title: Beyond viral response: A prospective evaluation of a community-based, multi-disciplinary, peer-driven model of HCV treatment and support.
abstract: BACKGROUND
  Although the majority of new cases of hepatitis C (HCV) occur among people who inject drugs, very few receive treatment. In response, low-barrier, multidisciplinary models of HCV treatment have emerged in recent years to serve illicit drug users and have demonstrated comparable outcomes to the care delivered in tertiary care settings. However, few studies have measured comprehensive outcomes of these models.
  
  
  METHODS
  The Toronto Community Hep C Program (TCHCP) is a community-based partnership between three primary health care centres with integrated specialist support. Program clients were interviewed using standardized questionnaires at three time points (baseline, post completion of HCV support group, and one year post group completion). The primary outcome of this study was self-reported overall health. Secondary outcomes included mental health, substance use, housing and income stability, and access to health care.
  
  
  RESULTS
  TCHCP clients reported high rates of poverty, histories of trauma and incarceration. Physical and mental health co-morbidities were also very common; 78% reported having at least one chronic medical problem in addition to HCV and 41% had a lifetime history of hospitalization for mental health reasons. Participation in the program improved access to HCV care. Prior to joining the TCHCP, only 15% had been assessed by a HCV specialist. By the end of the study period this had increased significantly to 54%. Self-reported overall health did not improve during the study period. Housing status and income showed significant improvement. The proportion of participants with stable housing increased from 54% to 76% during the study period (p=0.0017) and the proportion of patients receiving income from provincial disability benefits also increased significantly (55% vs 75%, p=0.0216).
  
  
  CONCLUSIONS
  This study demonstrated that a multi-disciplinary, community-based model of HCV treatment improves participant's lives in ways that extend beyond hepatitis C.
authors.affiliation: South Riverdale Community Health Centre, Toronto, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Mason
authors.affiliation: South Riverdale Community Health Centre, Toronto, Canada.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Dodd
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Canada; Medical Psychiatry Program, University Health Network, Toronto, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.affiliation: South Riverdale Community Health Centre, Toronto, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Altenberg
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Peggy
authors.initials: P
authors.lastname: Millson
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada; Toronto East General Hospital, Toronto, Canada. Electronic address: jpowi@tegh.on.ca.
authors.forename: Jeff
authors.initials: J
authors.lastname: Powis
mesh_terms: D003153:Community Health Services; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006526:Hepatitis C / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010348:Patient Care Team; D010379:Peer Group; D015397:Program Evaluation; D011446:Prospective Studies; D012657:Self-Help Groups; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: Active drug use; Community-based; Health care models; Hepatitis C; Social determinants of health