Max Hopwood

Factors associated with specialist assessment and treatment for hepatitis C virus infection in New South Wales, Australia

Summary.  Assessment and treatment for hepatitis C virus (HCV) in the community remains low. We evaluated factors associated with HCV specialist assessment and treatment in a cross‐sectional study to evaluate treatment considerations in a sample of 634 participants with self‐reported HCV infection in New South Wales, Australia. Participants having received HCV specialist assessment (n = 294, 46%) were more likely to be have been older (vs <35 years; 35–44 OR 1.64, P = 0.117; 45–54 OR 2.00, P = 0.024; ≥55 OR 5.43, P = 0.002), have greater social support (vs low; medium OR 3.07, P = 0.004; high OR 4.31, P < 0.001), HCV‐related/attributed symptoms (vs none; 1–10 OR 3.89, P = 0.032; 10–21 OR 5.01, P = 0.010), a diagnosis of cirrhosis (OR 2.40, P = 0.030), have asked for treatment information (OR 1.91, P = 0.020), have greater HCV knowledge (OR 2.49, P = 0.001), have been told by a doctor to go onto treatment (OR 3.00, P < 0.001), and less likely to be receiving opiate substitution therapy (OR 0.10, P < 0.001) and never to have seen a general practitioner (OR 0.24, P < 0.001). Participants having received HCV treatment (n = 154, 24%) were more likely to have greater fibrosis (vs no biopsy; none/minimal OR 3.45, P = 0.001; moderate OR 11.47, P < 0.001; severe, OR 19.51, P < 0.001), greater HCV knowledge (OR 2.57; P = 0.004), know someone who has died from HCV (OR 2.57, P = 0.004), been told by a doctor to go onto treatment (OR 3.49, P < 0.001), were less likely to have been female (OR 0.39, P = 0.002), have recently injected (OR 0.42, P = 0.002) and be receiving opiate substitution therapy (OR 0.22, P < 0.001). These data identify modifiable patient‐, provider‐ and systems‐level barriers associated with HCV assessment and treatment in the community that could be addressed by targeted interventions.

Hepatitis C and injecting-related discrimination in New South Wales, Australia

Hepatitis C-related discrimination is reportedly common, however few studies have investigated this phenomenon. This paper presents findings from a cross-sectional study of people with self-reported hepatitis C virus (HCV) infection (N = 504) conducted in New South Wales (NSW), Australia throughout 2001 and 2002. Participants completed a self-administered questionnaire enquiring into their experience of living with HCV. Over a half of the participants (57.5%, n = 290) reported that they had acquired their infection from injecting drug use. Discrimination was reported by 64.7% (n = 326) of participants and healthcare was the most commonly reported site where discrimination occurred. A logistic regression identified the predictors of any discrimination as: knowing many other people with HCV infection; feeling tired due to HCV symptoms; and being younger (<51 years). Predictors of higher levels of discrimination were: knowing many other people with HCV infection; being limited in the time spent with family, friends, neighbours and groups due to HCV; and feeling pessimistic about HCV treatment and the future because of HCV-related ill health. Although discrimination occurred in a range of social domains, effort is needed to improve healthcare workers’ service delivery to people with HCV. Continued discrimination may inhibit people from seeking a range of health services and impede efforts to contain the epidemic.

Factors associated with hepatitis C knowledge among a sample of treatment naive people who inject drugs

BACKGROUND Assessment and uptake of treatment for hepatitis C among people who inject drugs (PWID) is low and strategies to enhance hepatitis C care in this group are needed. Knowledge of hepatitis C and its treatment is one precursor to decisions about treatment. METHODS We conducted a cross-section study designed to evaluate treatment considerations in participants with self-reported hepatitis C infection in New South Wales, Australia. Participants were recruited from needle and syringe programs, opiate substitution clinics, pharmacies that dispensed opiate substitution treatment and from the mailing list of a community-based hepatitis C organisation and completed a self-administered survey. Knowledge of hepatitis C was assessed by a 48-item scale addressing the natural history and treatment of hepatitis C. Factors associated with knowledge were assessed by ordinal regression. RESULTS Among the 997 participants recruited, 407 self-reported acquiring hepatitis C through injecting drug use and had never received hepatitis C treatment. Knowledge about hepatitis C was overall poor and the effects of the long term consequences of hepatitis C were over-estimated. Higher knowledge scores were associated with recruitment site, higher education levels and recent contact with a general practitioner. One-third of participants indicated that they did not intend to have treatment and one-fifth did not answer this question. CONCLUSION Knowledge is a precursor to informed decisions about hepatitis C treatment. These results indicate that efforts to support those less engaged with hepatitis C care (and specifically those on opiate substitution treatment) and those with lower literacy are required.

The Experience of Interferon-Based Treatments for Hepatitis C Infection

Clinical trials of interferon-based treatments for hepatitis C infection show decrements in patients’ health-related quality of life due to side effects of therapy. The impact of side effects on patients’ overall quality of life still remains unclear. To explore this issue, the authors interviewed people living in New South Wales, Australia, who had undergone treatment for hepatitis C. Their aim in this article is to report participants’ experiences of treatment side effects. In Australia, this information is important, because a new interferon-based regimen has been adopted as the mainstay of hepatitis C treatment, and it is predicted that many more people will seek treatment. The authors argue for further qualitative research to enhance knowledge of the impact of this therapy.

