Chronic Hepatitis Intervention Project for Drug Users

描述（由申请人提供）：注射吸毒者似乎对艾滋病毒、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染具有特别高的风险，这表明需要采取干预措施，同时解决这些问题，同时澄清它们之间的差异。在大多数城市，注射吸毒者中丙型肝炎病毒的流行率为60%至80%。注射毒品使用者通过直接和间接共用注射器具以及通过无保护的性行为感染这三种病毒的风险增加。由于注射吸毒者的风险行为和感染状况存在异质性，干预措施需要根据这些特征进行个性化调整。这项修订后的4.5年社区现场试验将纳入840名治疗外注射吸毒者，分为两组设计。更具体地说，它将比较针对HIV、HCV和HBV的标准化六期教育干预的结果、成本和成本效益，与针对每个参与者的变化阶段、性别、个人风险概况和血清状态量身定制的个性化风险评估和动机访谈的六期动机干预的结果、成本和成本效益。个人风险概况将由计算机根据评估数据生成。计算机也将被编程，以提供特定的干预提示卡/幻灯片，以响应每个参与者的HIV、HCV和HBV检测结果的独特概况。将对假设进行检验，以确定干预对6个月和12个月结果的影响。目的1：比较6期个性化动机干预与6期教育干预在注射风险、性行为、酒精使用以及与HBV和HCV相关的知识和认知方面的有效性。目的2：评估6期个性化动机干预相对于6期教育干预的成本和成本效益。这项研究是建立在个性化和动机干预的基础上的，这些干预在我们之前对治疗外药物滥用者的研究中被证明是有效的，并且提出的干预的试点测试证明了风险行为的短期改变。我们认为，拟议研究的意义在于需要接触未治疗的注射吸毒者，以确定他们的HIV/HBV/HCV血清状态，教育他们了解每种疾病，预防未感染者的新感染，并减缓已感染者的疾病进展。我们认为，该研究的创新之处在于其个性化的动机干预，针对每个idu的HIV、HCV和HBV检测结果的独特组合量身定制。

DESCRIPTION (provided by applicant): IDUs appear to be at particular high risk for HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections, suggesting the need for an intervention that addresses them simultaneously while clarifying how they differ. The prevalence of HCV among IDUs ranges from 60% to 80% in most cities. Injecting drug users are at increased risk of all three viral infections through the direct and indirect sharing of injection equipment and through unprotected sexual behavior. Due to the heterogeneity in risk behaviors and infection status among IDUs, interventions need to be personalized by tailoring them to these characteristics. This revised 4.5-year community- based field experiment will enroll 840 out-of-treatment IDUs into a two-group design. More specifically, it will compare the outcomes, cost, and cost-effectiveness of a standardized six-session educational intervention that addresses HIV, HCV, and HBV to those of a six-session motivational intervention that includes a personalized risk assessment and motivational interviewing tailored to each participant's stage of change, gender, personal risk profile, and serostatus. The personal risk profile will be computer generated from assessment data. The computer will also be programmed to present specific intervention cue-cards/slides in response to each participant's unique profile of HIV, HCV, and HBV test results. Hypotheses will be tested to determine intervention impact on the 6- and 12-month outcomes. The specific aims of the proposed study are: Aim 1: To compare the effectiveness of a 6-session personalized motivational intervention to a 6-session educational intervention in terms of injection risk, sexual behavior, alcohol use and knowledge and perception related to HBV and HCV. Aim 2: To estimate the cost and cost-effectiveness of a 6-session personalized motivational intervention relative to a 6-session educational intervention. This proposed study builds upon the personalized and motivational interventions shown to be effective in our previous studies with out-of-treatment substance abusers, and the pilot test of the proposed intervention that demonstrated short-term change in risk behaviors. We believe the significance of the proposed study arises from the need to reach out-of-treatment IDUs to determine their HIV/HBV/HCV serostatus, educate them on each disease, prevent new infections among those who are not infected, and slow disease progression among those already infected. We believe the innovation of the proposed study lies in its personalized motivational intervention tailored to each IDUs unique combination of HIV, HCV, and HBV test results.