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1. Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre- and post-universal access to direct-acting antiviral treatment in Australia: The LiveRLife study

Author

Bajis, S ; https://orcid.org/0000-0003-2663-3845, Grebely, J, Hajarizadeh, B, Applegate, T, Marshall, AD ; https://orcid.org/0000-0001-7476-7894, Ellen Harrod, M, Byrne, J, Bath, N, Read, P, Edwards, M, Gorton, C, Hayllar, J, Cock, V, Peterson, S, Thomson, C, Weltman, M, Jefferies, M, Wood, W, Haber, P, Ezard, N, Martinello, M ; https://orcid.org/0000-0001-9444-0186, Maher, L ; https://orcid.org/0000-0001-6020-6519, Dore, GJ, Peolim, L, How-Chow, D, Telenta, J, Harvey, P, Jones, S, Dunlop, A, Treloar, C ; https://orcid.org/0000-0002-8230-0386, Samuel, Y, Poeder, F, Crawford, S, Baxter, A, Keats, J, Mowat, Y ; https://orcid.org/0000-0002-3451-9164, Silk, D, Micallef, M, Tamaddoni, M, Marks, P, Lamoury, F, Jayasinghe, I, Reid, H, Cunningham, EB ; https://orcid.org/0000-0002-8048-3473, Bartlett, S ; https://orcid.org/0000-0003-0699-2250, Jacka, B ; https://orcid.org/0000-0002-5910-853X, Erratt, A, Jauncey, M, Collie, P, Lam, T, Gilliver, R, Hazelwood, S, Houlihan, N, Burns, C, Lewis, R, Morris, D, Donohue, K, Carthew, A, Horasak, N, Cherry, R, Shin, S, Peterson, D, Sellwood, T, McKeown, W, Pritchard-Jones, J, Smyth, F, Adey, S, Clark, K, Grebely, Jason ; https://orcid.org/0000-0002-1833-2017, Applegate, Tanya ; https://orcid.org/0000-0002-8657-4261, Read, Phillip ; https://orcid.org/0000-0001-5422-3777, Hajarizadeh, Behzad ; https://orcid.org/0000-0003-2212-2028, Ezard, Nadine ; https://orcid.org/0000-0002-7495-8305, Dore, Gregory ; https://orcid.org/0000-0002-4741-2622, Edwards, Michael, Bajis, S ; https://orcid.org/0000-0003-2663-3845, Grebely, J, Hajarizadeh, B, Applegate, T, Marshall, AD ; https://orcid.org/0000-0001-7476-7894, Ellen Harrod, M, Byrne, J, Bath, N, Read, P, Edwards, M, Gorton, C, Hayllar, J, Cock, V, Peterson, S, Thomson, C, Weltman, M, Jefferies, M, Wood, W, Haber, P, Ezard, N, Martinello, M ; https://orcid.org/0000-0001-9444-0186, Maher, L ; https://orcid.org/0000-0001-6020-6519, Dore, GJ, Peolim, L, How-Chow, D, Telenta, J, Harvey, P, Jones, S, Dunlop, A, Treloar, C ; https://orcid.org/0000-0002-8230-0386, Samuel, Y, Poeder, F, Crawford, S, Baxter, A, Keats, J, Mowat, Y ; https://orcid.org/0000-0002-3451-9164, Silk, D, Micallef, M, Tamaddoni, M, Marks, P, Lamoury, F, Jayasinghe, I, Reid, H, Cunningham, EB ; https://orcid.org/0000-0002-8048-3473, Bartlett, S ; https://orcid.org/0000-0003-0699-2250, Jacka, B ; https://orcid.org/0000-0002-5910-853X, Erratt, A, Jauncey, M, Collie, P, Lam, T, Gilliver, R, Hazelwood, S, Houlihan, N, Burns, C, Lewis, R, Morris, D, Donohue, K, Carthew, A, Horasak, N, Cherry, R, Shin, S, Peterson, D, Sellwood, T, McKeown, W, Pritchard-Jones, J, Smyth, F, Adey, S, Clark, K, Grebely, Jason ; https://orcid.org/0000-0002-1833-2017, Applegate, Tanya ; https://orcid.org/0000-0002-8657-4261, Read, Phillip ; https://orcid.org/0000-0001-5422-3777, Hajarizadeh, Behzad ; https://orcid.org/0000-0003-2212-2028, Ezard, Nadine ; https://orcid.org/0000-0002-7495-8305, Dore, Gregory ; https://orcid.org/0000-0002-4741-2622, and Edwards, Michael

Abstract

Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19; 95% CI, 1.61-6.32) or physician (aOR, 11.83; 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.

