JMIR Publications

ABSTRACT

Background:

Syringe service programs (SSPs) are safe, highly effective programs for promoting health among people who inject drugs. However, resource limitations prevent delivering a full package of prevention services to many clients in need. Computer-tailored interventions may represent a promising approach for providing prevention information to people who inject drugs in resource-constrained settings.

Objective:

Assess the effect of a computer-tailored behavioral intervention, called Hep-Net, on safe injection practices, substance use reduction, overdose prevention, and hepatitis C virus (HCV) testing among SSP clients.

Methods:

Using a social network–based recruitment strategy, we recruited clients of an established SSP in Wisconsin and peers from their social networks. Participants completed a computerized baseline survey and were then randomly assigned to receive the Hep-Net intervention. Components of the intervention included an overall risk synthesis, participants’ selection of a behavioral goal, and an individualized risk reduction exercise. Individuals were followed up 3 months later to assess behavior change. The effect of Hep-Net on receiving a HCV screening test, undergoing Narcan training, and reducing the frequency of drug use and sharing drug equipment was assessed. Individual’s readiness to change each behavior was also examined.

Results:

From 2014 to 2015, a total of 235 people who inject drugs enrolled into the Hep-Net study. Of these, 151 (64%) completed the follow-up survey 3 to 6 months post-enrollment. Compared to the control group, individuals who received the Hep-Net intervention were more likely to undergo HCV testing, receive Narcan training, and reduce sharing of drug equipment. Likewise, individuals who received the intervention were more likely to advance their stage of readiness to change these 3 behaviors. However, intervention participants did not appear to reduce the frequency of drug use or increase readiness to reduce drug use more than control participants, despite the fact that the majority of intervention participants selected this as the primary goal to focus on after participation in the baseline survey.

Conclusions:

Implementing computer-based risk reduction interventions in SSPs may reduce harms related to sharing of injection equipment and prevent overdose deaths, however brief computerized interventions may not be robust enough to overcome the challenges associated with reducing and ceasing drug use when implemented in settings centered on the delivery of prevention services. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT02474043