Chronic Hepatitis Intervention Project for Drug Users

描述（由申请方提供）：注射吸毒者感染HIV、B型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的风险似乎特别高，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HCV的流行率为60%至80%。注射吸毒者通过直接和间接共用注射设备和通过无保护的性行为，感染所有三种病毒的风险增加。由于注射吸毒者的危险行为和感染状况的异质性，干预措施需要个性化，使其适应这些特点。这项修订后的4.5年基于社区的田间试验将招募840名未接受治疗的注射吸毒者进入两组设计。更具体地说，它将比较结果，成本和成本效益的标准化六届教育干预，解决艾滋病毒，丙型肝炎病毒和乙型肝炎病毒的六届动机干预，包括个性化的风险评估和动机访谈量身定制每个参与者的变化阶段，性别，个人风险状况和血清状态。个人风险简介将由计算机根据评估数据生成。计算机还将被编程为根据每个参与者独特的HIV、HCV和HBV检测结果的概况呈现特定的干预提示卡/幻灯片。将对假设进行检验，以确定干预对6个月和12个月结局的影响。拟议研究的具体目的是：目的1：比较6次个性化动机干预与6次教育干预在注射风险、性行为、酒精使用以及HBV和HCV相关知识和认知方面的有效性。目标二：评估6次个性化动机干预相对于6次教育干预的成本和成本效益。这项拟议的研究建立在个性化和激励性干预措施的基础上，这些干预措施在我们以前对治疗外药物滥用者的研究中显示出有效性，并且对拟议的干预措施进行了试点测试，证明了风险行为的短期变化。我们认为，拟议研究的重要性来自于需要接触治疗外的注射吸毒者，以确定他们的HIV/HBV/HCV血清状态，对他们进行每种疾病的教育，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，拟议研究的创新在于其个性化的动机干预，针对每个注射吸毒者独特的HIV，HCV和HBV检测结果的组合。

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.