Integrated Treatment of Persons with Co-Occurring HCV and Alcohol Use/Abuse

背景：对于丙型肝炎（HCV）感染者，酒精使用对肝脏有直接的负面影响，增加肝纤维化和肝细胞癌的风险和进展，可导致肝衰竭和死亡。很少有研究系统地检查了解决丙型肝炎病毒和酒精使用同时发生的有效方法。综合行为健康-医学模型已经证明在初级保健机构中酒精使用减少，但很少在丙型肝炎专科护理机构中进行测试。非洲裔美国人HCV患者的综合模型数据缺乏。医疗服务提供者需要有关有效治疗hcv感染患者所出现的各种饮酒问题的数据。目的：本R21的目的是测试实施一种有希望的综合治疗模式的可行性，该模式在艾滋病毒和问题饮酒人群中进行了测试，并在丙型肝炎病毒和问题饮酒人群中进行了测试，范围从危险消费到有害饮酒。本R21提案将审查a)将为使用酒精的艾滋病毒人群设计的综合干预措施适用于丙型肝炎病毒人群的可行性；b)该干预措施对参与酒精治疗、酒精使用变化和参与HCV医疗保健的影响；c)与本样本结果相关的因素。研究设计：60名参与者将接受HCV医学诊所提供的酒精-HCV综合治疗模型。结果变量将在干预前、干预中和干预后进行评估。如果成功实施并取得积极的结果趋势，本研究的结果将用于准备R01提案，该提案将采用随机对照试验（RCT）设计来测试集成模型的有效性。意义：本研究的结果将作为全面随机对照试验的基础，以测试HCV患者群体综合服务模式的有效性。有一些重要的领域，这一研究旨在解决。首先，本研究将检验一种综合方法的效用，以提高丙型肝炎病毒和一系列饮酒问题患者参与酒精治疗的程度。其次，研究结果可以帮助确定在许多类似疾病状态下整合护理的原则。最后，这项研究可能会大大提高对影响患者参与的环境因素的理解，以及对这一高危人群的其他关键结果的理解。

DESCRIPTION (provided by applicant): BACKGROUND: For those infected with hepatitis C (HCV), alcohol use has a direct negative impact on the liver, increasing the risk and progression of liver fibrosis and hepatocellular carcinoma, which can lead to liver failure and death. Few studies have systematically examined effective approaches to address co-occurring HCV and alcohol use. Integrated Behavioral Health-Medical models have demonstrated decreases in alcohol use in primary care settings, but have rarely been tested in HCV specialty care settings. Data on integrated models for African American patients with HCV are lacking. Medical providers need data on effective treatments for the spectrum of problem drinking with which their HCV-infected patients present. AIMS: The objective of this R21 is to test the feasibility of implementing a promising integrated treatment model tested among persons with HIV and problem drinking to persons with HCV and problem drinking ranging from hazardous consumption to harmful alcohol use. This R21 proposal will examine a) the feasibility of adapting an integrated intervention designed for alcohol-using HIV populations to an HCV population; b) the impact of this intervention on participation in alcohol treatment, changes in alcohol use, and participation in HCV medical care; and c) the factors associated with outcomes in this sample. RESEARCH DESIGN: Sixty participants will receive the Integrated Alcohol-HCV treatment model provided at an HCV medical clinic. Outcome variables will be assessed pre-, during, and post-intervention. If successfully implemented with positive outcome trends, the results from this study will be used to prepare an R01 proposal that will employ a Randomized Controlled Trial (RCT) design to test the integrated model's effectiveness. SIGNIFICANCE: Results from this study will serve as the foundation for a full-scale RCT to test the effectiveness of an integrated service model with HCV patient populations. There are a number of important areas which this research is designed to address. First, this study will examine the utility of an integrated approach to enhance participation in alcohol treatment for persons with co-occurring HCV and a range of problem drinking. Second, the results could help define principles for integrating care across a number of similar disease states. Finally, this study may lead to greatly enhanced understanding of the contextual factors that impact on patient participation as well as other critical outcomes in this at-risk population.