A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C

Objectives. We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection.Methods. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups.Results. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio OR]=0.46; 95% confidence interval CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy.Conclusions. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users.Hepatitis C virus (HCV) infection is an important public health problem, with an estimated global prevalence of 3%1 and a prevalence rate ranging from 65% to 95% among injection drug users.2^–10 HCV may cause liver cirrhosis and hepatocellular carcinoma; only 15% to 20% of infected individuals spontaneously recover without treatment.11 As a result of limited efficacy, tolerability, and availability,12^–17 treatment has not substantially reduced the burden of HCV, although improved treatment provision to injection drug users may reduce the burden more effectively.The combined effects of high HCV prevalence among injection drug users, a persistently infectious carrier state, high transmissibility, and lack of an effective vaccine call for interventions intended to change behaviors among injection drug users both with and without HCV infection. One study showed promise in reducing unsafe injection behaviors associated with HCV acquisition (receptive risk),18 but we know of no studies that have evaluated the efficacy of an intervention focused on reducing behaviors that can transmit HCV (i.e., distributive risk behaviors). We report the results of a randomized, controlled trial evaluating a 6-session intervention aimed at reducing distributive risk behaviors among injection drug users with HCV infection.