Research paper
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

https://doi.org/10.1016/j.drugpo.2015.01.005Get rights and content

Highlights

  • Peer workers were trusted information sources for opioid substitution (OST) clients.

  • Peer workers mediated between OST client and staff to produce better relationships.

  • Peer workers can prepare clients for hepatitis C care.

  • Peer workers are low cost and can contribute to effective use of health resources.

  • Peer workers can change support adherence to hepatitis C treatment.

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.

Introduction

Improving access to and uptake of hepatitis C virus (HCV) treatment to avert the personal, social and health burden of increasing rates of advanced liver disease remains an ongoing challenge (Grebely and Dore, 2014, MacLachlan and Cowie, 2012). Broadening access to HCV treatment beyond the traditional model of the tertiary hospital has been a key strategy (Bruggmann & Litwin, 2013), targeting settings such as general practices (Baker et al., 2014, Hellard and Wang, 2009, Hopwood and Treloar, 2013), community health centres (Alavi et al., 2013, Grebely et al., 2010), prisons (Lloyd et al., 2013) and opioid substitution treatment (OST) (Alavi et al., 2013, Harris et al., 2010, Sylvestre, 2002).

HCV treatment uptake is low due to personal, provider and system levels barriers to care (Grebely and Tyndall, 2011, Morrill et al., 2005). As reviewed elsewhere (Crawford & Bath, 2013), peer support services can facilitate access to HCV treatment for populations that may experience significant barriers to accessing care, particularly people who inject drugs (PWID). Peer support services also have the capacity to support PWID to improve their HCV-related knowledge and gain confidence engaging and negotiating health care systems, sensitise health care providers to the specific needs of PWID clients, and highlight and address systemic barriers (Crawford and Bath, 2013, Norman et al., 2008, Roose et al., 2014). Given OST services’ reputation as a highly regulated and sometimes punitive environment, characterised by frequent tensions between staff and clients (Fraser and valentine, 2008, Harris and McElrath, 2012), peer support workers can often provide a bridge between clients and providers.

A variety of peer support models have been described, including community-controlled and service-generated models (Crawford and Bath, 2013, Roose et al., 2014). These models differ according to the degree of control that the affected community has in the design and delivery of peer support services. Community-controlled models are initiated and managed by drug user organisations in partnership with health services (Norman et al., 2008). Service-generated models are conceived of and managed by a health service and implemented with the involvement of individual peers or peer groups (Galindo et al., 2007, Grebely et al., 2010, Roose et al., 2014, Sylvestre and Zweben, 2007, Wollhouse et al., 2013). To date there has been little research on community-controlled models relative to service-generate models.

This study examined the performance of two (newly established) community-controlled peer support services from the client, staff and peer worker perspectives. The peer support service was introduced within a larger study aimed at increasing access to HCV care and treatment in the OST setting.

Section snippets

Methods

As described in detail elsewhere (Alavi et al., 2013), the ETHOS study was designed to evaluate an innovative model for the provision of HCV assessment and treatment among people with a history of injecting drug use in NSW, Australia. The core components of the ETHOS model include the provision of on-site HCV nursing and physician assessment and treatment in clinics with existing infrastructure for addiction care (the majority of services had limited previous experience in providing HCV care).

Results

Thirty-one client participants (age range, 25–58 years) were recruited (16 from clinic 1 and 15 from clinic 2), with 9 having ‘no assessment’, 11 having an ‘initial assessment’ and 8 were ‘awaiting or had initiated treatment’. About two-thirds were men (n = 20), nearly all were social security recipients, with four in either full time or part time employment. Four participants identified as Aboriginal and Torres Strait Islander. The 11 staff participants included 5 nurses, 1 ‘witness’ (a person

Discussion

This investigation of a peer support service introduced within two integrated OST/HCV treatment clinics demonstrated its acceptability to both clients and clinic staff. All three 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.

Participant groups noted both the tangible effects of the peer worker service – facilitating client engagement in HCV care – as well as

Competing interests

Nicky Bath conceived of and implemented the peer support service on behalf of NUAA. Hope Everingham was one of the peer workers interviewed as part of this study. All authors would like to emphasise that the information presented in this paper is a true representation of participant responses. Interviews were conducted by Jake Rance. Jake Rance and Carla Treloar conducted the primary analysis and maintained autonomy over the interpretation and presentation of the results following review and

Acknowledgements

This work was supported by the National Health and Medical Research Council (568985) and New South Wales Ministry of Health. The Centre for Social Research in Health and the Kirby Institute are supported by grant from the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. JG is supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship. GD is

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