title: Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study.
abstract: BACKGROUND
  The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign.
  
  
  METHODS
  The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey.
  
  
  RESULTS
  Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa).
  
  
  CONCLUSIONS
  Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression.
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia. Electronic address: amarshall@kirby.unsw.edu.au.
authors.forename: A D
authors.initials: AD
authors.lastname: Marshall
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Micallef
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Erratt
authors.affiliation: Centre for Health and Social Research, Australian Catholic University, VIC, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Telenta
authors.affiliation: Centre for Social Research in Health, UNSW Australia, NSW, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Treloar
authors.affiliation: NSW Users and AIDS Association, Inc., NSW, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Everingham
authors.affiliation: Centre for Health and Social Research, Australian Catholic University, VIC, Australia.
authors.forename: S C
authors.initials: SC
authors.lastname: Jones
authors.affiliation: NSW Users and AIDS Association, Inc., NSW, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Bath
authors.affiliation: St Vincent's Hospital Sydney, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: How-Chow
authors.affiliation: Australian Injecting and Illicit Drug Users League, ACT, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Hepatitis NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Harvey
authors.affiliation: University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Dunlop
authors.affiliation: Australian Injecting and Illicit Drug Users League, ACT, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Jauncey
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia; Kirketon Road Centre, NSW, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Read
authors.affiliation: Coffs Harbour Drug and Alcohol Service, NSW, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Collie
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia.
authors.forename: G J
authors.initials: GJ
authors.lastname: Dore
authors.affiliation: The Kirby Institute, UNSW Australia, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Grebely
mesh_terms: D000328:Adult; D001315:Australia; D059788:Dried Blood Spot Testing; D054459:Elasticity Imaging Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D010353:Patient Education as Topic; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D055815:Young Adult
keywords: Drug users; HCV; Hepatitis C; Knowledge; PWID; Willingness