Computerized Tailored Interventions to Enhance Prevention and Screening for Hepatitis C Virus Among People Who Inject Drugs: Protocol for a Randomized Pilot Study

Ryan P Westergaard, Shawnika J Hull, Alana Merkow, Laura K Stephens, Karli R Hochstatter, Heidi K Olson-Streed, Lisa M Baker, Timothy M Hess, Ryan P Westergaard, Shawnika J Hull, Alana Merkow, Laura K Stephens, Karli R Hochstatter, Heidi K Olson-Streed, Lisa M Baker, Timothy M Hess

Abstract

Background: Hepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed.

Objective: The goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program.

Methods: This 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network-based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion.

Results: Recruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV.

Conclusions: This study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors.

Trial registration: ClinicalTrials.gov NCT02474043; https://ichgcp.net/clinical-trials-registry/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J).

Keywords: health behavior; hepatitis C; needle exchange programs; substance abuse, intravenous.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The Integrative Model (adapted from Fishbein [24]).
Figure 2
Figure 2
Assessment of readiness to change based on the Transtheoretical Model.
Figure 3
Figure 3
Network diagram of peer referral chains by hepatitis C virus testing history.

References

    1. Barocas JA, Brennan MB, Hull SJ, Stokes S, Fangman JJ, Westergaard RP. Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study. Harm Reduct J. 2014;11:1. doi: 10.1186/1477-7517-11-1.
    1. Peng M. Comparative Effectiveness of Social Networks Strategies Versus Standard Counseling, Testing, and Referral for HIV Screening in a State-Wide Testing Program. IDWeek 2014; 10/09/2014; Philadelphia PA. 2014.
    1. Centers for Disease Control and Prevention Notes from the field: hepatitis C virus infections among young adults--rural Wisconsin, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(19):358.
    1. Centers for Disease Control and Prevention Notes from the field: risk factors for hepatitis C virus infections among young adults--Massachusetts, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(42):1457–1458.
    1. Conrad C, Bradley HM, Broz D, Buddha S, Chapman EL, Galang RR, Hillman D, Hon J, Hoover KW, Patel MR, Perez A, Peters PJ, Pontones P, Roseberry JC, Sandoval M, Shields J, Walthall J, Waterhouse D, Weidle PJ, Wu H, Duwve JM, Centers for Disease Control and Prevention Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone--Indiana, 2015. MMWR Morb Mortal Wkly Rep. 2015 May 1;64(16):443–444.
    1. Zibbell JE, Iqbal K, Patel RC, Suryaprasad A, Sanders KJ, Moore-Moravian L, Serrecchia J, Blankenship S, Ward JW, Holtzman D, Centers for Disease Control and Prevention Increases in hepatitis C virus infection related to injection drug use among persons aged 30 years and younger--Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. MMWR Morb Mortal Wkly Rep. 2015 May 8;64(17):453–458.
    1. Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo C, Jewett A, Baack B, Rein DB, Patel N, Alter M, Yartel A, Ward JW, Centers for Disease Control and Prevention Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012 Aug 17;61(RR-4):1–32.
    1. Hagan H, Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. Am J Public Health. 1995 Nov;85(11):1531–1537.
    1. Vlahov D, Junge B, Brookmeyer R, Cohn S, Riley E, Armenian H, Beilenson P. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Dec 15;16(5):400–406.
    1. Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS. 1998;12 Suppl A:S217–S230.
    1. Strathdee S. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11(8):59–65.
    1. Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011 Jul 1;204(1):74–83. doi: 10.1093/infdis/jir196.
    1. Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, Palmateer N, Doyle JS, Hellard ME, Hutchinson SJ. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014 Feb;43(1):235–248. doi: 10.1093/ije/dyt243.
    1. Centers for Disease Control and Prevention Syringe exchange programs--United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(45):1488–1491.
