrated Alcohol-HCV treatment model provided at an HCV medical clinic. Outcome variables will be assessed pre-, during, and post-intervention. If successfully implemented with positive outcome trends, the results from this study will be used to prepare an R01 proposal that will employ a Randomized Controlled Trial (RCT) design to test the integrated model's effectiveness. SIGNIFICANCE: Results from this study will serve as the foundation for a full-scale RCT to test the effectiveness of an integrated service model with HCV patient populations. There are a number of important areas which this research is designed to address. First, this study will examine the utility of an integrated approach to enhance participation in alcohol treatment for persons with co-occurring HCV and a range of problem drinking. Second, the results could help define principles for integrating care across a number of similar disease states. Finally, this study may lead to greatly enhanced understanding of the contextual factors that impact on patient participation as well as other critical outcomes in this at-risk population.