Increasing HCV Knowledge & Service Use in Drug Tx Pgms

描述：这是我们目前nida资助的研究“药物治疗方案中的HCV服务创新”的竞争性延续申请。从药物治疗项目的患者、工作人员和管理人员那里收集的数据表明，向患者和工作人员提供的丙型肝炎病毒（HCV）教育往往不足，丙型肝炎病毒服务严重未得到充分利用。这尤其令人遗憾，因为吸毒者中丙型肝炎病毒的流行率很高，特别是那些合并感染艾滋病毒的人，他们迫切需要有关丙型肝炎病毒的信息和服务。药物治疗计划在教育、咨询和检测吸毒者的丙型肝炎病毒和艾滋病毒方面具有独特的地位，并促进他们获得医疗。然而，药物治疗项目目前提供的丙型肝炎病毒服务存在差距，患者往往不使用现有的有限服务。由于与工作人员的沟通可以影响患者的健康行为，因此工作人员鼓励使用现有的HCV服务至关重要。然而，很少有工作人员知道如何告诉患者有关丙型肝炎病毒的信息，如何帮助他们处理检测结果，以及如何向他们提供医疗建议。在处理同时感染艾滋病毒和丙型肝炎病毒的患者时，这种需求尤其大，因为双重感染使其医疗管理明显更加复杂。通过解决治疗人员对基于证据的HCV培训的明确需求，本研究将评估这种培训是否可以改善工作人员的HCV和HCV/HIV知识、态度、意图和行为，如果可以，是否会给患者和药物治疗组织带来好处。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)制定一项工作人员干预措施，包括当前HCV信息和培训，如何与患者就HCV和HIV/HCV合并感染问题进行最佳沟通；(2)调查干预措施对员工HCV和HCV/HIV合并感染知识的影响，以及他们鼓励患者使用HCV服务的态度、自我效能、意图和行为的影响；(3)考察长期干预对以下方面的影响：(a)患者的HCV/HIV知识、态度、意图和实际使用HCV服务的情况；(b)药物治疗组织对丙型肝炎病毒服务的意图和实际扩展，以及处理丙型肝炎病毒和丙型肝炎病毒/艾滋病毒合并感染的气氛。干预措施将提供给美国四个人口普查区24个药物治疗项目的工作人员，平均分为无毒和美沙酮项目：16个项目将被随机分配到干预条件下，8个项目被分配到对照组（延迟干预）。干预的有效性将通过分析在干预和控制条件项目中从主任、工作人员和患者那里收集的定性和定量数据来检验。培训的成功内容将以手册形式传播到全国各地的方案

(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