Psychosocial support for IDUs and effects on HCV treatment Bernd Schulte.

Psychosocial support for IDUs and effects on HCV treatment

Bernd Schulte

Determinants for heath care utilisation

Andersen 1995

Health caresystem

Externalenvironment

Predisposingcharacteristics

Enablingresources

Need

Personalhealth

practices

Use ofhealth

services

Perceivedhealth status

Evaluatedhealth status

Consumersatisfaction

Environment Population characteristics OutcomesHealthbehaviour

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

Knowledge Improvement Among MMT Clients in a Hepatitis Intervention Program RCT: 256 alcohol drinking MMT clients Interventions:

MI-Individual vs. MI-Group vs. Nurse-led HHP Measures:

– 6-item HBV & 7-item HCV “Knowledge & Attitudes towards Hepatitis tool”

– Baseline and 6-month follow-up

Nyamathi et al. 2010

Improvement Among MMT Clients in a Hepatitis Intervention Program Overall, knowledge of HCV/HBV increased

significantly from pretest to posttest (P < .0001)

Nyamathi et al. 2010

Program type

Improvement in knowledge mean (SE)

HBV HCV

MI-I 3.08 (0.36) 3.78 (0.42)

MI-G 2.62 (0.44) 4.17 (0.36)

NL-HHP 3.33 (0.42) 4.24 (0.42)

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

Managed care networks (MCN) to improve access to HCV specific care

Majority of HCV+ individuals referred by medical staff (i.e. GPs), most of them not attending HCV clinic

Single mode of referral is not effective enough Interventions: Managed care networks (MCN)

– Incorporation of relevant stakeholders– Referral protocol, educational sessions – Referral pathway including nonmedical referrals– Outreach clinics in drug treatment- and prison clinics.

Tait et al. 2009

Managed care networks (MCN) to improve access to HCV specific care Total access to care increased from 61% to 82%

Tait et al. 2009

Managed care networks (MCN) to improve access to HCV specific care

Tait et al. 2009

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

20-minute educational program to accept HCV treatment

Gupta et al. 2009

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment HCV treatment uptake Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

HCV self-management programme RCT: 132 HCV+ patients Intervention: 6-weeks HCV self-management

programme (2-h weekly) vs. information-only Main measures at baseline and 6 weeks later:

– HRQOL: SF-36; HQLQ – HCV knowledge: 15 item questionnaire– Self-efficacy: HCV-specific self-efficacy questions

Groessl et al. 2010

HCV self-management programme Self-management programmes can improve HCV

disease knowledge and HRQOL

Groessl et al. 2010

HCV self-management programme: 1 year follow-up

Groessl et al. 2013

HCV self-management programme and SVR

Groessl et al. 2013

Influenceable variables for HCV treatment success

Knowledge Access to HCV care Readiness for HCV treatment HCV treatment uptake Improved HCV treatment outcomes

– Health related quality of life– Sustained virological response (SVR)

Nurse-led psychoeducation and SVR RCT: 244 HCV+ GT1 patients Intervention: Medical consultation + systematic

nurse-led PE vs. medical consultation Measure: SVR evaluated at 12 and 24 weeks after

the end of treatment

Larrey et al. 2011

Nurse-led psychoeducation and SVR

Larrey et al. 2011

Multidisciplinary support programme increases the efficiency of HCV treatment RCT: 447 patients in antiviral HCV treatment Intervention:

– Multidisciplinary support programme (MSP): (Hepatologist/Nurse, Psychologist, Pharmacists, Psychiatrist)

– Treatment as usual (TAU) (Hepatologist/Nurse)

– 3 groups: MSP, TAU, MSP validation group Measures:

– Impact of MSP on adherence to HCV treatment– Efficacy (SVR)

Carrion et al. 2013

MSP increases efficiency of HCV treatment

Carrion et al. 2013

MSP increases efficiency of HCV treatment

Rates of SVR according to HCV-genotype in the MSP, control, and MSP-validation groups.

All GT1 GT2/3 GT4

Carrion et al. 2013

Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution Controlled, Prospective Multicenter Trial with 189

OST patients in antiviral HCV treatment HCV specific PE (group) intervention vs. TAU

– Module 1: HCV infection, risk factors, etc.– Module 2: HCV treatment, side effects, etc. – Module 3: Coping strategies, self-help, etc.

PE sessions and follow-ups– GT1/4: 12 + 10 – GT2/3: 12 PE + 5

Reimer et al. 2013

Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution

Figure 1: Completion of treatment depending on GT and PE

Reimer et al. 2013

Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution

Figure 2: SVR depending on GT and the number of attended PE sessions

Reimer et al. 2013

Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution

Figure 3: Completion per protocol depending on GSI score and PE

Reimer et al. 2013

Determinants for heath care utilisation

Andersen 1995

Health caresystem

Externalenvironment

Predisposingcharacteristics

Enablingresources

Need

Personalhealth

practices

Use ofhealth

services

Perceivedhealth status

Evaluatedhealth status

Consumersatisfaction

Environment Population characteristics OutcomesHealthbehaviour

KNOWLEDGE and COMPETENCE

COSTS

MOTIVATION

SVR

HRQOL

Thank you for your attention!

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