Columbia University School of Social Work, New York, NY, United States.
Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC, DC, United States.
J Med Internet Res. 2020 Sep 29;22(9):e19703. doi: 10.2196/19703.
Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent the delivery of a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings.
The aim of this paper is to assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients.
Using a social network-based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants' selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess their behavior change. The effect of Hep-Net on receiving an HCV screening test, undergoing Narcan training, reducing the frequency of drug use, and sharing drug equipment was assessed. The individual's readiness to change each behavior was also examined.
From 2014 to 2015, a total of 235 people who injected drugs enrolled into the Hep-Net study. Of these, 64.3% (151/235) completed the follow-up survey 3-6 months postenrollment. Compared with the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing (odds ratio [OR] 2.23, 95% CI 1.05-4.74; P=.04) and receive Narcan training (OR 2.25, 95% CI 0.83-6.06; P=.11), and they shared drug equipment less frequently (OR 0.06, 95% CI 0.55-0.65; P<.001). Similarly, individuals who received the intervention were more likely to advance in their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase their readiness to reduce drug use more than control participants, despite the fact that the majority of the intervention participants selected this as the primary goal to focus on after participation in the baseline survey.
Implementing computer-based risk reduction interventions in SSPs may reduce harms associated with the sharing of injection equipment and prevent overdose deaths; however, brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services.
ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/resprot.4830.
注射器服务项目（SSP）是在注射毒品人群中促进健康的安全、高效计划。然而，资源限制使许多有需要的客户无法获得完整的预防服务包。基于计算机的个性化干预措施可能是在资源有限的环境中向注射毒品者提供预防信息的一种有前途的方法。
本文旨在评估基于计算机的行为干预措施 Hep-Net 对 SSP 客户安全注射行为、减少药物使用、预防药物过量和丙型肝炎病毒（HCV）检测的影响。
我们使用基于社交网络的招募策略，招募了威斯康星州一家成熟 SSP 的客户及其社交网络中的同伴。参与者完成了一项计算机基线调查，然后被随机分配接受 Hep-Net 干预。干预的组成部分包括总体风险综合评估、参与者选择行为目标以及个体化风险降低练习。3 个月后对个人进行随访，以评估他们的行为变化。评估了 Hep-Net 对接受 HCV 筛查测试、接受纳拉康培训、减少药物使用频率和共享药物设备的影响。还检查了个人改变每种行为的准备情况。
2014 年至 2015 年，共有 235 名注射毒品者参加了 Hep-Net 研究。其中，64.3%（151/235）在入组后 3-6 个月完成了随访调查。与对照组相比，接受 Hep-Net 干预的个体更有可能接受 HCV 检测（比值比[OR]2.23，95%置信区间[CI]1.05-4.74；P=.04）和接受纳拉康培训（OR 2.25，95%CI 0.83-6.06；P=.11），并且他们较少共享药物设备（OR 0.06，95%CI 0.55-0.65；P<.001）。同样，接受干预的个人在改变这 3 种行为的准备程度上更有可能取得进展。然而，尽管大多数干预参与者在基线调查后选择将其作为主要关注目标，但干预参与者似乎并没有比对照组参与者更能减少药物使用频率或增加他们减少药物使用的准备程度。
在 SSP 中实施基于计算机的风险降低干预措施可能会减少与注射设备共享相关的危害并预防药物过量死亡；然而，当在以提供预防服务为中心的环境中实施时，简短的计算机化干预措施可能不足以克服减少和停止药物使用所带来的挑战。
ClinicalTrials.gov NCT02474043；https://clinicaltrials.gov/ct2/show/NCT02474043。
国际注册报告标识符（IRRID）：RR1-10.2196/resprot.4830。
