School of Social Work, Columbia University, New York, NY, United States.
Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
JMIR Mhealth Uhealth. 2021 Feb 22;9(2):e23080. doi: 10.2196/23080.
The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery.
We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing.
HCV intervention content, including dissemination of educational information, private messages tailored to individuals' stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment.
Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06).
Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed.
ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12620.
阿片类药物使用障碍（OUD）和相关注射药物使用的流行呈上升趋势，导致新的丙型肝炎病毒（HCV）感染激增。大约一半的 HCV 感染者不知道自己的 HCV 状况。提高 HCV 意识并增加 OUD 患者的筛查至关重要。成瘾综合健康增强支持系统（A-CHESS）是一种基于证据的、通过智能手机提供的、用于预防复发的系统，已在接受药物治疗的 OUD 患者中实施，以改善长期康复。
我们将 HCV 相关内容和功能纳入 A-CHESS，以描述早期缓解和接受 OUD 药物治疗的患者的 HCV 护理连续体，并确定将此类内容和功能纳入 A-CHESS 是否会增加 HCV 检测。
在 2016 年 4 月至 2020 年 4 月期间，将 HCV 干预内容纳入 A-CHESS 平台，包括传播教育信息、针对个人 HCV 护理阶段的个性化信息以及公共讨论论坛。共纳入 416 名 OUD 患者进行本研究。参与者被随机分配接受 MAT 单独治疗（对照组）或 MAT+A-CHESS（实验组）。从基线到第 24 个月，每季度进行一次电话访谈，以评估风险行为和 HCV 检测史。Cox 比例风险回归用于评估使用 A-CHESS 的参与者是否比对照组更频繁地接受 HCV 检测（抗体 [Ab] 或 RNA 检测）。为了评估 A-CHESS 对 HCV 风险最高的参与者亚组的影响，还进行了额外的分析，以检查干预措施对注射毒品和共用注射设备的参与者的影响。
总体而言，44.2%（184/416）的研究参与者 HCV Ab 阳性，30.3%（126/416）HCV Ab 阴性，25.5%（106/416）基线时未检测。在第 24 个月，干预组和对照组之间 HCV 检测率没有总体差异。然而，在 109 名参与注射吸毒的参与者亚组中，使用 A-CHESS 的参与者 HCV 检测率略有上升（89% vs 85%；风险比：1.34；95%CI 0.87-2.05；P=.18），当关注报告共用注射设备的 32 名参与者亚组时，这种趋势更明显（87% vs 56%；风险比：2.92；95%CI 0.959-8.86；P=.06）。
在实施高危行为（如共用污染的注射设备）的人群中，将 HCV 预防和护理信息纳入 A-CHESS 可能会增加 HCV 检测率，同时预防阿片类药物复发。然而，需要更多有能力检测高危人群 HCV 检测差异的研究。
ClinicalTrials.gov NCT02712034；https://clinicaltrials.gov/ct2/show/NCT02712034。
国际注册报告标识符（IRRID）：RR2-10.2196/12620。
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