The Staying Safe Intervention: Preventing HCV among Young Opioid Injectors

项目摘要/摘要 丙型肝炎病毒感染是美国最常见的慢性血液传播感染，绝大多数 在注射吸毒者中发生新的丙型肝炎病毒感染(PWID)。共用注射器和其他注射剂 设备是丙型肝炎病毒传播的主要危险因素。丙型肝炎病毒在美国大部分地区的流行率极高。 PWID人群(通常在~40-70%之间)。研究表明，年轻的PWID(30岁以下)参与 风险注射比率特别高，丙型肝炎发病率最高的是在 个人的注射职业。这一公共卫生问题的国家意义因最近的 处方阿片类药物(PO)在青年中的滥用流行，已演变为广泛使用海洛因和 注射吸毒，造就了新一代有感染丙型肝炎病毒和艾滋病毒风险的年轻注射者。这些趋势 展示迫切需要创新的新方法来预防丙型肝炎 年轻的PWID人口。到目前为止，还没有任何行为干预足够有效地产生 PWID高危人群的丙型肝炎发病率显著降低。为了解决这一关键差距，我们的团队 开发了持续安全(SSafe)，这是一种创新的、基于力量的社会行为丙型肝炎预防干预措施 对于年轻的PWID来说。SSAFE解决了风险的多层次“上游”决定因素， 风险因果链，除直接风险外，还包括生态社会条件、社会关系和风险状况 瞄准有风险的注射做法。SSAFE培训和激励PWID更好地管理药物使用，以便 避免促进危险注射的情况和做法(例如，对药物的“狂热”)，并实施健康- 保护性行为(例如，促进注射网络中的降低风险规范)。在初步研究中，我们 发现SSAFE具有很高的可接受性和可行性，具有很强的疗效迹象。在这项研究中，我们建议 进行随机对照试验以评估SSAFE干预措施的有效性(使用移动电话 手机递送的助推器应用程序)在18-18岁的人群中降低与注射相关的危险行为和丙型肝炎病毒发病率 29岁(n=456)注射阿片类药物(海洛因和/或POS)并在 基线。我们假设SSAFE将显著减少注射危险行为和丙型肝炎病毒感染 相对于时间和注意力匹配的对照干预。我们还将检查SAFE的影响是否 (A)药物使用管理做法(注射频率、药物摄入量、阿片类药物戒断事件)； (B)个人层面的行为改变机制(动机/自我效能、规划技能)；和(C)关键 上游社会结构和网络层面的风险决定因素(社会支持、避免PWID的技能- 相关的污名、药物治疗和SEP利用、注射网络规模和风险规范)。建议数 试验承诺显著提高我们在不断增长的年轻人口中预防丙型肝炎病毒感染的能力， PO启动的喷油器。

Project Summary/Abstract HCV infection is the most common chronic blood-borne infection in the U.S., with the overwhelming majority of new HCV infections occurring among people who inject drugs (PWID). Sharing syringes and other injection equipment is the primary risk factor for HCV transmission. HCV prevalence is extremely high in most U.S. PWID populations (typically ranging from ~40-70%). Research shows that young PWID (under age 30) engage in particularly high rates of risky injection, and that HCV incidence is highest in the first 3-5 years of an individual's injection career. The national significance of this public health problem is heightened by the recent epidemic of prescription opioid (PO) misuse in youth which has evolved into widespread heroin use and injection drug use, creating a new generation of young injectors at risk for HCV and HIV. These trends demonstrate the urgent need for innovative new approaches to HCV prevention tailored to the growing population of young PWID. To date, no behavioral intervention has been sufficiently potent to produce significant reductions in HCV incidence in at-risk groups of PWID. To address this critical gap, our team developed Staying Safe (Ssafe), an innovative, strengths-based, socio-behavioral HCV prevention intervention for young PWID. Ssafe addresses multi-level “upstream” determinants of risk that occur relatively early in the causal chain of risk, including eco-social conditions, social relations and risk situations, in addition to directly targeting risky injection practices. Ssafe trains and motivates PWID to better manage drug use in order to avoid situations and practices that promote risky injection (e.g., “binging” on drugs), and to implement health- protective behaviors (e.g., promoting risk-reduction norms in injection networks). In preliminary research we found Ssafe to be highly acceptable and feasible, with strong indications of efficacy. In this study we propose to conduct a randomized, controlled trial to assess the effectiveness of the Ssafe intervention (with a mobile phone-delivered booster application) in reducing injection-related risk behavior and HCV incidence among 18- 29 year-olds (n=456) who inject opioids (heroin and/or POs) and test HCV and HIV antibody-negative at baseline. We hypothesize that Ssafe will significantly reduce injection risk behaviors and HCV infections relative to a time- and attention-matched control intervention. We will also examine whether Ssafe's effects are mediated by (a) drug use management practices (injection frequency, drug intake, opioid withdrawal episodes); (b) individual-level mechanisms of behavior change (motivation/self-efficacy, planning skills); and (c) key upstream socio-structural and network-level determinants of risk (social support, skills to avoid PWID- associated stigma, drug treatment and SEP utilization, injection network size and risk norms). The proposed trial promises to significantly advance our ability to prevent HCV infection in the growing population of young, PO-initiated injectors.