HBV Prevention for Homeless at Risk for HBV/HCV/HIV

对有 HBV/HCV/HIV 风险的无家可归者进行 HBV 预防

• 批准号: 7859977
• 负责人: Adeline M Nyamathi
• 金额: $ 3.28万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7859977
• 关键词: Address; Admission activity; Adult; Age; Anus; Area; Award; Beech; Behavior Therapy; Behavioral; Bisexual; California; Case Management; Case Manager; Centers for Disease Control and Prevention (U.S.); Cercopithecine Herpesvirus 1; Cities; Cocaine; Communities; Contracts; Control Groups; Coping Skills; Crack Cocaine; Data; Dose; Drug usage; Drug user; Education; Effectiveness; Epidemic; Ethnic Origin; Exposure to; Frequencies; Friends; Funding; Gays; HBV Vaccination; HIV; Hepatitis; Hepatitis A; Hepatitis B Antibodies; Hepatitis B Vaccines; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Homeless Youth; Homeless persons; Homelessness; Hospitals; Hygiene; Incentives; Infection; Infection prevention; Injection of therapeutic agent; Intervention; Knowledge; Length; Life; Los Angeles; Mediating; Methamphetamine; Needle Sharing; Needles; Nurses; Outcome; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Randomized; Relative (related person); Reporting; Research; Research Personnel; Risk; Risk Factors; Risk Reduction; Series; Sex Behavior; Simian B disease; Social Health Services; Social support; Specific qualifier value; Sterility; Subgroup; Substance abuse problem; Syringes; Targeted Research; Tattooing; Test Result; Time; Treatment Efficacy; Unemployment; Urine; Vaccination; Vaccines; Viral Hepatitis Vaccines; Virus Diseases; Water; Work; Youth; base; cocaine use; compare effectiveness; contingency management; cost; cost effective; cost effectiveness; depression; design; drug addict; experience; follow-up; high risk; improved; innovation; male; men; men who have sex with men; prevent; programs; public health relevance; seal; self esteem; sex; sex risk; successful intervention; therapy design; young adult

DESCRIPTION (provided by applicant): Homeless adults are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Our NIDA-funded RO1 award has enabled us to implement a successful intervention designed to evaluate the effectiveness of a HBV vaccination intervention with homeless adults. Our findings revealed that a greater percent of homeless adults randomized to the Nurse Case Managed Plus Incentive and Tracking group completed the HAV/HBV vaccine series compared to a Standard program without tracking. Homeless persons least likely to complete the vaccine series were young (<40), and were men having sex with men (MSM); a significant number of these young adults also reported methamphetamine (MA) and cocaine/crack use. Stimulants (SAs), including MA and cocaine/crack are commonly used by homeless MSM, who contend with disorganized lives, unemployment, and little access to health and social services; thus, HBV vaccination is particularly challenging in this population. HAV/HBV vaccination and effective behavioral treatment are two of the most important strategies for reducing HBV infection among this at-risk group of SA users. Based upon advice from our community partners who have successfully treated SA-using gay and bisexual men (GBM), we will incorporate contingency management into our vaccination completion program, which had lower completion rates among young adults and MSMs. Thus, in this competitive renewal, we propose a randomized, experimental, two-group design to evaluate the effectiveness of a Nurse Case Managed Program, which includes specialized education and Contingency Management and Tracking (NCCMT), with a Standard Program, including brief education, Contingency Management and Tracking (SCMT) with 500 homeless, young (18-39), SA-using GBM, on completion of theTwinrixHAV/HBV vaccine and, secondarily, on reduction of risk for hepatitis and HIV. This study is innovative in that it will allow us to look at the effect of an enhanced case management and contingency management program versus a standard contingency management program. The proposed study combines optimal strategies to approach, engage and intervene with a hidden and high- risk population to assess the feasibility and efficacy of interventions that may prove beneficial in preventing HBV and HAV infections. We will also assess the relative cost of these programs in terms of completion of the HAV/HBV vaccination series. As use of SAs threatens to intensify homeless persons' risk of exposure to HAV and HBV, particularly among young users who may not yet be HBV-infected, research targeted to engage this group in treatment, until they are suitably protected from HBV, is critical. PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA and Friends Community Center will work together in designing a program to assist young homeless stimulant-using gay and bisexual homeless men to complete the hepatitis vaccine and in reducing drug and sexual activity. Using nurse case management strategies, found successful with homeless adults as well as contingency management strategies, found successful with gay and bisexual homeless adults by our community partners, we will evaluate the effectiveness of a program that combines both strategies. As Stimulant use threatens to increase homeless persons' risk of exposure to hepatitis A and B viruses, particularly among young users who may not yet be HBV-infected, this research is targeted to engage this group in treatment, until they are suitably protected from HBV, and hopefully reduce risk for HCV and HIV as well.