Heterosexual attitudes to homosexuality: Homophobia at a rural Australian university.

Abstract This study compared attitudes towards homosexuality of 164 students from two faculties at a rural Australian university. Eighty-two percent of participants were aged from 18–24 years, 65% percent of the sample were female with 58% of participants enrolled in a humanities course and 42% in a business course. A cross-sectional design using the Heterosexual Attitudes to Homosexuals (H.A.T.H.) and Fear of HIV/AIDS questionnaires found that for the total sample the major predictors of homophobia were fear of HIV/AIDS, gender, religiosity, and academic major. Business majors were significantly more homophobic than humanities majors. The findings imply that homophobia may be prevalent among university faculties and that staff and student programs need to be implemented to address homophobia, especially among business majors and lecturers.

Resilient Coping Applying Adaptive Responses to Prior Adversity during Treatment for Hepatitis C Infection

Social marginalization is associated with poor health outcomes for affected people. However, in a psychosocial study of treatment for hepatitis C infection conducted in Sydney, Australia, participants living in socially disadvantaged circumstances applied adaptive approaches learned from past experiences of drug dependence, living with symptoms of chronic illness, coping with depression and childhood sexual abuse to enable them to cope with severe treatment-related side-effects. This finding has implications for the clinical management of hepatitis C treatment; the factors and processes that facilitate adaptive coping to adversity associated with social marginalization can be assessed for their clinical contribution to coping with an arduous regimen.

Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south-east Sydney

INTRODUCTION AND AIMS The comprehensive needle and syringe distribution system in New South Wales is partly based on the premise that different points of access to injecting equipment may attract different groups of injecting drug users. This paper examines patterns of equipment acquisition and risk for blood-borne virus transmission among injecting drug users who use pharmacies and needle and syringe programs (NSP) in south-east Sydney. DESIGN AND METHODS Clients obtaining injecting equipment from four NSP (n = 147) and eight pharmacies (n = 227) in 2006 voluntarily completed a self-administered questionnaire. Respondents were grouped into three categories based on their needle and syringe acquisition patterns: exclusive use of NSP, exclusive use of pharmacies and use of both. RESULTS Although it was common for respondents to report using both pharmacies and NSP to obtain needles and syringes (57%), a proportion reported exclusive use of pharmacies (17%) and NSP (14%). Exclusive pharmacy users were more likely to have never received treatment for their drug use and the least likely to have had a recent test for hepatitis C. Compared with respondents who exclusively used NSP, respondents who exclusively used pharmacies were more likely to report receptive sharing of injecting equipment (adjusted odds ratio 5.9, 95% confidence interval 2.02-17.14), as were respondents who reported using both sources (adjusted odds ratio 5.8, 95% confidence interval 2.35-14.40). DISCUSSION AND CONCLUSIONS The high prevalence of receptive equipment sharing among pharmacy clients indicates a need to improve access to needles and syringes and ancillary equipment, possibly by including ancillary equipment at no cost in existing pre-packaged pharmacy products.

Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia

BACKGROUND In Australia, sterile needles are distributed to people who inject drugs through formal services for the purposes of limiting the transmission of blood borne viruses (BBV). Secondary exchange (SE) involves people acquiring needles from formal services and redistributing them to others. This paper describes the extent, patterns and contexts of SE in south east Sydney, Australia and examines whether SE is independently associated with BBV risk practices. METHODS Quantitative and qualitative data were collected through a cross-sectional study using surveys and in-depth interviews. Respondents were people using community-based pharmacies to obtain sterile needles and syringes. RESULTS Data were collected from 229 survey respondents, over half of whom (54%) reported SE in the previous month. Of these, 40% engaged in distribution only, 25% in receipt only and 36% in both. Respondents reported passing on 21.7% of their needles to others in the last month, most commonly to friends (51.6%) and partners (27.4%). Recipients of SE were four times more likely than non-secondary exchangers to report borrowing used syringes in the last month. Respondents reported supplying sterile equipment to others to prevent reuse and to reduce risks associated with unplanned drug use. CONCLUSION SE is a common activity in south east Sydney but does not appear to be highly organised, usually taking place in small networks of friends and/or partners for altruistic reasons. Harm reduction programs could capitalise on the prevalence of SE to reach injecting drug users who do not use formal distribution services.

Receiving a hepatitis C-positive diagnosis

Abstract

Disclosing hepatitis C infection within everyday contexts: implications for accessing support and healthcare.

In this paper the authors quantify hepatitis C disclosure outcomes across social contexts and identify the factors associated with widespread disclosure of infection. In a cross-sectional survey of people with hepatitis C (N = 504) more than half reported receiving a bad reaction from someone following disclosure. Unauthorized disclosure occurred, and many participants had been pressured into disclosing their infection. The factors associated with widespread disclosure were: education level; knowing other people with hepatitis C; feeling fatigued; receiving disclosure advice; and experiencing unauthorized disclosure. Bad reactions following disclosure are common and may impede health-seeking behaviour including uptake of hepatitis C treatment.