文章基本信息

标题：Effects of a Hepatitis C Virus Educational Intervention or a Motivational Intervention on Alcohol Use, Injection Drug Use, and Sexual Risk Behaviors Among Injection Drug Users
本地全文：下载
作者：William A. Zule ; Elizabeth C. Costenbader ; Curtis M. Coomes 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：Suppl 1
页码：S180-S186
DOI：10.2105/AJPH.2007.126854
语种：English
出版社：American Public Health Association
摘要：Objectives. We compared the effects of 2 interventions on alcohol use, use of a new syringe at last injection, and condom use at last sexual encounter in a community sample of injection drug users. Methods. Between 2003 and 2006, 851 out-of-treatment injection drug users were recruited in Raleigh, NC, and Durham, NC, through street outreach and were randomly assigned to either a 6-session educational intervention or a 6-session motivational intervention. Intervention effects were examined at 6 and 12 months after enrollment. Results. In multiple logistic regression analyses adjusted for baseline alcohol use and HCV status, participants assigned to the motivational intervention were significantly less likely than were participants in the educational intervention to be drinking at the 6-month follow-up (odds ratio = 0.67; 95% confidence interval = 0.46, 0.97). There were no significant between-group differences in use of a new syringe at last injection or condom use at last sexual encounter at either follow-up. Conclusions. Reducing alcohol use among persons with HCV may slow disease progression and provide important health benefits. Additional strategies are needed for slowing HCV disease progression until more effective HCV treatments are available. HCV is the most prevalent bloodborne infection in the United States; an estimated 3.2 to 3.5 million persons are chronically infected.^{1 , 2} Although the incidence of HCV has decreased since the early 1990s, prevalence remains high because of the slow progression of the disease.³ HCV currently accounts for an estimated 8000 to 12 000 deaths annually, and that number is predicted to grow substantially as persons are infected longer.⁴ HCV-related liver disease is projected to cause 165 900 deaths in the United States from 2010 to 2019. An additional 27 200 deaths caused by HCV-related hepatocellular carcinoma are projected during the same period.² HCV is a particular problem among injection drug users (IDUs). The prevalence in this group ranges from 50% to 90%,^{5 , 6} and incidence rates range from 13% to 47% per year.^{7 – 9} Although HCV incidence among IDUs has declined, 50% of new HCV infections still occur in this risk group.¹⁰ Clearly, more-effective interventions are needed to reduce incidence among HCV-negative IDUs, but simultaneously, increased efforts are also needed to identify and treat HCV-positive IDUs.^{5 , 11 , 12} Current treatment options, however, have several drawbacks: they produce a sustained response in only 50% of patients, have severe side effects, and are expensive.^{13 , 14} Furthermore, many persons infected with HCV may not even need treatment, and those who do may be either unwilling or unable to access it.^{15 – 18} In light of the limitations of current treatment options, it seems clear that a priority for public health workers should be the development of behavioral interventions to slow disease progression among infected individuals. One obvious behavioral target for these interventions is reducing or eliminating alcohol use. Heavy alcohol use is one of the most important behavioral predictors of HCV progression.^{19 – 21} Alcohol use is also common among IDUs. In one study of young HCV-positive IDUs, 37% met the criteria for harmful drinking on the Alcohol Use Disorders Identification Test.²² About one quarter of heroin users entering treatment in 2002 reported alcohol as a secondary substance,²³ and Hillebrand et al.²⁴ found that 41% of their methadone maintenance patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ), criteria for past-year alcohol dependence.²⁵ These statistics are particularly disturbing in light of recent evidence showing deleterious effects on HCV progression and liver disease of even moderate alcohol use.^{26 , 27} One approach that has shown promise in reducing alcohol use is motivational interviewing. Motivational interviewing is a client-centered intervention approach that has been used to reduce alcohol use and other problem behaviors in a variety of settings.²⁸ A meta-analysis of brief motivational interviewing interventions found that it was more effective in reducing alcohol use than were a variety of other brief interventions, with an aggregate effect size of 0.43.²⁹ Motivational interviewing has also been shown to reduce alcohol use among IDUs who were needle exchange clients.³⁰ However, the effectiveness of motivational interviewing in reducing sexual and injection-related HIV risk behaviors has been mixed.^{31 – 33} We present the results of a randomized trial of 2 HCV risk-reduction interventions in IDUs. We compared a motivational intervention with an educational intervention, both of which emphasized reductions in alcohol use as well as use of a new syringe for injection and condom use during sexual intercourse. Our primary objective was to compare the effects of the motivational intervention with those of an educational intervention on eliminating alcohol use among out-of-treatment IDUs, most of whom were infected with HCV. Secondary objectives of the study were to compare the effects of the motivational intervention with those of the educational intervention on use of a new syringe at last injection and condom use at last sexual encounter among out-of-treatment IDUs.