Targeting a Narrow Window of Opportunity for Prevention: Tailoring the Staying Safe HCV-Prevention Intervention for Young Adults Who Inject Opioids

Introduction: As a consequence of the current opioid epidemic, HCV prevalence is rising among drug injectors under 30. Because risk for HCV exposure is highest in the first 3-5 years of a person’s injection career, there is a narrow window of opportunity to prevent HCV among young, recently-initiated injectors. These trends underscore an urgent public health need for effective interventions to prevent HCV and related health problems among young opioid injectors. This presentation describes the evidence-informed process used to adapt Staying Safe, a novel behavioral HCV-prevention intervention, for delivery to young opioid injectors.

Methods: Intervention tailoring was informed by mixed-methods data collected from opioid-using young adults. Structured assessment data derived from a recent study of 539 18-29 year-olds recruited by Respondent-Driven Sampling who reported past-month nonmedical use of POs and/or heroin. HCV status was assessed via rapid antibody testing. Qualitative input on the tailoring process was elicited from members of the target population in a focus group (n=8) and individual feedback sessions (n=4).

Results: RDS study results revealed an array of distinctive behaviors relevant to the prevention of HCV and related health problems, including: high rates of non-fatal overdose (43%), PO injection (37%) and polydrug use, especially co-use of opioids and benzodiazepines (56%); limited knowledge of the HCV risk from sharing non-syringe injection equipment; and, among injectors, a 30% prevalence of HCV. Focus group and feedback session results indicated strong interest in mobile delivery of intervention content, tools to facilitate self-monitoring of opioid use behaviors (e.g., injection frequency, withdrawal episodes, overdose experiences), and a curated compendium of resources for drug users. Based on these findings, new intervention content was developed to address topics such as HCV-transmission risks from injecting PO pills and overdose prevention and response. A core element of the tailoring process was the development of a mobile phone app to reinforce key risk-reduction strategies and support positive behavior change post-intervention.

Conclusions: Findings illustrate the usefulness of soliciting input from members of an intervention’s target population in program development and adaptation. Guided by feedback from young opioid injectors, we leveraged mobile technology to better engage a youthful target population and boost intervention effectiveness. A randomized controlled trial is currently evaluating the effectiveness of the tailored version of Staying Safe in reducing HCV incidence and injection-related risk behavior in a sample of young opioid injectors.