    1. Rudolph AE, Standish K, Amesty S, Crawford ND, Stern RJ, Badillo WE, Boyer A, Brown D, Ranger N, Orduna JMC, Lasenburg L, Lippek S, Fuller CM. A community-based approach to linking injection drug users with needed services through pharmacies: an evaluation of a pilot intervention in New York City. AIDS Educ Prev. 2010 Jun;22(3):238–251. doi: 10.1521/aeap.2010.22.3.238.
    1. Bingham C. Efficacy of a web-based, tailored, alcohol prevention/intervention program for college studentsmonth follow-up. J Drug Educ. 2011;41(4):3–30.
    1. Agricola E, Pandolfi E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, Mastroiacovo P, Tozzi AE. A cohort study of a tailored web intervention for preconception care. BMC Med Inform Decis Mak. 2014;14:33. doi: 10.1186/1472-6947-14-33.
    1. Levesque DA, Johnson JL, Welch CA, Prochaska JM, Fernandez AC. Computer-tailored intervention for juvenile offenders. J Soc Work Pract Addict. 2012 Jan 1;12(4):391–411. doi: 10.1080/1533256X.2012.728107.
    1. Marsch LA, Grabinski MJ, Bickel WK, Desrosiers A, Guarino H, Muehlbach B, Solhkhah R, Taufique S, Acosta M. Computer-assisted HIV prevention for youth with substance use disorders. Subst Use Misuse. 2011;46(1):46–56. doi: 10.3109/10826084.2011.521088.
    1. Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010;51(3-4):214–21. doi: 10.1016/j.ypmed.2010.06.004.
    1. McCree DH, Millett G, Baytop C, Royal S, Ellen J, Halkitis PN, Kupprat SA, Gillen S. Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men. Am J Public Health. 2013 Oct;103(10):1851–6. doi: 10.2105/AJPH.2013.301260.
    1. Halkitis PN, Kupprat SA, McCree DH, Simons SM, Jabouin R, Hampton MC, Gillen S. Evaluation of the relative effectiveness of three HIV testing strategies targeting African American men who have sex with men (MSM) in New York City. Ann Behav Med. 2011 Dec;42(3):361–9. doi: 10.1007/s12160-011-9299-4.
    1. Kimbrough LW, Fisher HE, Jones KT, Johnson W, Thadiparthi S, Dooley S. Accessing social networks with high rates of undiagnosed HIV infection: The social networks demonstration project. Am J Public Health. 2009 Jun;99(6):1093–9. doi: 10.2105/AJPH.2008.139329.
    1. Fishbein M, Ajzen I. Belief, atitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley; 1975.
    1. Fishbein M. The role of theory in HIV prevention. AIDS Care. 2000 Jun;12(3):273–8. doi: 10.1080/09540120050042918.
    1. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991 Dec;50(2):179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Fishbein M, Ajzen I. Attitudes and voting behavior: An application of the theory of reasoned action. In: Stephenson GM, Davis JM, editors. Progress in Applied Social Psychology. London: Wiley; 1981.
    1. Montano DE, Kasprzyk D. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. In: Rimer BK, Glanz B, Viswantath K, editors. Health Behavior Health Education, 4th ed. San Francisco: Jossey-Bass; 2008.
    1. Albarracín D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001 Jan;127(1):142–61.
    1. Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001 Dec;40(Pt 4):471–99.
    1. Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychol Bull. 2006 Mar;132(2):249–68. doi: 10.1037/0033-2909.132.2.249.
    1. Yzer M. The integrative model of behavioral prediction as a tool for designing health messages. In: Cho H, editor. Health Communication Message Design: Theory and Practice. Los Angeles: Sage; 2012.
    1. Prochaska JO, Redding CA, Harlow LL, Rossi JS, Velicer WF. The transtheoretical model of change and HIV prevention: a review. Health Educ Q. 1994;21(4):471–86.
    1. Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011 Feb;67(2):143–54. doi: 10.1002/jclp.20758.
    1. Kurth A, Kuo I, Peterson J, Azikiwe N, Bazerman L, Cates A, Beckwith CG. Information and Communication Technology to Link Criminal Justice Reentrants to HIV Care in the Community. AIDS Res Treat. 2013;2013:547381. doi: 10.1155/2013/547381.
    1. Walters ST, Ondersma SJ, Ingersoll KS, Rodriguez M, Lerch J, Rossheim ME, Taxman FS. MAPIT: development of a web-based intervention targeting substance abuse treatment in the criminal justice system. J Subst Abuse Treat. 2014 Jan;46(1):60–5. doi: 10.1016/j.jsat.2013.07.003.
    1. Prochaska JO, Redding CA, Evers KE. The transtheoretical model and stages of change. In: Glanz K, Rimer BK, Viswantath K, editors. Health Behavior and Health Education: Theory, Research and Practice, 4th ed. San Francisco: Jossey-Bass; 2008. pp. 97–121.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj