Reducing HCV/HIV risks comparing two interventions

描述(申请人提供)：背景：丙型肝炎病毒(丙型肝炎病毒)感染是目前我国注射吸毒者的主要健康威胁。迄今为止，很少有专门针对丙型肝炎病毒的干预措施，尽管许多干预努力针对的是人类免疫缺陷病毒(HIV)的传播。这两种疾病都是通过类似的注射相关行为传播的，特别是共用针头和其他用具。在这项应用中，我们建议测试两种被发现在减少艾滋病毒相关危险行为方面有效的干预措施。其中包括我们自1987年以来一直在丹佛使用的以个人为重点的街头外展干预，以及由卡尔·拉特金博士在巴尔的摩开发的以网络为导向的同伴教育干预。在这两种方法中，将招募一批注射吸毒者并对其进行培训，以在社区中担任丙型肝炎病毒/艾滋病毒预防专家。这些专家被称为“索引”对象，他们将被要求将其注入网络中的两名成员带到该项目中。个人干预将专注于改变指数参与者的行为，而同行干预将专注于为指数参与者提供必要的教育和技能，以改变他们的网络规范。该项目的目的是：1.比较同伴网络干预和个人重点干预在增加指数成员和网络成员对丙型肝炎病毒和艾滋病病毒的认识方面的有效性；2.比较两种干预方法在降低指数成员和网络成员的丙型肝炎病毒/艾滋病相关风险方面的有效性；以及3.比较两种干预方法在提高自我效能感方面的有效性，以减少指数成员和网络成员中的丙型肝炎病毒和艾滋病毒风险相关行为。总共750名注射吸毒者将被随机分配到两种干预措施中的一种。其中一半人将参加研究的同伴教育部门，另一半人将参加个人重点干预。将检查250个网络，同样是每个分支各占一半。指标受试者将引入两名网络成员参与研究。然后，索引成员将被随机分配到两个干预分支中的一个。如果在同伴教育部门，索引受试者将接受同伴教育干预，包括五个小组会议，重点是为期三周的同伴教育。还需要一个助推器课程。在基线、6个月和12个月时，将对两个分支机构的网络成员进行危险行为、自我效能和丙型肝炎病毒/艾滋病毒知识评估。在以个人为重点的ARM中，指数受试者将在三周的时间内接受五次个人风险降低会议。所有受试者在基线、6个月和12个月时都需要进行检测前和检测后的咨询。

DESCRIPTION (provided by applicant): Background: Hepatitis C virus (HCV) infection is currently a major health threat among injection drug users (IDUs) in this country. To date, few interventions have specifically targeted HCV, although a great many intervention efforts have targeted human immunodeficiency virus (HIV) transmission. Both of these diseases are transmitted by similar injection-related behaviors, specifically sharing needles and other paraphernalia. In this application we propose to test two interventions found to be effective in reducing HIV-related risk behaviors. These include an individually focused street outreach intervention we have been using in Denver since 1987, and a network oriented peer education intervention developed in Baltimore by Carl Latkin, Ph.D. In both approaches, a cohort of IDUs will be recruited and trained to serve as HCV/HIV prevention experts in the community. These experts, referred to as "index" subjects, will be asked to bring to the project two members of their injecting network. The individually focused intervention will focus on changing the index participants' behavior, while the peer intervention will focus on providing index participants with the education and skills necessary to change the norms of their network. The aims of the project are: 1. To compare the effectiveness of a peer network intervention vs. an individually focused intervention in increasing knowledge about HCV and HIV among both index and network members; 2. To compare the two intervention approaches on both index and network members in reducing HCV/HIV-related risks; and 3. To compare the effectiveness of the two interventions in increasing self-efficacy to reduce HCV and HIV risk-related behaviors among index and network members. A total of 750 IDUs will be randomly assigned to one of the two interventions. Half of these will participate in the peer education arm of the study and half will participate in the individually focused intervention. Two hundred and fifty networks will be examined, again with half in each arm. Index subjects will bring in two network members to participate in the study. Index members will then be randomly assigned to one of the two intervention arms. If in the peer education arm, index subjects will undergo the peer education intervention, consisting of five group sessions focusing on peer education over a period of three weeks. A booster session will also be required. Network members in both arms will be assessed for risk behaviors, self-efficacy, and HCV/HIV knowledge at baseline, six months and 12 months. In the individually- focused arm, index subjects will undergo five individual risk reduction sessions over three weeks time. HCV and HIV pre- and post-test counseling will be required of all subjects at baseline, six months and 12 months.