title: Computerized Tailored Interventions to Enhance Prevention and Screening for Hepatitis C Virus Among People Who Inject Drugs: Protocol for a Randomized Pilot Study.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infection is a growing problem among people who inject drugs. Strategies to reduce disease transmission (eg, syringe exchange programs) and facilitate HCV screening and linkage are available but are under-utilized in many communities affected by injection drug use. Novel approaches to increasing the use of these strategies are needed.
  
  
  OBJECTIVE
  The goals of this project are to (1) develop and pilot test a computerized tailored intervention for increasing HCV screening and decreasing risky drug use behavior among people who inject drugs and (2) determine the feasibility of disseminating such an intervention using peer-based referrals in the setting of a community-based syringe exchange program.
  
  
  METHODS
  This 2-arm, randomized pilot study is being conducted in a large-volume, multisite syringe exchange program in southern Wisconsin. A social network-based strategy was used to recruit a total of 235 adults who reported past-month injection of opioids, cocaine, or methamphetamine. Network recruiters were identified among clients requesting services from the syringe exchange program and were enlisted to refer eligible peers to the study. All participants completed a computer-adapted questionnaire eliciting information about risk behaviors and their knowledge, attitudes, and prior experiences related to HCV screening. Subjects were then randomly assigned to receive usual care, consisting of standard counseling by syringe exchange staff, or the Hep-Net intervention, which provides algorithm-based, real-time tailored feedback and recommendations for behavior change in the style of motivational interviewing. Changes in drug use behaviors and attitudes will be assessed during a second session between 90 and 180 days after the baseline visit. Frequency of repeat HCV testing and HCV incidence will be assessed through a database search 1 year after study completion.
  
  
  RESULTS
  Recruitment for this study was completed in April 2015. Follow-up of enrolled participants is expected to continue until March 2016. Network recruiters were enrolled who referred a total of 195 eligible peers (overall N=235). At baseline, the median age was 34 years; 41.3% (97/235) were non-white; and 86.4% (203/235) reported predominantly injecting heroin. Most participants (161/234, 68.8%) reported sharing injection equipment in the past and of these, 30.4% (49/161) had never been tested for HCV.
  
  
  CONCLUSIONS
  This study will provide preliminary evidence to determine whether incorporating computerized behavioral interventions into existing prevention services at syringe exchange programs can lead to adoption of healthier behaviors.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02474043; https://clinicaltrials.gov/ct2/show/NCT02474043 (Archived by WebCite at http://www.webcitation.org/6dbjUQG7J).
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States. rpw@medicine.wisc.edu.
authors.forename: Ryan P
authors.identifier: http://orcid.org/0000-0001-5701-4516
authors.initials: RP
authors.lastname: Westergaard
authors.forename: Shawnika J
authors.identifier: http://orcid.org/0000-0002-3503-3289
authors.initials: SJ
authors.lastname: Hull
authors.forename: Alana
authors.identifier: http://orcid.org/0000-0002-1683-8348
authors.initials: A
authors.lastname: Merkow
authors.forename: Laura K
authors.identifier: http://orcid.org/0000-0001-7155-0614
authors.initials: LK
authors.lastname: Stephens
authors.forename: Karli R
authors.identifier: http://orcid.org/0000-0001-6891-953X
authors.initials: KR
authors.lastname: Hochstatter
authors.forename: Heidi K
authors.identifier: http://orcid.org/0000-0002-6376-3780
authors.initials: HK
authors.lastname: Olson-Streed
authors.forename: Lisa M
authors.identifier: http://orcid.org/0000-0001-8823-1804
authors.initials: LM
authors.lastname: Baker
authors.forename: Timothy M
authors.identifier: http://orcid.org/0000-0002-6236-7006
authors.initials: TM
authors.lastname: Hess
keywords: health behavior; hepatitis C; needle exchange programs; substance abuse, intravenous