Mary H. Latka ¹, Holly Hagan ², Farzana Kapadia ³, Elizabeth T. Golub ⁴, Sebastian Bonner ⁵, Jennifer V. Campbell ⁶, Micaela H. Coady ⁷, Richard S. Garfein ⁸, Minya Pu ⁸, Dave L. Thomas ⁹, Thelma K. Thiel ¹⁰, Steffanie A. Strathdee ^8*

¹ At the time of the study: Center for Urban Epidemiologic Studies, The New York Academy of Medicine
² National Development and Research Institute
³ At time of this study: Center for Urban Epidemiological Studies, New York Academy of Medicine
⁴ Johns Hopkins University of Medicine, Bloomberg School of Medicine
⁵ Center for Urban Epidemiological Studies, New York Academy of Medicine
⁶ Seattle-King County Department of Public Health, HIV/AIDS Prevention Program
⁷ Center for Urban Epidemiological Studies
⁸ University of California at San Diego, Department of Family and Preventative Medicine
⁹ Johns Hopkins University, School of Mediccine
¹⁰ Hepatitis Foundation International

^* To whom correspondence should be addressed. E-mail: sstrathdee{at}ucsd.edu.

	Abstract

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.

Key Words: Health Policy, HIV/AIDS, Hepatitis, Hispanics/Latinos, Drugs, Urban Health