Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia.
BACKGROUND
Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high; however HCV treatment uptake remains low. New models of care are needed to address the growing burden of HCV-related disease in PWID and to understand the barriers to assessment and treatment of HCV. This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment (OST) clinic with an integrated peer support worker model.


METHODS
Clients with a history of IDU and chronic HCV infection, attending the Newcastle Pharmacotherapy Service, Newcastle Australia, were recruited as part of a multisite prospective observational study (the ETHOS Cohort). Additional chart review was conducted for clients not enrolled in the ETHOS Cohort. A peer support worker was introduced to complement and extend services offered by the clinical team. Client contacts and assessments with a nurse and/or peer worker were evaluated, including those who commenced HCV treatment.


RESULTS
A total of 1447 clients attended the OST service during February 2009 and June 2014. Of these, 378 (26%) were assessed by a nurse and 242 (17%) by a clinician. HCV treatment was commenced by 20 (5%) participants and 15 (75%) achieved a sustained virological response (SVR). During May 2009 and July 2011, 332 nurse contacts and 726 peer worker contacts were evaluated. The nurse-led contacts were related to HCV treatment (50%) and review of pathology tests (34%), whereas peer worker contacts included discussion about HCV treatment (75%), education, counselling and/or support (53%) and general discussion about HCV infection (59%).


CONCLUSIONS
These data demonstrate that peer support workers facilitate broader discussion about HCV treatment, education and/or support, allowing nurses to focus on HCV-related assessment and treatment. HCV treatment uptake was very low in this cohort, but SVR was high. The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care, but further studies are needed to assess their impact on assessment and treatment outcomes.
Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
Julian
J
Keats
The Kirby Institute, UNSW, Kensington, NSW, Australia. Electronic address: mmicallef@kirby.unsw.edu.au.
Michelle
M
Micallef
The Kirby Institute, UNSW, Kensington, NSW, Australia.
Jason
J
Grebely
Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
Susan
S
Hazelwood
Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; NSW Users and AIDS Association, Inc., Sydney, NSW, Australia.
Hope
H
Everingham
Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; NSW Users and AIDS Association, Inc., Sydney, NSW, Australia.
Nikrant
N
Shrestha
Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia.
Tracey
T
Jones
NSW Users and AIDS Association, Inc., Sydney, NSW, Australia.
Nicky
N
Bath
Centre for Social Research in Health, UNSW, Kensington, NSW, Australia.
Carla
C
Treloar
The Kirby Institute, UNSW, Kensington, NSW, Australia.
Gregory J
GJ
Dore
Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia.
Adrian
A
Dunlop
D000328:Adult; D001315:Australia; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D058850:Opiate Substitution Treatment; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010379:Peer Group; D015397:Program Evaluation; D016320:Substance Abuse Treatment Centers; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
Community support; HCV; Peer-based support; People who inject drugs; Treatment