An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs

Gilchrist, Gail; Tirado-Muñoz, Judit; Taylor, Avril; Fischer, Gabriele; Moskalewicz, Jacek; Köchl, Birgit; Giammarchi, Cinzia; Dąbrowska, Katarzyna; Shaw, April; Munro, Alison; Furia, Lucia Di; Torrens, Marta

doi:10.1080/09687637.2016.1197885

Cited by 4 publications

(3 citation statements)

References 70 publications

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“…Participants were also asked to consent to researchers liaising with the service from which they were recruited, should it not have been possible to contact them through details provided. This method had been successfully used in the Reducing hepatitis C sexual and drug taking risk behaviours among female drug users in Europe (REDUCE): translating evidence into practice study 237 to improve engagement and retention in research studies. In cases where participants did not show up three or more times for their follow-up research appointment, telephone follow-up interviews were offered.…”

Section: Consent Proceduresmentioning

confidence: 99%

“…Based on previous studies, retention was estimated around 60-88% at the 1-month follow-up (77-113 participants). 188,197,237 Approvals obtained …”

Section: Sample Sizementioning

confidence: 99%

“…These statements were a reduced version of the HCV Transmission Knowledge Questionnaire used in the Reducing Hepatitis C Sexual and Drug Taking Risk Behaviours Among Female Drug Users in Europe (REDUCE): Translating Evidence into Practice study, 237 adapted from Balfour et al 240 and updated to include gender-specific questions and questions that incorporated recent advances in sexual and vertical transmission. 4 Two questions were considered ambiguous and responses did not count towards the total.…”

Section: Hepatitis C Virus Transmission Knowledgementioning

confidence: 99%

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Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

Gilchrist

Swan

Shaw

et al. 2017

Health Technol Assess

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Background Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. Objectives To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. Design A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. Setting NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. Participants Current PWID, aged ≥ 18 years. Interventions A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus treatment as usual (TAU) (intervention), or information booklet plus TAU (control). Main outcome measures Recruitment, retention and follow-up rates measured feasibility. Feedback questionnaires, focus groups with participants who attended at least one intervention session and facilitators assessed the intervention’s acceptability. Results A systematic review of what works to reduce BBV risk behaviours among PWID; in-depth interviews with PWID; and stakeholder and expert consultation informed the intervention. Sessions covered improving injecting technique and good vein care; planning for risky situations; and understanding BBV transmission. Fifty-six per cent (99/176) of eligible PWID were randomised: 52 to the intervention group and 47 to the control group. Only 24% (8/34) of male and 11% (2/18) of female participants attended all three intervention sessions. Overall, 50% (17/34) of men and 33% (6/18) of women randomised to the intervention group and 47% (14/30) of men and 53% (9/17) of women randomised to the control group were followed up 1 month post intervention. Variations were reported by location. The intervention was acceptable to both participants and facilitators. At 1 month post intervention, no increase in injecting in ‘risky’ sites (e.g. groin, neck) was reported by participants who attended at least one session. PWID who attended at least one session showed a trend towards greater reduction in injecting risk behaviours, a greater increase in withdrawal planning and were more confident about finding a vein. A mean cost of £58.17 per participant was calculated for those attending one session, £148.54 for those attending two sessions and £270.67 for those attending all three sessions, compared with £0.86 in the control group. Treatment costs across the centres vary as a result of the different levels of attendance, as total session costs are divided by attendees to obtain a cost per attendee. The economic analysis suggests that a cost-effectiveness study would be feasible given the response rates and completeness of data. However, we have identified aspects where the service use questionnaire could be abbreviated given the low numbers reported in several care domains. No adverse events were reported. Conclusions As only 19% of participants attended all three intervention sessions and 47% were followed up 1 month post intervention, a future definitive randomised controlled trial of the intervention is not feasible. Exposure to information on improving injecting techniques did not encourage riskier injecting practices or injecting frequency, and benefits were reported among attendees. The intervention has the potential to positively influence BBV prevention. Harm reduction services should ensure that the intervention content is routinely delivered to PWID to improve vein care and prevent BBVs. Future work The intervention did not meet the complex needs of some PWID, more tailoring may be needed to reach PWID who are more frequent injectors, who are homeless and female. Limitations Intervention delivery proved more feasible in London than other locations. Non-attendance at the York trial site substantially influenced the results. Trial registration Current Controlled Trials ISRCTN66453696 and PROSPERO 014:CRD42014012969. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 72. See the NIHR Journals Library website for further project information.

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Section: Consent Proceduresmentioning

confidence: 99%

“…Based on previous studies, retention was estimated around 60-88% at the 1-month follow-up (77-113 participants). 188,197,237 Approvals obtained …”

Section: Sample Sizementioning

confidence: 99%

Section: Hepatitis C Virus Transmission Knowledgementioning

confidence: 99%

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Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

Gilchrist

Swan

Shaw

et al. 2017

Health Technol Assess

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Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study

Tirado-Muñoz

Gilchrist

Fischer

et al. 2017

Arch Womens Ment Health

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Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychiatric disorder than those recruited from harm reduction services, specifically dysthymia (OR 5.32 95% CI 2.27-12.48; p = 0.000) and post-traumatic stress disorder (OR 1.83 95% CI 1.02-3.27; p = 0.040). WWID who reported sharing needles and syringes were almost three times as likely to meet criteria for lifetime psychiatric comorbidity than those who did not (OR 2.65 95% CI 1.07-6.56). Compared to WWID who had not experienced IPV, victims (70%) were almost two times more likely to meet criteria for post-traumatic stress disorder (OR 1.95 95% CI 1.10-3.48). Psychiatric comorbidity and IPV among WWID are common. Drug treatment and harm reduction services should address psychiatric comorbidity and IPV to improve treatment outcomes.

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Hepatitis C infection and psychiatric burden in two imprisoned cohorts: Young offenders and opioid-maintained prisoners

et al. 2018

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An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs

Cited by 4 publications

References 70 publications

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: a cross-sectional study

Hepatitis C infection and psychiatric burden in two imprisoned cohorts: Young offenders and opioid-maintained prisoners

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