title: A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care.
abstract: HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients' knowledge about their condition and to overcome barriers to access treatment.
  
  
  
  The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals' workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test.
  
  
  
  Overall, 504 patients with chronic hepatitis C were included: 78 % male, mean age 42.3 ± 6.6 years, 14 % school education ≤ 4 years, disease duration 11.0 ± 6.0 years and 26 % HIV co-infected. A higher baseline knowledge was independently associated with educational level ≥ 10 years (regression coefficient [B] =15.13, p < 0.001), current use of intravenous drugs (B = 7.99, p = 0.038), previous referral for treatment (B = 4.26, p = 0.008) and previous HCV treatment (B = 5.40, p = 0.003). Following HEP, mean knowledge score increased from 69 % to 79 % (p < 0.001). The rate of patient referral to a liver specialist increased from 56.2 % to 67.5 % (p < 0.001).
  
  
  
  An HEP conducted at STDCs improved significantly patient knowledge about hepatitis C, even among patients with a high baseline knowledge. The HEP has also increased the rate of referral to the liver specialist and showed a great potential to support healthcare professionals in managing HCV. Education programs may promote treatment access among PWID, a population that represents the majority of HCV infected patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Lisbon, Hospital Santa Maria - Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, Lisbon, 1649-035, Portugal. ruitatomarinho@sapo.pt.
authors.forename: Rui Tato
authors.initials: RT
authors.lastname: Marinho
authors.affiliation: UD Centro das Taipas, Parque de Saúde de Lisboa - Av. Brasil n.° 53, Pavilhão 2, 1° andar, 1749-002, Lisbon, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Costa
authors.affiliation: ETET de Almada, Rua das Terras dos Cortes Reais n°1, 2805-025, Almada, Portugal.
authors.forename: Teodomiro
authors.initials: T
authors.lastname: Pires
authors.affiliation: ETET do Barreiro, Rua Almirante Reis n°50, 2830-326, Barreiro, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Raposo
authors.affiliation: ETET de Gondomar, Rua Caminho de Pevidal, R/C - S/N, 4420-264, Gondomar, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vasconcelos
authors.affiliation: ETET de Setúbal, Praça da República, 2900-587, Setúbal, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Polónia
authors.affiliation: ETET da Figueira da Foz, Rua Doutor Calado 2, Figueira da Foz, 3080-153, Figueira da Foz, Portugal.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Borges
authors.affiliation: ETET Eixo Oeiras Cascais, Rua Professor Orlando Ribeiro, n.°3A, B, n.° 5A, B e n.° 7, 2740-222, Porto Salvo, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Soares
authors.affiliation: SICAD- General-Directorate for Intervention on Addictive Behaviours and Dependencies, Avenida da República, n° 61, 3° piso, 1050-189, Lisbon, Portugal.
authors.forename: Graça
authors.initials: G
authors.lastname: Vilar
authors.affiliation: MSD Portugal, a subsidiary of Merck & Co., Inc., Quinta da Fonte, Edifício Vasco da Gama, 19, 2770-192, Paço de Arcos, Portugal.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Nogueira
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011174:Portugal; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000628:therapy*
keywords: Chronic hepatitis C treatment; Health education program; Hepatitis C; People who inject drugs; Substance abuse; Treatment access