描述（由申请人提供）：由于注射吸毒率高和无保护的性活动，无家可归的成年人感染乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和艾滋病毒的风险很高。我们获得 NIDA 资助的 RO1 奖，使我们能够实施一项成功的干预措施，旨在评估对无家可归的成年人进行乙肝疫苗接种干预的有效性。我们的研究结果显示，与没有跟踪的标准计划相比，随机分配到护士案例管理加激励和跟踪组的无家可归成年人中完成 HAV/HBV 疫苗系列的比例更高。最不可能完成疫苗系列的无家可归者是年轻人（<40 岁），并且是男男性行为者 (MSM)；其中相当多的年轻人还报告使用甲基苯丙胺 (MA) 和可卡因/强效快克。无家可归的男男性接触者通常会使用兴奋剂 (SA)，包括 MA 和可卡因/强效快克，他们的生活无条理、失业，而且很难获得医疗和社会服务；因此，乙型肝炎疫苗接种在这一人群中尤其具有挑战性。 HAV/HBV 疫苗接种和有效的行为治疗是减少 SA 高危人群中 HBV 感染的两个最重要的策略。根据我们成功治疗使用 SA 的男同性恋和双性恋男性 (GBM) 的社区合作伙伴的建议，我们将把应急管理纳入我们的疫苗接种完成计划中，该计划在年轻人和 MSM 中的完成率较低。因此，在这次竞争性更新中，我们提出了一种随机、实验、两组设计来评估护士案例管理计划的有效性，其中包括专业教育和应急管理和跟踪 (NCCMT)，以及标准计划，包括简短教育，对 500 名无家可归的年轻人（18-39 岁）使用 GBM 的 SA 进行应急管理和跟踪 (SCMT)，在完成 TwinrixHAV/HBV 疫苗后，其次是降低肝炎风险和艾滋病毒。这项研究的创新之处在于，它将使我们能够了解增强的案例管​​理和应急管理计划与标准应急管理计划的效果。拟议的研究结合了接近、参与和干预隐性高危人群的最佳策略，以评估可能有益于预防 HBV 和 HAV 感染的干预措施的可行性和有效性。我们还将评估这些计划在完成 HAV/HBV 疫苗接种系列方面的相对成本。由于使用 SA 可能会增加无家可归者接触 HAV 和 HBV 的风险，特别是在可能尚未感染 HBV 的年轻使用者中，因此针对该群体进行治疗直至他们得到适当保护以免受 HBV 侵害的研究至关重要。 公共健康相关性：在这项研究中，加州大学洛杉矶分校和朋友社区中心的研究人员将共同设计一项计划，帮助使用兴奋剂的年轻无家可归的同性恋和双性恋无家可归者完成肝炎疫苗接种并减少吸毒和性活动。使用护士案例管理策略（在无家可归成年人方面取得成功）以及应急管理策略（我们的社区合作伙伴在同性恋和双性恋无家可归成年人方面取得成功），我们将评估结合这两种策略的计划的有效性。由于兴奋剂的使用可能会增加无家可归者接触甲型和乙型肝炎病毒的风险，特别是在可能尚未感染乙肝病毒的年轻使用者中，因此这项研究的目标是让这一群体接受治疗，直到他们得到适当的保护，免受乙肝病毒的侵害，并有望降低丙肝病毒和艾滋病毒的风险。