Research paper
Beyond viral response: A prospective evaluation of a community-based, multi-disciplinary, peer-driven model of HCV treatment and support

https://doi.org/10.1016/j.drugpo.2015.04.012Get rights and content

Highlights

  • We prospectively study a community-based hepatitis C (HCV) treatment program serving active drug users in Toronto, Canada.

  • We examine HCV care outcomes and changes in psycho-social status, including social determinants of health and measures of well-being.

  • Participation in the program improved access to HCV care.

  • Housing stability and income supports improved significantly over time.

  • Community-based models of HCV care have benefits beyond Hep C anti-viral treatment.

Abstract

Background

Although the majority of new cases of hepatitis C (HCV) occur among people who inject drugs, very few receive treatment. In response, low-barrier, multidisciplinary models of HCV treatment have emerged in recent years to serve illicit drug users and have demonstrated comparable outcomes to the care delivered in tertiary care settings. However, few studies have measured comprehensive outcomes of these models.

Methods

The Toronto Community Hep C Program (TCHCP) is a community-based partnership between three primary health care centres with integrated specialist support. Program clients were interviewed using standardized questionnaires at three time points (baseline, post completion of HCV support group, and one year post group completion). The primary outcome of this study was self-reported overall health. Secondary outcomes included mental health, substance use, housing and income stability, and access to health care.

Results

TCHCP clients reported high rates of poverty, histories of trauma and incarceration. Physical and mental health co-morbidities were also very common; 78% reported having at least one chronic medical problem in addition to HCV and 41% had a lifetime history of hospitalization for mental health reasons. Participation in the program improved access to HCV care. Prior to joining the TCHCP, only 15% had been assessed by a HCV specialist. By the end of the study period this had increased significantly to 54%. Self-reported overall health did not improve during the study period. Housing status and income showed significant improvement. The proportion of participants with stable housing increased from 54% to 76% during the study period (p = 0.0017) and the proportion of patients receiving income from provincial disability benefits also increased significantly (55% vs 75%, p = 0.0216).

Conclusion

This study demonstrated that a multi-disciplinary, community-based model of HCV treatment improves participant's lives in ways that extend beyond hepatitis C.

Section snippets

Background

Hepatitis C (HCV) is one of the world's most common chronic viral infections, infecting an estimated 170 million individuals worldwide (World Health Organization [WHO], 1998). In Canada, estimated seroprevalence rates are 0.8%, with 4000–6000 new cases occurring each year (Remis et al., 1998, Zou et al., 2000). Although the majority of new cases of HCV occur among people who inject drugs, most illicit drug users are not treated despite the fact that effective therapies exist. Studies in both

Program model

The Toronto Community Hep C Program (TCHCP) is a partnership between three community-based primary health care centres with integrated specialist support from nearby hospitals. The aim of the program, which began in 2007, is to provide low-barrier HCV treatment and support to people who use illicit drugs and/or have mental health issues. In addition to HCV care and treatment, the program offers comprehensive social, emotional and practical supports. The program is anchored by a weekly

Results

A total of 84 individuals were approached to participate in the study, of which six were excluded (two due to negative HCV RNA, one due to language limitations and three who refused to participate). Data was available for 78 individuals at baseline. Post-group (week 16–18) interviews were completed with 75 (96%) participants and 58 (74%) participants at 1-year post-group. Thirty-one individuals were still receiving support from the program at this latter time period. There were three known

Discussion

This study demonstrated that a multidisciplinary, community-based model of HCV treatment can improve access to care for clients with multiple health and social challenges with impacts beyond HCV including significant improvements to key social determinants of health in terms of housing and income.

Participants served by the TCHCP in this study were highly marginalized. The majority of participants reported very low income and education levels, histories of trauma and incarceration. Current

Conclusions

The Toronto Community Hep C Program successfully provides HCV care and support to highly marginalized individuals who would be unlikely to receive treatment elsewhere. Our study shows that community-based, multidisciplinary, harm reduction models of HCV care driven by peer engagement and group support, can lead to improved access to HCV treatment with benefits that extend beyond HCV to key social determinants of health. Even as treatment regimens for Hepatitis C become shorter and easier to

Conflict of interest statement

None declared.

Acknowledgements

The authors acknowledge the support of Regent Park Community Health Centre, South Riverdale Community Health Centre, Sherbourne Health Centre, the Toronto Community Hep C Program Staff and Patient Advisory Board. This study was supported by funding from the Ontario Ministry of Health and Long Term Care, Hepatitis C Secretariat. The authors would also like to thank all of the Toronto Community Hep C Program clients who participated in this study. The views expressed in this paper are those

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