title: The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS study.
abstract: BACKGROUND
  The objective was to assess social functioning and its association with treatment intent, specialist assessment and treatment uptake for hepatitis C virus (HCV) infection among people with a history of injecting drug use.
  
  
  METHODS
  ETHOS is a prospective observational cohort evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from nine community health centres and opioid substitution treatment clinics (NSW, Australia). Social functioning was assessed using a short form of the Opioid Treatment Index social functioning scale. Those classified in the highest quartile (score >6) were considered having lower social functioning. Analyses were performed using logistic regression.
  
  
  RESULTS
  Among 415 participants (mean age 41 years, 71% male), 24% were considered having lower social functioning, 70% had early HCV treatment intent (intention to be treated in the next 12 months), 53% were assessed by a specialist and 27% initiated treatment. Lower social functioning was independently associated with unemployment, unstable housing, recent injecting drug use and moderate to extremely severe symptoms of depression, anxiety and stress. Lower social functioning was independently associated with reduced early HCV treatment intent (aOR 0.51, 95% CI 0.30-0.84) and lower specialist assessment (aOR 0.48, 95% CI 0.29-0.79), but not HCV treatment uptake (aOR 0.76, 95% CI 0.40-1.43). Living with someone was independently associated with HCV treatment uptake (with someone and children: aOR 2.28, 95% CI 1.01-5.14; with someone and no children: aOR 2.36, 95% CI 1.30-4.31), but not early HCV treatment intent or specialist assessment.
  
  
  CONCLUSIONS
  This study highlights the need for the development and implementation of strategies targeting people who inject drugs with lower social functioning to enhance HCV treatment intent and specialist assessment. Further, strategies to enhance social support may play a role in increasing HCV treatment uptake.
authors.affiliation: Département de médecine familiale et de médecine d'urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Fortier
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alavi
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Micallef
authors.affiliation: University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Dunlop
authors.affiliation: Clinic 96, Kite St Community Health Centre, Orange, NSW, Australia.
authors.forename: Annie C
authors.initials: AC
authors.lastname: Balcomb
authors.affiliation: Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Day
authors.affiliation: Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
authors.affiliation: NSW Users & AIDS Association, Inc., Sydney, NSW, Australia.
authors.forename: Nicky
authors.initials: N
authors.lastname: Bath
authors.affiliation: Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Dore
authors.affiliation: Département de médecine familiale et de médecine d'urgence, Université de Montréal, Montréal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Bruneau
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia. Electronic address: jgrebely@kirby.unsw.edu.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Grebely
mesh_terms: D000328:Adult; D000818:Animals; D015331:Cohort Studies; D017831:Diagnosis, Dual (Psychiatry); D023381:Endpoint Determination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D011817:Rabbits; D012919:Social Behavior; D012959:Socioeconomic Factors; D013038:Specialization; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D014478:Unemployment
keywords: Barriers; Drug users; Education; HCV; PWID; Therapy; Treatment