Published
2020

2. The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand.

Author

Tan E., Burcham J., Coggins A.R., Delaney A., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F.B., May K., Peake S., Williams P., Nguyen K., Foong L.H., Hullick C., McNulty R., Na A., Trethewy C., Lutze L., Zhang M., Cowan T., Middleton P., Avis S., Vidler S., Salter M., Janes S., Harwood T., Oliver M., Jazayeri F., Jones S., Davoren M., Coggins A., Pradhananga B., Newby L., Beck S., Sandleback B., Rabas S., Harger S., Song R., Gutenstein M., Munro A., Connely M., Goodson J., Mclean A., Brabyn C., Mukerji S., Simmonds H., Young P., Sugeng Y., Bird C., McConnell A., Henderson P., Johnson D., Perez S., Mahani A., Orda U., Thom O., Roberts K., Kinnear F., Hazelwood S., Pham H., Eley R., Livesay G., Devlin M., Murdoch I., Wood E., Williams J., Brown N., King A., Sadewasser J., Jones L., Gangathimmaiah V., Manudhane A., Haustead D., Ascencio-Lane J.-C., Taylor D.M., Buntine P., Walker K., Pouryahya P., Crompton D., Sultana R., Campbell T., Dwyer R., Blecher G., Knott J., Mitra B., Luckhoff C., Young R., Rudling N., Mukherjee A., Dyke K.-L., Parker C., Cooper A., Nagree Y., Koay K., Kruger C., Ghedina N., Smedley B., Macdonald S., Hamersley H., Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., Blecher G.E., Tan E., Burcham J., Coggins A.R., Delaney A., Fatovich D.M., Fraser J.F., Harley A., Jones P., Kinnear F.B., May K., Peake S., Williams P., Nguyen K., Foong L.H., Hullick C., McNulty R., Na A., Trethewy C., Lutze L., Zhang M., Cowan T., Middleton P., Avis S., Vidler S., Salter M., Janes S., Harwood T., Oliver M., Jazayeri F., Jones S., Davoren M., Coggins A., Pradhananga B., Newby L., Beck S., Sandleback B., Rabas S., Harger S., Song R., Gutenstein M., Munro A., Connely M., Goodson J., Mclean A., Brabyn C., Mukerji S., Simmonds H., Young P., Sugeng Y., Bird C., McConnell A., Henderson P., Johnson D., Perez S., Mahani A., Orda U., Thom O., Roberts K., Kinnear F., Hazelwood S., Pham H., Eley R., Livesay G., Devlin M., Murdoch I., Wood E., Williams J., Brown N., King A., Sadewasser J., Jones L., Gangathimmaiah V., Manudhane A., Haustead D., Ascencio-Lane J.-C., Taylor D.M., Buntine P., Walker K., Pouryahya P., Crompton D., Sultana R., Campbell T., Dwyer R., Blecher G., Knott J., Mitra B., Luckhoff C., Young R., Rudling N., Mukherjee A., Dyke K.-L., Parker C., Cooper A., Nagree Y., Koay K., Kruger C., Ghedina N., Smedley B., Macdonald S., Hamersley H., Keijzers G., Macdonald S.P.J., Udy A.A., Arendts G., Bailey M., Bellomo R., and Blecher G.E.

