Increasing HCV Knowledge & Service Use in Drug Tx Pgms - Competing Continuation

Principal Investigator: Shiela M. Strauss, Ph.D.

Funding Source: National Institutes on Drug Abuse

Funding period: 7/1/2004 - 12/31/2008


Hepatitis C virus (HCV) is currently the most common blood-borne virus in the United States, especially among drug users. Because of the efficiency with which HCV is transmitted via multi-person use of contaminated injection equipment, injection drug users are at special risk for contracting the virus. Non-injection drug users, especially those who smoke crack cocaine or use cocaine intranasally, are also at increased risk for contracting HCV. Drug treatment programs are uniquely situated to educate, counsel, and test drug users for HCV and HIV/HCV co-infection, and facilitate their access to medical treatment. However, there are gaps in drug treatment programs' current provision of HCV services, and patients often don't use the limited services that do exist. Because communication with staff can affect patients' health behaviors, staff's encouragement of the use of existing HCV services is essential. Few staff, however, know what to tell patients about HCV, how to help them deal with test results, and how to counsel them about medical treatment. The need is especially great when dealing with patients co-infected with HIV and HCV, whose medical management is significantly more complicated because of the dual infection. By addressing the expressed need of treatment staff for an evidence-based HCV and HCV/HIV training, this study will assess whether such a training can improve staff's HCV knowledge, attitudes, intentions and behaviors, and if so, whether it will lead to benefits to patients and the drug treatment organization. The Specific Aims are therefore:
(1) To develop a staff intervention that includes current information on HCV and HCV/HIV co-infection and training in how to best communicate with patients about HCV and HIV/HCV issues;
(2) To examine the intervention's impact over time on staff's knowledge about HCV and HIV/HCV co-infection and their attitudes, self-efficacy, intentions and behaviors to encourage their patients to use HCV services; and
(3) To examine the impact of the intervention over time on: (a) Patients' HCV and HIV/HCV co-infection knowledge, attitudes, intentions, and actual use of HCV services; and on (b) The drug treatment organization's intentions toward, and actual expansion of HCV services, as well as its climate toward dealing with HCV and HIV/HCV co-infection.

Methods: The study involves recruiting 24 drug treatment programs (12 methadone maintenance treatment programs and 12 drug-free programs) representing all 4 census regions in the U.S. (i.e., northeast, midwest, south, and west). NDRI training consultants will deliver the intervention at each site; 8 of the programs will serve as controls and receive the intervention after their data have been collected. To assess the immediate impact of the intervention, assessment instruments will be administered to staff immediately pre- and post-training. The impact of the intervention on staff and patients will also be examined one month and three months after the training is delivered, comparing HCV and HIV/HCV co-infection knowledge, attitudes, intentions, and behaviors regarding patients' HCV service use with baseline measures taken at the time of the staff training. Organizational level data will also be obtained in order to assess changes in HCV service provision and utilization in the pre- and post-staff training periods. Qualitative data will be collected one month post-training to provide a more in-depth understanding of the implementation of the intervention and its impact on patients, staff, and the organization. The qualitative component will include one-on-one interviews with the program director and several staff and patients, as well as focus groups with staff and patients. Analyses will examine both within program differences in staff, patient and organizational outcome measures, and differences in outcomes between programs in the intervention and control conditions.
Dissemination and Applications: In its manualized form, successful components of the intervention will be disseminated to program managers and researchers at scientific and professional conferences, and through NDRI's website and Training Institute. Reports on the impact of the training will also be written, intended for publication in both scientific and professional journals. Through these and other channels, the project's intentions are to elevate consciousness about the need to properly respond to the HCV epidemic among drug users, to provide tools that staff in drug treatment programs can use in order to support their patients concerning HCV and HIV/HCV co-infection needs, and to assist advocates for HCV services in fostering the development of these services in drug treatment programs.