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)
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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 time-matched, 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.
KeywordsBehavioral intervention Health-care utilization hepatitis C virus Injection drug user Randomized trial
The authors gratefully acknowledge the investigators, staff, and participants of the STRIVE project for their total commitment to the success of this project. Additionally, we thank David Purcell from the U.S. Centers for Disease Control for consulting on study design and the investigators of the DUIT study for generously sharing the DUIT study protocol and instruments.
The STRIVE group includes the following individuals:
Steffanie A. Strathdee, Elizabeth T. Golub, David Thomas, Marie Bailey-Kloch, Yvette Bowser, Peter O’Driscoll, Janet Reeves, Marcella Sapun, Dale Netski, McCay Moiforay, Fleesie Hubbard, Coralee Meslin, Karen Yen-Hobelmann, Marie Bailey-Kloch, Eddie Poole, David Hudson, Gina Gant, Eric Hendren from Johns Hopkins University, Baltimore, MD; Mary Latka, Farzana Kapadia, David Vlahov, Danielle Ompad, Micaela Coady, Sebastian Bonner, Joanna Cruz, Sandra DelVecchio, Dirk Jackson, Gregory Malave, Joan Monserrate, Clarisse Miller O’Shea, Manny Yonko from The New York Academy of Medicine, New York, NY; Holly Hagan, Jennifer V. Campbell, Eileen Hough, Hanne Thiede, Rong Lee, Susan Nelson, Jef St. De Lore, Kimberly Houk, Sarah Brooks, Carrie Shriver, Jeanette Frazier, Jean Pass, Paul Swenson from Seattle-King County Public Health, Seattle, WA; and Richard S. Garfein from the University of Califormia at San Diego, San Diego, CA.
Funding for this project was provided by the National Institute on Drug Abuse through grant DA14499. Trial registration: Study to Reduce Intravenous Exposures, NCT00391482, http://clinicaltrials.gov/ct/show/NCT00391482?order=1.
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