Reducing HCV/HIV Risk Behaviors among Injection Drug Users in China

描述（由申请人提供）：根据中国卫生部统计，中国丙型肝炎病毒（HCV）感染的发病率逐年上升。世界卫生组织（WHO）估计，中国至少有2.5-4.9%的人口是HCV阳性。注射吸毒是丙型肝炎病毒传播的主要途径。中国注射吸毒者（IDUs）的HCV感染率很高，特别是在美沙酮维持治疗（MMT）中（例如，在许多省份超过80%）。由于具有许多共同特征，HIV和HCV合并感染是常见的。考虑到中国吸毒人数众多，丙型肝炎病毒/艾滋病毒在这一人群内外传播迅速，病毒临床进展时间长，感染成瘾者获得常规治疗的机会有限，丙型肝炎病毒/艾滋病毒是中国主要的健康负担之一。尽管中国注射吸毒者的HCV/HIV感染率很高，但现有的HCV/HIV干预/预防策略有限。MMT可以为解决HCV/ hiv患者相关问题提供一个有效的平台，但在中国，患者和服务提供者普遍缺乏对HCV/ hiv相关问题的了解。美国和其他国家已经开发了许多关于HCV/HIV的材料，但需要进行研究工作，将它们整合并适应中国的环境，并对教育计划进行实证测试，以确保它有效地减少HCV/HIV风险行为，并增加中国吸毒者中HCV/HIV相关服务。我们建议调查MMT诊所注射吸毒者和服务提供者的HCV/HIV知识、态度和观念，并进一步探讨影响HCV/HIV相关服务和医疗保健的障碍。基于这些发现以及在美国和其他国家开发的HCV/HIV相关材料，我们计划在MMT诊所为注射吸毒者和MMT工作人员开发和提供HCV/HIV教育项目，长期目标是开发干预措施和服务，有效预防和减少中国注射吸毒者中的HCV/HIV感染和相关风险行为。本项目拟在上海开展，主要目的如下：1)评估美沙酮维持治疗（MMT）注射吸毒者的HCV/HIV知识、态度、认知、风险行为和HCV/HIV感染情况；2)评估MMT工作人员的HCV/HIV知识、态度和认知；3)为客户和MMT工作人员调整、制定和实施HCV/HIV教育方案。次要目标是：4)探讨影响注射吸毒者接受HCV/ hiv相关干预和医疗服务的障碍；5)探讨促进服务提供者向MMT内注射吸毒者提供HCV/ hiv相关服务的途径。拟制定的计划和拟议研究中收集的数据将为制定建议的HCV/HIV综合干预计划奠定基础，这些建议将在未来的正式实验试验中进行测试。如果证明有效，该干预方案可以在中国和其他国家广泛应用，以减少HCV/HIV的危险行为和不良后果。

DESCRIPTION (provided by applicant): The incidence of hepatitis C virus (HCV) infection increases year by year in China according to Ministry of Health statistics of China. The World Health Organization (WHO) has estimated that at least 2.5-4.9% of China's population is HCV positive. Injection drug use is a main route of HCV transmission. The HCV infection among Chinese injection drug users (IDUs) is high, particularly among those in methadone maintenance treatment (MMT) (e.g., more than 80% in many provinces). Due to share many characteristics, co-infection with HIV and HCV is common. Considering the enormous number of drug users in China, rapid transmission of HCV/HIV among and beyond this population, long duration of clinical progression of the virus, and limited access of infected addicts to routine treatment, HCV/HIV is one of China's major health burdens. Despite the high rate of HCV/HIV infection among IDUs in China, limited HCV/HIV intervention/prevention strategies are available. MMT can provide an efficient platform to address HCV/HIV-related issues among patients, but there is generally a lack of knowledge in HCV/HIV-related issues among both patients and service providers in China. Many materials regarding HCVHIV have been developed in the United States and other countries, but research efforts are needed to integrate and adapt them in Chinese settings and to empirically test the educational program to ensure that it is effective to reduce HCV/HIV risk behaviors and increase HCV/HIV-related services among Chinese addicts. We propose to investigate HCV/HIV knowledge, attitudes, and perceptions among injection drug users and service providers in MMT clinics, and further explore the barriers that impact HCV/HIV-related services and medical care. Based on these findings and HCV/HIV-related materials that have been developed in the United States and other countries, we plan to develop and deliver HCV/HIV education programs to IDUs and MMT staff in MMT clinics, with the long-term goal of developing interventions and services that will be effective preventing and reducing HCV/HIV infection and related risk behaviors among IDUs in China. The proposed project, to be conducted in Shanghai, has the following primary aims: 1) To assess HCV/HIV knowledge, attitudes, perceptions, risk behaviors, and HCV/HIV infection among IDUs in methadone maintenance treatment (MMT), 2) To assess HCV/HIV knowledge, attitudes, and perceptions among MMT staff, and 3) To adapt, develop, and deliver HCV/HIV education programs for clients and MMT staff. Secondary aims are: 4) To explore the barriers that impact IDUs receiving HCV/HIV-related intervention and medical service; 5) To explore ways to facilitate service providers to provide HCV/HIV-related services to IDUs in MMT. The program to be developed and the data collected in the proposed study will establish a basis for developing recommendations of a comprehensive HCV/HIV intervention program to be tested in a future, formal experimental trial. If proven effective, the intervention program can be widely used in China and other countries to reduce HCV/HIV risk behaviors and adverse consequences. PUBLIC HEALTH RELEVANCE: The study is unique and important because HCV/HIV infection and co-infection are major problems, especially among injection drug users, but there is little known about HCV or HCV/HIV co-infection, including HCV/HIV knowledge level among injection drug users (IDUs) and current barriers and intervention strategies for IDUs in China. If HCV/HIV infection and related consequences cannot be treated efficiently, it will result in a much greater disease burden. The proposed study will investigate the knowledge level, attitudes, and perceptions among MMT staff and IDUs who attending MMT clinics, which is the most reachable population for HCV/HIV intervention in China. This study will also explore the barriers that prevent IDUs from getting HCV/HIV intervention/prevention and medical care services. This study will help to understand and address this important problem in China and other Asian countries.