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      Improving engagement with healthcare in hepatitis C: a randomised controlled trial of a peer support intervention

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          Abstract

          Background

          Peer support can enable patient engagement with healthcare services, particularly for marginalised populations. In this randomised controlled trial, the efficacy of a peer support intervention at promoting successful engagement with clinical services for chronic hepatitis C was assessed.

          Methods

          In London, UK, potential participants were approached through outreach services for problematic drug use and homelessness. Individuals positive for hepatitis C virus (HCV) after confirmatory testing were randomised using an online service to the intervention (peer support) or standard of care. The primary outcome of interest was successful engagement with clinical hepatitis services. The study was non-blinded. Absolute differences were calculated using a generalised linear model and the results compared to logistic regression.

          Results

          Three hundred sixty-four individuals consented to participate. One hundred one had chronic hepatitis C and were randomised, 63 to receive the intervention (peer support). A successful outcome was achieved by 23 individuals in this arm (36.5%) and seven (18.4%) receiving the standard of care, giving an absolute increase of 18.1% (95% confidence interval 1.0–35.2%, p value = 0.04). This was mirrored in the logistic regression (odds ratio 2.55 (0.97–6.70), p = 0.06). No serious adverse events were reported.

          Conclusions

          Peer support can improve the engagement of patients with chronic HCV with healthcare services.

          Trial registration

          ISRCTN24707359. Registered 19th October 2012.

          Electronic supplementary material

          The online version of this article (10.1186/s12916-019-1300-2) contains supplementary material, which is available to authorized users.

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          Most cited references22

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          Limited uptake of hepatitis C treatment among injection drug users.

          We characterized hepatitis C virus (HCV) treatment knowledge, experience and barriers in a cohort of community-based injection drug users (IDUs) in Baltimore, MD. In 2005, a questionnaire on HCV treatment knowledge, experience and barriers was administered to HCV-infected IDUs. Self-reported treatment was confirmed from medical records. Of 597 participants, 71% were male, 95% African-American, 31% HIV co-infected and 94% were infected with HCV genotype 1; 70% were aware that treatment was available, but only 22% understood that HCV could be cured. Of 418 who had heard of treatment, 86 (21%) reported an evaluation by a provider that included a discussion of treatment of whom 30 refused treatment, 20 deferred and 36 reported initiating treatment (6% overall). The most common reasons for refusal were related to treatment-related perceptions and a low perceived need of treatment. Compared to those who had discussed treatment with their provider, those who had not were more likely to be injecting drugs, less likely to have health insurance, and less knowledgeable about treatment. Low HCV treatment effectiveness was observed in this IDU population. Comprehensive integrated care strategies that incorporate education, case-management and peer support are needed to improve care and treatment of HCV-infected IDUs.
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            Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support.

            We evaluated assessment and treatment for hepatitis C virus (HCV) among illicit drug users accepting referral to a weekly HCV peer-support group at a multidisciplinary community health centre. From March 2005 to 2008, HCV-infected individuals were referred to a weekly peer-support group and assessed for HCV infection. A retrospective chart review of outcomes 3 years after the initiation of the group was conducted (including HCV assessment and treatment). Two hundred and four HCV antibody-positive illicit drug users accepted referral to a weekly HCV peer-support group. Assessment for HCV occurred in 53% of patients(n= 109), with 13% (n= 14) having initiated or completed treatment for HCV infection before attending the support group, evaluation ongoing in 10% (n= 11) and treatment deferred/not indicated in 25% (n= 27). The major reasons for HCV treatment deferral included early disease (30%),drug dependence (37%), other medical (11%) or psychiatric comorbidities (4%). Sixty-eight percent of those deferred for reasons other than early liver disease showed multiple reasons for treatment deferral. The first 4 weeks of support group attendance predicted successful HCV assessment (odds ratio: 6.03, 95% confidence interval:3.27-11.12, P < 0.001). Overall, 28% (n= 57) received treatment. Among individuals having completed pegylated-interferon and ribavirin therapy with appropriate follow-up (n =19), the rate of sustained virologic response was 63% (12/19), despite illicit drug use in 53%. A high proportion of illicit drug users accepting referral to a weekly HCV peer-support group at a multidisciplinary health centre were assessed and treated for HCV infection. Peer support coupled with multidisciplinary care is an effective strategy for engaging illicit drug users in HCV care.
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              Recommendations for the management of hepatitis C virus infection among people who inject drugs.

              In the developed world, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). The burden of HCV-related liver disease in this group is increasing, but treatment uptake among PWID remains low. Among PWID, there are a number of barriers to care that should be considered and systematically addressed, but these barriers should not exclude PWID from HCV treatment. Furthermore, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provides a framework for HCV assessment, management, and treatment. Further research is needed to evaluate strategies to enhance assessment, adherence, and SVR among PWID, particularly as new treatments for HCV infection become available.
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                Author and article information

                Contributors
                helen.stagg@ed.ac.uk
                j.surey@ucl.ac.uk
                marie.francis@ucl.ac.uk
                jennifer.maclellan@ndm.ox.ac.uk
                g.r.foster@qmul.ac.uk
                andre.charlett@phe.gov.uk
                i.abubakar@ucl.ac.uk
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                1 April 2019
                1 April 2019
                2019
                : 17
                : 71
                Affiliations
                [1 ]ISNI 0000000121901201, GRID grid.83440.3b, Institute for Global Health, , University College London, ; 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
                [2 ]ISNI 0000 0004 1936 7988, GRID grid.4305.2, Usher Institute of Population Health Sciences and Informatics, , The University of Edinburgh, ; MacKenzie House, 30 West Richmond Street, Edinburgh, EH8 9DX UK
                [3 ]ISNI 0000 0001 2171 1133, GRID grid.4868.2, Barts Liver Centre, Blizard Institute, , Queen Mary University of London, ; London, E1 2AT UK
                [4 ]ISNI 0000 0004 5909 016X, GRID grid.271308.f, Statistics, Modelling and Economics Department, , Public Health England, ; 61 Colindale Avenue, London, NW9 5EQ UK
                Article
                1300
                10.1186/s12916-019-1300-2
                6442435
                30929642
                a519d234-2df2-4faf-b5ff-d4e2b74e1deb
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 October 2018
                : 6 March 2019
                Funding
                Funded by: Department of Health, UK
                Award ID: 015/0306
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Medicine
                hepatitis c,peer support,peer advocacy,peer worker
                Medicine
                hepatitis c, peer support, peer advocacy, peer worker

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