Brianna Norton, DO, MPH is an infectious diseases trained physician-investigator who cares for patients in a community-based Federally Qualified Health Center (FQHC) and conducts research to improve health outcomes among HCV- and HIV/HCV-infected injection drug users (IDUs). Though IDUs comprise the overwhelming majority of all HCV+ and HIV/HCV+ persons in the U.S, our current health care delivery system has failed to engage such patients in HCV care, and without imminent action, HCV-related deaths will triple over the next decade. New HCV medications have cure rates as high as 100% and few side effects, but gaps along the HCV cascade of care prevent IDUs from ever initiating treatment. Innovative health care delivery interventions, based in primary care settings that IDUs are already accessing, are urgently needed to improve uptake of life-saving HCV medications. Group medical visits can harness beneficial peer dynamics to provide support and motivation for positive health behaviors, and improve knowledge and self-efficacy skills through group education and training. The overall goal of this career development application is to test a primary care clinic-based HCV Group Evaluation and Treatment UPtake (HCV GET-UP) intervention for HCV+ and HIV/HCV+ IDUs. The proposal's specific aims are: 1) to conduct a feasibility and acceptability study of HCV GET-UP; 2) to test, in a pilot RCT, the efficacy of the HCV GET-UP intervention for improving HCV treatment uptake among HCV+ and HIV/HCV+ IDUs; and 3) to conduct quantitative and qualitative analyses in order to determine potential moderators and mediators of the HCV GET-UP intervention on HCV treatment uptake. To achieve Aim 1, we will conduct a feasibility and acceptability study of two HCV GET-UP groups (total of 16 participants). Based on these findings, we will refine the intervention and create an HCV GET-UP intervention manual. We anticipate that group medical visits will include HCV clinical assessments, education, peer and provider support, and self-management skill development. To test the efficacy of HCV GET-UP (Aim 2), we will enroll 96 HCV+ and HIV/HCV+ IDUs and randomize them 1:1 to HCV GET-UP vs. onsite treatment alone. The primary outcome will be initiation of HCV treatment; secondary outcomes will include HCV evaluation, treatment completion, and cure. Finally, using a sequential explanatory design, we will determine potential moderators and mediators of the HCV GET-UP intervention on HCV treatment uptake. These findings will help to improve the intervention design for a future R01, as well as enhance our understanding of current barriers and facilitators to HCV treatment uptake for IDUs. Dr. Norton will receive mentorship from a multidisciplinary team of experts. Dr. Norton's training goal is to develop skills in: 1) development and testing of behavioral interventions; 2) design and conduct of randomized controlled trials, 3) statistical analysis of complex data; and 4) qualitative methods. Completion of the proposed project will provide the foundation for Dr. Norton's career as an independent investigator dedicated to improving health outcomes for HCV and HIV/HCV+ IDUs.

Public Health Relevance

Injection drug users (IDUs) represent the overwhelming majority of both HCV and HIV/HCV infected people in the United States. Though new, direct-acting HCV medications are highly efficacious and have the potential to end the HCV epidemic, few IDUs ever initiate treatment. We seek to improve HCV treatment uptake and cure among HCV and HIV/HCV+ IDUs by testing a primary care based HCV Group Evaluation and Treatment UPtake (HCV GET-UP) intervention. If efficacious, this innovative care intervention could provide a means to reduce the growing mortality from HCV, as well as decrease the current reservoir for HCV transmission.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZRG1)
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Flournoy Floyd, Minnjuan Wyncephel
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Albert Einstein College of Medicine
United States
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Norton, Brianna L; Akiyama, Matthew J; Zamor, Philippe J et al. (2018) Treatment of Chronic Hepatitis C in Patients Receiving Opioid Agonist Therapy: A Review of Best Practice. Infect Dis Clin North Am 32:347-370
Norton, Brianna L; Fleming, Julia; Bachhuber, Marcus A et al. (2017) High HCV cure rates for people who use drugs treated with direct acting antiviral therapy at an urban primary care clinic. Int J Drug Policy 47:196-201
Shuter, Jonathan; Litwin, Alain H; Sulkowski, Mark S et al. (2017) Cigarette Smoking Behaviors and Beliefs in Persons Living With Hepatitis C. Nicotine Tob Res 19:836-844
Norton, B L; Beitin, A; Glenn, M et al. (2017) Retention in buprenorphine treatment is associated with improved HCV care outcomes. J Subst Abuse Treat 75:38-42
Grebely, Jason; Bruneau, Julie; Lazarus, Jeffrey V et al. (2017) Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. Int J Drug Policy 47:51-60
Norton, Brianna L; Southern, William N; Steinman, Meredith et al. (2016) No Differences in Achieving Hepatitis C Virus Care Milestones Between Patients Identified by Birth Cohort or Risk-Based Screening. Clin Gastroenterol Hepatol 14:1356-60
Hawks, L; Norton, B L; Cunningham, C O et al. (2016) The Hepatitis C virus treatment cascade at an urban postincarceration transitions clinic. J Viral Hepat 23:473-8