Instruments

The primary outcome, frequency of injection with a sterile syringe, was asked in the following way, “In the past 12 months when you injected, how often did you use a new, sterile needle? By a new, sterile needle, I mean a needle never used before by anyone, even you.” Participants responded using Likert scale options from never, rarely, about half the time, most of the time, or always. Items were coded along a five-point scale where higher values reflect increased risk behavior (i.e., zero indicates always using a new, sterile syringe and four indicates never using a new, sterile syringe in the past 12 months). Participation in drug treatment programs was assessed with the question: “Have you ever participated in a drug treatment program?” Previous knowledge of HCV status was assessed by asking, “Has a doctor, nurse, or other healthcare provider ever told you that you had hepatitis?” For those who answered yes, they were prompted to indicate which type of hepatitis they had. HCV status was confirmed by screening for HCV antibodies using OraQuick HCV Rapid Anitbody Test (OraSure Technologies, Inc.).