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

Kate Mason; Zoë Dodd; Sanjeev Sockalingam; Jason Altenberg; Christopher Meaney; Peggy Millson; Jeff Powis

doi:10.1016/j.drugpo.2015.04.012

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

Int J Drug Policy. 2015 Oct;26(10):1007-13. doi: 10.1016/j.drugpo.2015.04.012. Epub 2015 Apr 29.

Authors

Kate Mason¹, Zoë Dodd¹, Sanjeev Sockalingam², Jason Altenberg¹, Christopher Meaney³, Peggy Millson⁴, Jeff Powis⁵

Affiliations

¹ South Riverdale Community Health Centre, Toronto, Canada.
² Department of Psychiatry, University of Toronto, Toronto, Canada; Medical Psychiatry Program, University Health Network, Toronto, Canada.
³ Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁵ Department of Medicine, University of Toronto, Toronto, Canada; Toronto East General Hospital, Toronto, Canada. Electronic address: jpowi@tegh.on.ca.

PMID: 26005037
DOI: 10.1016/j.drugpo.2015.04.012

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.

Keywords: Active drug use; Community-based; Health care models; Hepatitis C; Social determinants of health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Community Health Services*
Female
Health Services Accessibility
Health Status
Hepatitis C / psychology
Hepatitis C / therapy*
Humans
Male
Middle Aged
Ontario
Patient Care Team*
Peer Group*
Program Evaluation*
Prospective Studies
Self-Help Groups
Socioeconomic Factors
Treatment Outcome