Abstract
Background: With annual rates of hepatitis C virus (HCV) reinfection among persons who inject drugs ranging from 5% to 22%, the need for behavioral interventions to prevent reinfection following successful treatment is clear. Methods: This report aims to describe the conception and development of an intervention to prevent HCV reinfection and present preliminary results from its pilot testing at an opioid treatment program offering on-site primary medical care, including treatment for HCV infection. We developed a two-session intervention combining a teachable moment followed by a session based on the Information-Motivation-Behavioral Skills (IMB) Model to reinforce learning. The teachable moment occurs in less than ten minutes during the routine blood draw to measure viral load during HCV treatment. The reinforcing IMB session builds knowledge, motivation, and self-efficacy in practicing safer injection skills. Formative exploratory work for the intervention involved a literature review, planning meetings with implementation staff, and development of study materials. Intervention staff were trained and the intervention was pilot tested. Measured outcomes included feasibility and acceptability of the intervention to patients and implementers, study recruitment and retention, and preliminary changes in knowledge, motivation, self-efficacy, and HCV reinfection risk behaviors over the study time period. Results: The study protocol and intervention content are both described, along with the preliminary results of implementation and psychosocial outcomes among 17 patients undergoing direct-acting antiviral treatment for HCV. Baseline data revealed gaps in HCV prevention knowledge that could lead to reinfection. We also report lessons learned related to implementation of such an intervention with this population in integrated care settings. After some minor adjustments, we found high levels of feasibility and acceptability for the intervention at the implementing organization. Intervention implementation was interrupted due to COVID-19 restrictions. Conclusions: It is possible to implement an intervention in an opioid treatment program to improve HCV prevention knowledge with the potential to prevent reinfection. Intervention staff must be attentive to participant needs regarding time and monetary constraints to maximize acceptability. Given the impact of the COVID-19 pandemic, future research should explore the possibility of offering the intervention via phone or video chat.
The impact of COVID-19 on opioid treatment program (OTP) services: Where do we go from here?
