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Abstract
Although hepatitis C virus (HCV) can be cleared, very few infected persons complete the treatment, resulting in disease progression and transmission. Motivational interventions effectively address health and substance-use-related conditions in many cultures. The research team piloted an HCV treatment motivational enhancement training and supervision for four counselors treating four patients in one (of 11) large methadone programs in Israel between 2007 and 2008. The counselors received a 3-day training followed by seven supervision sessions. Training included cultural and language adaptation from the original United States version to practice in Israel. Feasibility was assessed and demonstrated through training field notes and questionnaire feedback, review of taped intervention sessions for counselor proficiency and patient engagement, and patient completion of intervention sessions and piloted measures. While positive feasibility outcomes were noted, future studies should employ larger numbers of counselors and patients to assess the effectiveness of motivational enhancement in promoting HCV treatment in methadone patients.
RÉSUMÉ
Un programme pilote de formation pour une approche d'amélioration de motivation dans le traitement du virus d'Hépatite C chez les patients des centres de méthadone en Israel
Bien que le virus de l'Hépatite C (HCV) puisse être guéri, peu de personnes infectées finissent leur traitement, résultant ainsi dans la progression de la maladie et sa transmission. Les interviews de motivation abordent efficacement le problème de la santé et des conditions liées à l'usage des drogues dans de multiples cultures. L’équipe de recherche a dirigé une formation et un contrôle sur l'amélioration de la motivation du traitement du HCV auprès de 4 conseillers traitant quatre patients dans un (sur 11) des grands programmes de méthadone en Israël entre 2007 à 2008. Les conseillers ont reçu une formation de 3 jours suivis de 7 séances de supervision. La formation comportait une adaptation culturelle et linguistique de la version originale des États-Unis pour la pratique en Israël. La faisabilité a été évaluée et démontrée par les remarques des cours de formation et par les commentaires du questionnaire, par l'examen des séances d'intervention enregistrées pour la compétence du conseiller et l'engagement du patient, et par l'achèvement des séances d'intervention par le patient. Bien que des résultats positifs aient été relevés, les études futures devraient employer un plus grand nombre de conseillers et de patients pour évaluer l'efficacité de l'amélioration de la motivation dans la promotion du traitement HCV chez les patients à la méthadone.
RESUMEN
Programa piloto de entrenamiento con un enfoque en refuerzo motivacional para el tratamiento de la hepatitis C en individuos en centros de tratamiento con metadona en Israel.
Aunque la hepatitis C (VHC) se puede erradicar, solo una parte de las personas infectadas completan el tratamiento, lo que resulta en progresión de la enfermedad y transmisión. Las intervenciones motivacionales han abordado eficazmente el uso de sustancias psicoactivas y otros problemas de salud en diversos grupos culturales. El equipo de investigación implemento una prueba piloto para el entrenamiento y supervisión en terapia de refuerzo motivacional para el tratamiento del VHC de cuatro consejeros que trataban cuatro pacientes en uno de los 11 programas grandes de tratamiento con metadona en Israel entre 2007–2008. Los consejeros recibieron tres días de entrenamiento seguido de 7 sesiones de supervisión. El entrenamiento incluyó la adaptación cultural y lingüística de la versión original de los Estados Unidos para practicar en Israel. La viabilidad fue evaluada y demostrada a través de notas de campo de entrenamiento y de un cuestionario de retroalimentación, la revisión de las grabaciones de las sesiones de intervención en habilidades de consejería y de convocatoria de pacientes, y la finalización de las sesiones de intervención y de las pruebas piloto por parte de los pacientes. Si bien se encontraron resultados de viabilidad positivos, estudios futuros deben emplear un mayor número de consejeros y pacientes para evaluar la efectividad de la terapia de refuerzo motivacional en la promoción del tratamiento del VHC en pacientes tratados con metadona.
THE AUTHORS
Dr. Diane S. Morse, MD, is an Assistant Professor of medicine and psychiatry at the School of Medicine and Dentistry, University of Rochester. She is an internist whose present research focuses on the application of self-determination theory to comorbid HIV and HCV treatment utilization. She has also published research on sequelae of family violence history, including childhood abuse and intimate partner violence, and on empathy and self-disclosure in patient-physician communication. Her clinical work currently focuses on medical care of patients with psychiatric comorbidities. Her activities during the period of this project were funded by the National Institute of Mental Health (NIMH T32 MH18911, PI Eric Caine, MD) and the Fulbright Scholar Program, US Department of State.
Dr. Miriam Schiff, Ph.D., MSW, is a Senior Lecturer and the Head of the MSW program at the Paul Baerwald School of Social Work and Social Welfare, Hebrew University. She is also a Licensed School Psychologist and a Social Worker. Her research and publications focus on the associations between man-made trauma and substance use as well as mental health in general among youth and women. She has published several articles on the aftereffects of collective trauma and on the helping components in social work services and interventions. Her clinical activity includes working as a volunteer with drug-addicted women in a methadone clinic in Jerusalem, providing them individual and group treatment.
Dr. Shabtay Levit, Ph.D., MSW, IL, is the Chairman of Directors of Israel's Methadone Clinics. Dr. Levit created and directs both the methadone treatment programs and the needle exchange programs in Jerusalem and Ashdod. He is also an Adjunct Lecturer at the Hebrew University School of Social Work and Social Welfare. His areas of interest are creating and improving systems and individual models of rehabilitation for substance use clients, and utilizing technology to improve the quality of social and health services for deprived populations such as substance users. He has several publications on these topics.
Rinat Cohen-Moreno, MPH and licensed paramedic, is the Director of the Branch for Welfare Statistics in the Central Bureau of Statistics, Israel. Her research topics are children at risk and juvenile and adult delinquency. Previously, she worked for several years in a Methadone Maintenance Treatment Program as the Director of methadone distribution. She was a member of the methadone program management and development committee, and led the clinical and research efforts toward extending the HCV testing and treatment coverage at the program.
Dr. Geoffrey C. Williams, Ph.D., MD, is currently the Director of the Healthy Living Center at the University of Rochester. He is also a Professor of medicine, psychiatry, and psychology. He has 20 years of practice experience in academic internal medicine and training as a health psychologist. He has contributed to the development of the self-determination theory model for health behavior change. He has been the recipient of numerous grants including research support from the National Cancer Institute, the National Institute on Drug Abuse, the National Institute of Diabetes and Digestive and Kidney Diseases, Small Business Innovation Research, and the National Institute of Mental Health. He has published over 50 peer-reviewed articles as well as books and numerous book chapters. In addition, he has presented at over 50 major national professional meetings.
Dr. Yehuda Neumark, Ph.D., MPH, is a tenured Senior Lecturer of epidemiology at the Braun School of Public Health and Community Medicine of Hebrew University-Hadassah in Jerusalem, Israel. His research focuses on the epidemiology of alcohol and drug use and misuse in Israel and globally, using his research findings to inform policy whenever possible. He serves as the Director of the Braun School's International Master of Public Health Program, mentors master and doctoral students, and teaches courses in epidemiology, quantitative research methods in public health, and community-oriented health care. He is becoming increasingly interested in the use of information and communication technologies for health promotion, specifically developing drug and alcohol Internet-based interventions for young adults. If asked about his greatest accomplishment, he would say his children and grandchildren.