Abstract

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Method(s): This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Result(s): A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). Conclusion(s): Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.Copyright © 2020 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian

Published
2020

3. The Australasian Resuscitation In Sepsis Evaluation: Fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Author

Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Coggins, AR, Delaney, A, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, FB, May, K, Peake, S, Taylor, DM, Williams, P, Khanh, N, Foong, LH, Hullick, C, McNulty, R, Na, A, Trethewy, C, Lutze, L, Zhang, M, Cowan, T, Middleton, P, Avis, S, Vidler, S, Salter, M, Janes, S, Harwood, T, Oliver, M, Jazayeri, F, Jones, S, Davoren, M, Coggins, A, Pradhananga, B, Newby, L, Beck, S, Sandleback, B, Rabas, S, Harger, S, Tan, E, Song, R, Gutenstein, M, Munro, A, Connely, M, Goodson, J, Mclean, A, Brabyn, C, Mukerji, S, Simmonds, H, Young, P, Sugeng, Y, Bird, C, McConnell, A, Henderson, P, Johnson, D, Perez, S, Mahani, A, Orda, U, Thom, O, Roberts, K, Kinnear, F, Hazelwood, S, Hanh, P, Eley, R, Livesay, G, Devlin, M, Murdoch, I, Wood, E, Williams, J, Brown, N, King, A, Sadewasser, J, Jones, L, Gangathimmaiah, V, Manudhane, A, Haustead, D, Ascencio-Lane, J-C, Buntine, P, Walker, K, Pouryahya, P, Crompton, D, Sultana, R, Campbell, T, Dwyer, R, Blecher, G, Knott, J, Mitra, B, Luckhoff, C, Young, R, Rudling, N, Mukherjee, A, Dyke, K-L, Parker, C, Cooper, A, Nagree, Y, Koay, K, Kruger, C, Ghedina, N, Smedley, B, Macdonald, S, Hamersley, H, Keijzers, G, Macdonald, SPJ, Udy, AA, Arendts, G, Bailey, M, Bellomo, R, Blecher, GE, Burcham, J, Coggins, AR, Delaney, A, Fatovich, DM, Fraser, JF, Harley, A, Jones, P, Kinnear, FB, May, K, Peake, S, Taylor, DM, Williams, P, Khanh, N, Foong, LH, Hullick, C, McNulty, R, Na, A, Trethewy, C, Lutze, L, Zhang, M, Cowan, T, Middleton, P, Avis, S, Vidler, S, Salter, M, Janes, S, Harwood, T, Oliver, M, Jazayeri, F, Jones, S, Davoren, M, Coggins, A, Pradhananga, B, Newby, L, Beck, S, Sandleback, B, Rabas, S, Harger, S, Tan, E, Song, R, Gutenstein, M, Munro, A, Connely, M, Goodson, J, Mclean, A, Brabyn, C, Mukerji, S, Simmonds, H, Young, P, Sugeng, Y, Bird, C, McConnell, A, Henderson, P, Johnson, D, Perez, S, Mahani, A, Orda, U, Thom, O, Roberts, K, Kinnear, F, Hazelwood, S, Hanh, P, Eley, R, Livesay, G, Devlin, M, Murdoch, I, Wood, E, Williams, J, Brown, N, King, A, Sadewasser, J, Jones, L, Gangathimmaiah, V, Manudhane, A, Haustead, D, Ascencio-Lane, J-C, Buntine, P, Walker, K, Pouryahya, P, Crompton, D, Sultana, R, Campbell, T, Dwyer, R, Blecher, G, Knott, J, Mitra, B, Luckhoff, C, Young, R, Rudling, N, Mukherjee, A, Dyke, K-L, Parker, C, Cooper, A, Nagree, Y, Koay, K, Kruger, C, Ghedina, N, Smedley, B, Macdonald, S, and Hamersley, H

Abstract

OBJECTIVES: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. METHODS: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. RESULTS: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87-100). Median time to first intravenous antimicrobials was 77 min (42-148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500-3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000-5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4-8.5%). CONCLUSION: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.

