Increasing HCV Knowledge & Service Use in Drug Tx Pgms

(修订摘要)描述：这是我们目前由NIDA资助的研究“药物治疗计划中的丙型肝炎病毒服务创新”的竞争延续申请。这是从患者、工作人员和药物治疗项目经理那里收集的数据的直接结果，他们报告说，向患者和工作人员提供的丙型肝炎病毒(丙型肝炎病毒)教育往往不足，丙型肝炎病毒服务严重未得到充分利用。这是特别不幸的，因为丙型肝炎病毒在吸毒者中的高流行率，特别是那些同时感染艾滋病毒的人，以及他们迫切需要关于丙型肝炎病毒的信息和服务。药物治疗计划的独特之处在于对吸毒者进行丙型肝炎病毒和艾滋病毒的教育、咨询和检测，并促进他们获得医疗服务。然而，药物治疗项目目前提供的丙型肝炎病毒服务存在缺口，患者往往不使用确实存在的有限服务。由于与工作人员的沟通会影响患者的健康行为，工作人员鼓励使用现有的丙型肝炎病毒服务是至关重要的。然而，很少有工作人员知道应该告诉患者什么关于丙型肝炎病毒，如何帮助他们处理检测结果，以及如何就医疗问题向他们提供咨询。在处理同时感染艾滋病毒和丙型肝炎病毒的患者时，这种需求尤其强烈，因为双重感染使他们的医疗管理明显更加复杂。通过解决治疗人员对基于证据的丙型肝炎病毒培训的表达需求，本研究将评估这种培训是否可以改善工作人员的丙型肝炎病毒和丙型肝炎病毒/艾滋病毒的知识、态度、意图和行为，如果是，它是否会给患者和药物治疗机构带来好处。因此，在社会认知理论和信息-动机-行为技能模型的指导下，具体目标是：(1)开发包括当前丙型肝炎病毒信息和如何最好地与患者沟通有关丙型肝炎病毒和艾滋病毒/丙型肝炎病毒混合感染问题的培训的工作人员干预措施；(2)考察随着时间的推移，干预措施对工作人员对丙型肝炎病毒和丙型肝炎病毒/艾滋病合并感染的知识的影响，以及他们鼓励患者使用丙型肝炎病毒服务的态度、自我效能、意图和行为；以及(3)检查干预对以下方面的影响：(A)患者对丙型肝炎病毒/艾滋病毒的知识、态度、意图和实际使用丙型肝炎病毒服务；以及(B)药物治疗机构对丙型肝炎病毒服务的意图和实际扩展，以及其应对丙型肝炎病毒和丙型肝炎病毒/艾滋病毒混合感染的氛围。干预措施将在美国四个人口普查地区的24个药物治疗项目中向工作人员提供，平均分配给无毒和美沙酮项目：16个项目将被随机分配到干预条件下，8个项目被分配给对照组(延迟干预)。在干预和控制条件计划中，将通过分析从主任、工作人员和患者那里收集的定性和定量数据来检验干预的有效性。培训的成功要素将以其手册形式传播到全国各地的方案中

(Revised Abstract) DESCRIPTION: This is a competing continuation application for our current NIDA-funded study, "HCV Service Innovations in Drug Treatment Programs." It is proposed as a direct result of data collected from patients, staff, and managers in drug treatment programs who report that the hepatitis C virus (HCV) education provided to patients and staff is often inadequate, and HCV services are seriously underutilized. This is especially unfortunate because of the high prevalence of HCV among drug users, especially those co-infected with HIV, and their pressing need for information about, and services for HCV. Drug treatment programs are uniquely situated to educate, counsel, and test drug users for HCV and HIV, and facilitate their access to medical treatment. However, there are gaps in drug treatment programs' current provision of HCV services, and patients often don't use the limited services that do exist. Because communication with staff can affect patients' health behaviors, staff's encouragement of the use of existing HCV services is essential. Few staff, however, know what to tell patients about HCV, how to help them deal with test results, and how to counsel them about medical treatment. The need is especially great when dealing with patients co-infected with HIV and HCV, whose medical management is significantly more complicated because of the dual infection. By addressing the expressed need of treatment staff for an evidence-based HCV training, this study will assess whether such a training can improve staff's HCV and HCV/HIV knowledge, attitudes, intentions and behaviors, and if so, whether it will lead to benefits to patients and the drug treatment organization. Guided by Social Cognitive Theory and the Information-Motivation-Behavioral Skills Model, the Specific Aims are therefore: (1) To develop a staff intervention that includes current HCV information and training in how to best communicate with patients about HCV and HIV/HCV co-infection issues; (2) To examine the intervention's impact over time on staff's knowledge about HCV and HCV/HIV co-infection, and their attitudes, self-efficacy, intentions and behaviors to encourage their patients to use HCV services; and (3) To examine the impact of the intervention over time on: (a) Patients' HCV/HIV knowledge, attitudes, intentions, and actual use of HCV services; and on (b) The drug treatment organization's intentions toward, and actual expansion of HCV services, as well as its climate toward dealing with HCV and HCV/HIV co-infection. The intervention will be delivered to staff in 24 drug treatment programs in the four U.S. census regions, equally divided among drug-free and methadone programs: 16 programs will be randomly assigned to an intervention condition, and 8 to a control group (delayed intervention). The intervention's effectiveness will be examined by analyzing qualitative and quantitative data collected from the director, staff, and patients in the intervention and control condition programs. In its manualized form, successful elements of the training will be disseminated to programs nationwide