Chronic Hepatitis Intervention Project for Drug Users

说明(由申请人提供)：注射吸毒者似乎特别容易感染艾滋病毒、乙肝病毒(乙肝病毒)和丙型肝炎病毒(丙型肝炎病毒)，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区别。在大多数城市，注射吸毒者中丙型肝炎病毒的流行率在60%到80%之间。注射吸毒者通过直接和间接共用注射设备以及通过无保护的性行为，感染所有三种病毒的风险都增加了。由于注射吸毒者的危险行为和感染状况的异质性，干预措施需要根据这些特点进行个性化调整。这项修订后的为期4.5年的基于社区的现场试验将840名未接受治疗的注射吸毒者纳入两组设计。更具体地说，它将比较针对艾滋病毒、丙型肝炎和乙肝病毒的标准化六节教育干预与六节激励干预的结果、成本和成本效益，激励干预包括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做的个性化风险评估和动机访谈。个人风险概况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艾滋病毒、丙型肝炎病毒和乙肝病毒检测结果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个月结果的影响。这项研究的具体目的是：目标1：从注射风险、性行为、饮酒以及与乙肝病毒和丙型肝炎相关的知识和认知方面，比较6节个性化动机干预和6节教育干预的有效性。目的2：评估6节个性化动机干预相对于6节教育干预的成本和成本-效果。这项拟议的研究建立在我们之前对未接受治疗的药物滥用者进行的个性化和激励性干预措施被证明是有效的基础上，以及对拟议干预措施的试点测试，该试验表明危险行为的短期变化。我们认为，这项拟议研究的意义在于，需要接触未接受治疗的注射吸毒者，以确定他们的艾滋病毒/乙肝/丙型肝炎血清状态，对他们进行有关每种疾病的教育，防止未感染的人新感染，并减缓已感染的人的疾病进展。我们相信，这项研究的创新之处在于它为每个注射吸毒者量身定做了针对艾滋病毒、丙型肝炎病毒和乙肝病毒检测结果的独特组合的个性化动机干预。

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.