Published
2020

4. Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study

Author

Cunningham, EB ; https://orcid.org/0000-0002-8048-3473, Hajarizadeh, B ; https://orcid.org/0000-0003-2212-2028, Dalgard, O, Amin, J ; https://orcid.org/0000-0003-2161-9366, Hellard, M, Foster, GR, Bruggmann, P, Conway, B, Backmund, M, Robaeys, G, Swan, T, Marks, PS, Quiene, S, Applegate, TL ; https://orcid.org/0000-0002-8657-4261, Weltman, M, Shaw, D, Dunlop, A, Bruneau, J, Midgard, H, Bourgeois, S, Thurnheer, MC, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Grebely, J ; https://orcid.org/0000-0002-1833-2017, Shaw, I, Siriragavan, S, Horschik, T, Sharma, S, Eevers, A, Andreassen, J, Melkeraaen, I, Widder, N, Lesneuck, K, Kotsoros, B, Hazelwood, S, Holland, R, Axten, D, Von Bibra, S, Powis, J, Mason, K, Ryder, S, Jack, K, Scheidegger, C, Huber, C, Ferguson, C, Staehelin, C, Lacalamita, M, Fragomeli, V, Sevehon, A, Cunningham, EB ; https://orcid.org/0000-0002-8048-3473, Hajarizadeh, B ; https://orcid.org/0000-0003-2212-2028, Dalgard, O, Amin, J ; https://orcid.org/0000-0003-2161-9366, Hellard, M, Foster, GR, Bruggmann, P, Conway, B, Backmund, M, Robaeys, G, Swan, T, Marks, PS, Quiene, S, Applegate, TL ; https://orcid.org/0000-0002-8657-4261, Weltman, M, Shaw, D, Dunlop, A, Bruneau, J, Midgard, H, Bourgeois, S, Thurnheer, MC, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Grebely, J ; https://orcid.org/0000-0002-1833-2017, Shaw, I, Siriragavan, S, Horschik, T, Sharma, S, Eevers, A, Andreassen, J, Melkeraaen, I, Widder, N, Lesneuck, K, Kotsoros, B, Hazelwood, S, Holland, R, Axten, D, Von Bibra, S, Powis, J, Mason, K, Ryder, S, Jack, K, Scheidegger, C, Huber, C, Ferguson, C, Staehelin, C, Lacalamita, M, Fragomeli, V, and Sevehon, A

Abstract

Background: The aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection. Methods: ACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). Results: Among 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9-193.8). Conclusions: This study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatm

Published
2017

5. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia

Author

Treloar, C ; https://orcid.org/0000-0002-8230-0386, Rance, J ; https://orcid.org/0000-0001-7782-1235, Bath, N, Everingham, H, Micallef, M, Day, C, Hazelwood, S, Grebely, J ; https://orcid.org/0000-0002-1833-2017, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Treloar, C ; https://orcid.org/0000-0002-8230-0386, Rance, J ; https://orcid.org/0000-0001-7782-1235, Bath, N, Everingham, H, Micallef, M, Day, C, Hazelwood, S, Grebely, J ; https://orcid.org/0000-0002-1833-2017, and Dore, GJ ; https://orcid.org/0000-0002-4741-2622

Abstract

Aim: Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. Methods: Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n = 31), staff (n = 8) and peer workers (n = 3) and examined the operation of the service in relation to process, outputs and impacts. Results: There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing "feel" of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. Conclusions: The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.

Published
2015

6. Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia

Author

Keats, J, Micallef, M, Grebely, J ; https://orcid.org/0000-0002-1833-2017, Hazelwood, S, Everingham, H, Shrestha, N, Jones, T, Bath, N, Treloar, C ; https://orcid.org/0000-0002-8230-0386, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Dunlop, A, Haber, P, Carolyn, D, Gregory, D, Tawil, V, Krahn, M, Loveday, S, Thein, HH, Keats, J, Micallef, M, Grebely, J ; https://orcid.org/0000-0002-1833-2017, Hazelwood, S, Everingham, H, Shrestha, N, Jones, T, Bath, N, Treloar, C ; https://orcid.org/0000-0002-8230-0386, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Dunlop, A, Haber, P, Carolyn, D, Gregory, D, Tawil, V, Krahn, M, Loveday, S, and Thein, HH

Abstract

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%). Conclusion: 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 program

Published
2015

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