Hepatitis C Clinical Trial
Official title:
A Respondent Driven Sampling Study to Identify the Hidden Population of Former Intravenous Drug Users With Hepatitis C Infection Who Are no Longer in Contact With Services. "Ask a Friend"
This exploratory study will carry out a respondent-driven sampling exercise, where participants will identify their previous injecting partners and contact these individuals to invite them to take an Hepatitis C test. The data from participants about their injecting network will be used to construct a social network map (egonet) of the interlinking injecting networks. The numbers of individuals identified in the injecting networks will be used to estimate the size of the injecting population in Dundee. Participants will be interviewed to find out how they felt about the processes used.
Initial seed participants (25 individuals) will be identified from local support
organisations who work with drug users, by members of the research team. Members of the
research team will identify seeds from the Cairn Centre initially and sequentially visit
partner organisations as the study proceeds. Seed participants will be current or former
injecting drug users who are in contact with services. Seed participants will be provided
with the study information sheet (PIS, participant information sheet) and asked to provide
consent to take part in the study, according to standard practice. All members of the
research team are trained in study procedures and Good Clinical Practice Seed participants
will be requested to identify members of their previous injecting network by providing
general information about these individuals to create a pseudo-identity. They may be assisted
in doing this by the use of a mapping tool. The researchers will collect a standard dataset:
Given name; approximate age; approximate area of town/city (if known); Ethnicity; Strength of
tie (How often they injected with this person - Likert scale, year first and last injected
with). The pseudo-identities created by the seeds will be insufficient to identify an actual
person, but will enable the seed participant to focus on who they might like to contact. The
actual identities of the person they contact will only be known to the researchers when this
person presents for testing and consents to participation.
Advice will be given to the seed participants about sensitively approaching individuals who
they used to inject with and about how people who are approached by them can access HCV
testing. The data from identified contacts will be recorded onto an Excel Spreadsheet held on
a password-protected computer within a locked office at the University of Dundee. These data
will be utilised to construct an egomap using a computer programme designed for this purpose
such as "Egonet". However it should be noted that the identified contacts are "pseudo
identities" since the details do not correspond to a real person until they come forward for
testing and can be linked to a CHI number.
Seed participants will have the study coupon system explained to them, which they will use to
invite injecting partners to take an HCV test. Each study coupon will contain a unique
reference number that links it to the individual who gave the former IDU the invitation. The
participants will be handed sufficient coupons to cover the number of alters identified by
them, up to a maximum of 5 coupons at one time. The seed participants will be issued with
study information cards and study coupons to enable them to invite their contacts to present
for an HCV test. The former drug users identified by seeds represent wave 1 of the
respondent-driven sample. The respondent driven sampling will be managed with standard
software (RDSAT). If seeds only identify contacts known to services, then this will be
recorded and the participant's social network logged.
Seed participants will be contacted weekly by phone or when they are visiting the Cairn
Centre for up to 4 weeks, by a designated member of the research team to ask about progress
in contacting social network contacts. The contact will be recorded on a log sheet that will
enable a summary of the conversation to be recorded The study will initially offer Dried
Blood Spot Testing (DBST) through the Cairn Centre in Dundee, where the study methods will be
first piloted. Individuals who wish to be tested will contact the Cairn Centre using the
telephone number included on the coupon and make an arrangement to be tested. All testing
will be done according to the standard operating procedures and guidance prepared by the
Sexual Health and Blood Borne Virus Managed Care Network.
As the study proceeds, additional sites will be visited by the research team and additional
seeds identified and invited to participate if required. These additional sites are already
in use by the intended participant groups as community hubs and community pharmacies in
Dundee at Lochee, Hilltown, Albert Street and Menzieshill. At this stage, potential
participants may be approached by the care team (community/pharmacy) only who will introduce
the research team to potential participants When the potential wave 1 study participant (who
is a contact identified by the seed participant) contacts the Cairn Centre about a DBST, all
relevant details to enable their clinical care will be recorded by the member of the
specialist nurse, who works in the Cairn Centre, to enable the results of the test to be
communicated to the participant and advice on any future care and treatment provided. The
information collected will be sufficient to enable a CHI number to be identified. The CHI
number is an essential requirement to ensure that all participants who are tested can be
informed of the test result and can access ongoing referral and treatment as appropriate. The
processing of results and documentation in the clinical record will be undertaken by a
research nurse attached to the HCV clinical team. The participant will be provided with
information about the HCV test and its meaning and offered referral for treatment as NHS
standard of care. In addition and making it clear this is an additional option the nurse will
give a PIS, to advise them about the opportunity to join the study. Caldicott approvals will
be gained for all appropriate data that will be collected At least 24 hours after they have
received study information they will be asked if they will consent to participate in the
study and then visit the Cairn Centre for a test. Wave 1 participants will be invited to
provide standard information about people that they injected with, as described above, to
enable an egomap to be constructed. The participant will be supported to complete a standard
form containing the minimum dataset required to construct the egomap. The Standard dataset
is: Name; approximate age; area of town/city; Ethnicity; Strength of tie (How often they
injected with this person - Likert scale). Specialist nurses from the clinical team who work
at the Cairn Centre will talk to Seeds about sensitively approaching individuals who they
have discussed who they used to inject with and about how people who are approached can
access HCV testing. The information collected will be used to identify how many potential
contacts the participant has knowledge of and compared to the actual recruitment and to
ascertain the relationships between one injecting network and an adjacent network.
The people handed coupons by the Wave 1 participants will constitute Wave 2 participants.
When the wave 2 participant present for HCV testing, the person testing them will follow the
same procedure as outlined above so that the participant can be advised of their test result
and be referred for on-going care and treatment if required. The wave 2 participants will
receive the same training and guidance as the wave one participants received. Study
procedures regarding inclusion, exclusion and consent will be identical for each Wave.
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