This is a competing continuation application for our current NIDA-funded study, """"""""HCV Service Innovations in Drug Treatment Programs."""""""" It is proposed as a direct result of data collected from patients, staff, and managers in drug treatment programs who report that the hepatitis C virus (HCV) education provided to patients and staff is often inadequate, and HCV services are seriously underutilized. This is especially unfortunate because of the high prevalence of HCV among drug users, especially those co-infected with HIV, and their pressing need for information about, and services for HCV. Drug treatment programs are uniquely situated to educate, counsel, and test drug users for HCV and HIV, and facilitate their access to medical treatment. However, there are gaps in drug treatment programs' current provision of HCV services, and patients often don't use the limited services that do exist. Because communication with staff can affect patients' health behaviors, staff's encouragement of the use of existing HCV services is essential. Few staff, however, know what to tell patients about HCV, how to help them deal with test results, and how to counsel them about medical treatment. The need is especially great when dealing with patients co-infected with HIV and HCV, whose medical management is significantly more complicated because of the dual infection. By addressing the expressed need of treatment staff for an evidence-based HCV training, this study will assess whether such a training can improve staff's HCV and HCV/HIV knowledge, attitudes, intentions and behaviors, and if so, whether it will lead to benefits to patients and the drug treatment organization. Guided by Social Cognitive Theory and the Information-Motivation-Behavioral Skills Model, the Specific Aims are therefore: (1) To develop a staff intervention that includes current HCV information and training in how to best communicate with patients about HCV and HIV/HCV co-infection issues; (2) To examine the intervention's impact over time on staff's knowledge about HCV and HCV/HIV co-infection, and their attitudes, self-efficacy, intentions and behaviors to encourage their patients to use HCV services; and (3) To examine the impact of the intervention over time on: (a) Patients' HCV/HIV knowledge, attitudes, intentions, and actual use of HCV services; and on (b) The drug treatment organization's intentions toward, and actual expansion of HCV services, as well as its climate toward dealing with HCV and HCV/HIV co-infection. The intervention will be delivered to staff in 24 drug treatment programs in the four U.S. census regions, equally divided among drug-free and methadone programs: 16 programs will be randomly assigned to an intervention condition, and 8 to a control group (delayed intervention). The intervention's effectiveness will be examined by analyzing qualitative and quantitative data collected from the director, staff, and patients in the intervention and control condition programs. In its manualized form, successful elements of the training will be disseminated to programs nationwide
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