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

Abstract

BackgroundHepatitis 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.ObjectiveThe 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.MethodsThis 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.ResultsRecruitment 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.ConclusionsThis 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 RegistrationClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J)

Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort

“…As with primary HCV infection, a myriad of single and multicomponent prevention strategies have been suggested to reduce ongoing exposure [10]. These include provision of OAT and high-coverage needle-syringe programs (NSP) [34], as well as psychotherapy and peer-based drug cessation programs for stimulant use [35]. In our previous study, we have shown significant effect of OAT and psychotherapy in reducing risk of reinfection among PWIDs treated with interferon [20].…”

Promoting Safe Injection Practices, Substance Use Reduction, Hepatitis C Testing, and Overdose Prevention Among Syringe Service Program Clients Using a Computer-Tailored Intervention: Pilot Randomized Controlled Trial

“…Using the contact information provided at baseline, individuals were contacted 3 months later to complete the follow-up assessment. A protocol that describes in detail recruitment methods and intervention content and provides survey instruments and example content images of the Hep-Net intervention has been previously published [ 29 ].…”

“…Recognizing the growing demand for targeted, evidence-based interventions and the existing infrastructure of SSPs, a computer-tailored risk reduction intervention, called Hep-Net, was developed and implemented through a pilot randomized controlled trial (RCT) [ 29 ]. The objectives of this study are to evaluate whether incorporating a computerized behavioral intervention into existing prevention services at SSPs can lead to the adoption of healthier behaviors, including safer injection practices, substance use reduction, overdose prevention, and HCV testing.…”

Using database linkages to monitor the continuum of care for hepatitis C virus among syringe exchange clients: Experience from a pilot intervention

“…(Westergaard et al, 2016) Hep-Net was implemented in a community-based SEP that delivers prevention and testing services across Wisconsin through 10 statewide fixed sites as well as a mobile program. SEP staff enrolled 235 adults reporting past-month injection drug use into Hep-Net, and delivered a 2 session, computerized behavioral intervention aimed at promoting safer injecting behavior, linkage to addiction treatment, and HIV/HCV testing.…”

“…These programs often have established rapport and have earned the trust of target populations based on years of providing non-judgmental services. (Westergaard et al, 2016) Rapid screening for HCV is feasible and acceptable in SEPs (Barocas et al, 2014), and program staff is often knowledgeable and experienced in referring clients to other needed services. These features provide an opportunity to interface with difficult-to-reach populations that are both under-served and under-studied.…”