Design and Feasibility of a Randomized Behavioral Intervention to Reduce Distributive Injection Risk and Improve Health-Care Access Among hepatitisC virus Positive Injection Drug Users: The Study to Reduce Intravenous Exposures (STRIVE)

Abstract

Hepatitis C virus (HCV) is hyperendemic among injection drug users (IDUs). However, few scientifically proven interventions to prevent secondary transmission of HCV from infected IDUs to others exist. This report describes the design, feasibility, and baseline characteristics of participants enrolled in the Study to Reduce Intravenous Exposure (STRIVE). STRIVE was a multisite, randomized-control trial to test a behavioral intervention developed to reduce distribution of used injection equipment (needles, cookers, cottons, and rinse water) and increase health-care utilization among antibody HCV (anti-HCV) positive IDUs. STRIVE enrolled anti-HCV positive IDU in Baltimore, New York City, and Seattle; participants completed behavioral assessments and venipuncture for HIV, HCV-RNA, and liver function tests (LFTs) and were randomized to attend either a six-session, small-group, peer-mentoring intervention workshop or a timematched, attention-control condition. Follow-up visits were conducted at 3 and 6 months. At baseline, of the 630 HCV-positive IDUs enrolled (mean age of 26 years, 60% white, 76% male), 55% reported distributive needle sharing, whereas 74, 69, and 69% reported sharing cookers, cottons, and rinse water, respectively. Health-care access was low, with 41% reporting an emergency room as their main source of medical care. Among those enrolled, 66% (418/630) were randomized: 53% (222/418) and 47% (196/418) to the intervention and control conditions, respectively. Follow-up rates were 70 and 73% for the 3-and 6-month visits, respectively. As distributive sharing of used injection equipment was common while reports of receiving HCV care were low, these findings indicate an urgent need for HCV-related interventions with IDUs and demonstrate the acceptability and feasibility to do so.Kapadia is with the Guttmacher Institute,

Prevalence and Incidence of HCV Infection among Vietnam Heroin Users with Recent Onset of Injection

“…In examining this question prospectively in this study, we calculated time to seroconversion for each incident case using the interval between age at first injection and date of seroconversion. For IDUs injecting 4 years or less at baseline, the mean time to HCV seroconversion from onset of injecting was 1.2 years, earlier than detected in previously HCV studies 25,26 and indicating a significantly narrower window of opportunity for behavioral interventions for new heroin-using populations 27 . Three general arenas should be targeted for early intervention:…”

Traveling young injection drug users at high risk for acquisition and transmission of viral infections

“…Current methods for the prevention of viral infection in young IDU, such as HAV and HBV immunizations and behavioral interventions to reduce injecting and sexual risk, (Garfein et al, 2005;Kapadia et al, 2007) require multiple contacts over a defined period of time for optimal effectiveness. However, to minimize loss to follow up, the largest behavioral prevention trials with young IDU in the US to date excluded those young IDU who did not plan to stay in the town of recruitment for at least 12 months (Kapadia et al, 2007).…”

Health Consequences of Long-Term Injection Heroin Use Among Aging Mexican American Men

“…The tight-knit Mexican American communities and closed drug-using networks embedded in the Houston barrios may be protecting against the introduction of infectious agents such as HIV. Higher rates of HCV, HVB, and HIV in other studies of heroin users in California, New York, and other inner cities (Grebely et al, 2008; Hser et al, 2004; Kapadia et al, 2007) may be related not only to measurement variations, but also to the less isolated nature of those communities.…”