Chronic hepatitis C virus (HCV) is a significant public health problem and leading cause of liver failure and death for HIV(+) populations in the U.S. Many HIV(+) individuals have not benefited from HCV treatment advances due to opioid abuse despite the prevalence of this comorbidity. Buprenorphine (BPN), recently approved for office-based treatment of opioid addiction, provides opportunity to integrate HIV, HCV and addiction care in a single office-based setting. This Mentored Patient-Oriented Research Career Development Award will prepare Dr. Lynn Taylor to design and implement studies to improve health services delivery for HIV/HCV coinfected drug users and develop treatment and secondary prevention interventions to stem these epidemics and limit the morbidity and mortality of those at high risk for HCV disease progression. Dr. Taylor, an Assistant Professor of Medicine at Brown Medical School, has assembled an experienced mentorship team in the robust environment of Miriam Hospital and Brown University. With mentor Dr. Peter Friedmann and co-mentors Drs. Timothy Flanigan, Jack Wands, Joseph Hogan, Kathleen Morrow and Diana Sylvestre, Dr. Taylor will undertake advanced training in health services, substance abuse and viral hepatitis research;and qualitative, statistical and clinical trials methodologies for intervention development. Through the proposed project, an intervention will be developed to investigate BPN as a means to extend HCV therapy and optimize HCV, HIV and addiction outcomes among HIV/HCV coinfected opioid users. Phase I will evaluate barriers to the intervention using qualitative techniques. In Phase II, the intervention will be developed based on existing models utilizing BPN to stabilize HIV(-) street heroin injectors for HCV care, observed therapy and secondary prevention programs. In Phase III, a pilot feasibility study of the combined BPN/HCV treatment and secondary prevention intervention will be implemented and evaluated among 45 coinfected opioid users at an HIV primary care site to explore whether integrated care improves medical outcomes and decreases transmission behaviors. Results of this research may have implications not only for reducing the burden of HCV among HIV(+) drug users but also in developing reproducible models for integrating addiction and HCV treatment with HIV primary care. The information obtained will lead to the development of a future R01 submission.
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