Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study

A D Marshall; M Micallef; A Erratt; J Telenta; C Treloar; H Everingham; S C Jones; N Bath; D How-Chow; J Byrne; P Harvey; A Dunlop; M Jauncey; P Read; T Collie; G J Dore; J Grebely

doi:10.1016/j.drugpo.2015.07.002

Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study

Int J Drug Policy. 2015 Oct;26(10):984-91. doi: 10.1016/j.drugpo.2015.07.002. Epub 2015 Jul 16.

Authors

A D Marshall¹, M Micallef², A Erratt², J Telenta³, C Treloar⁴, H Everingham⁵, S C Jones³, N Bath⁵, D How-Chow⁶, J Byrne⁷, P Harvey⁸, A Dunlop⁹, M Jauncey⁷, P Read¹⁰, T Collie¹¹, G J Dore², J Grebely²

Affiliations

¹ The Kirby Institute, UNSW Australia, NSW, Australia. Electronic address: amarshall@kirby.unsw.edu.au.
² The Kirby Institute, UNSW Australia, NSW, Australia.
³ Centre for Health and Social Research, Australian Catholic University, VIC, Australia.
⁴ Centre for Social Research in Health, UNSW Australia, NSW, Australia.
⁵ NSW Users and AIDS Association, Inc., NSW, Australia.
⁶ St Vincent's Hospital Sydney, NSW, Australia.
⁷ Australian Injecting and Illicit Drug Users League, ACT, Australia.
⁸ Hepatitis NSW, Australia.
⁹ University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia.
¹⁰ The Kirby Institute, UNSW Australia, NSW, Australia; Kirketon Road Centre, NSW, Australia.
¹¹ Coffs Harbour Drug and Alcohol Service, NSW, Australia.

PMID: 26256938
DOI: 10.1016/j.drugpo.2015.07.002

Abstract

Background: The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign.

Methods: The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey.

Results: Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa).

Conclusion: Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression.

Keywords: Drug users; HCV; Hepatitis C; Knowledge; PWID; Willingness.

Publication types

Observational Study

MeSH terms

Adult
Australia
Dried Blood Spot Testing
Elasticity Imaging Techniques
Female
Health Knowledge, Attitudes, Practice*
Health Promotion / methods*
Hepatitis C / complications*
Hepatitis C / diagnosis
Hepatitis C / psychology
Humans
Liver Cirrhosis / complications*
Liver Cirrhosis / diagnosis*
Liver Cirrhosis / psychology
Male
Patient Education as Topic
Substance Abuse, Intravenous / complications*
Substance Abuse, Intravenous / psychology
Young Adult