Non-Medical Staff Knowledge, Beliefs and Practices about HIV and Hepatitis for Injection Drug Users Rowe, KA 1, Tesoriero, JM 1, Heavner, KK 1, Rothman, J 1, Litwin, AH 2, Slifer, M 1, Birkhead, GS 1 1 New York State Department of Health, AIDS Institute. 2 Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.

Background Globally, an estimated 170 million persons are chronically infected with the hepatitis C virus (HCV) and 3 to 4 million persons are newly infected each year. There are 3.9 million Americans estimated to be chronically infected with HCV. In the U.S., nearly 90% of individuals newly diagnosed with HCV have a history of injection drug use (IDU).

Background (continued…) Injection drug use is also among the leading risk factors for HIV/AIDS in the U.S. and accounts for just under one- third of new HIV infections outside of sub-Saharan Africa. Currently about 1 million Americans are infected with HIV and 300,000 Americans are co-infected with HIV and HCV.

Background (continued…) There are approximately 170,000 active IDUs in New York State; 125,000 active IDUs reside in New York City. Injection drug users are at increased risk for contracting both HIV and HCV.

Background (continued…) Historically IDUs have had less access to HCV evaluation and treatment than HIV related services. For example, in many syringe exchange programs (SEPs) and methadone maintenance treatment programs (MMTPs) few hepatitis services exist and if services do exist, HCV treatment is seldom utilized. The literature has also demonstrated that drug treatment providers are often skeptical about the efficacy of hepatitis treatment.

Viral Hepatitis Integration Project (VHIP) Five year grant from CDC that began October 2004 (CDC Grant #U50/CCU224192). Project seeks to integrate hepatitis screening, testing, prevention and treatment into drug treatment and substance use settings already providing HIV services to clients.

VHIP Sites in New York City Two SEPs (both SEPs have multiple sites) One MMTP – Albert Einstein College of Medicine (AECOM) (also has multiple sites) Note: many types of services are typically offered in both SEPs and MMTPs (for example, HIV testing, support groups, outreach, counseling, case management, etc.)

VHIP Services - SEPs Services available on-site: Hepatitis coordinator HAV, HBV and HCV screenings HAV and HBV vaccinations HCV evaluation and treatment referrals Hepatitis educational materials

VHIP Services - MMTPs Enhancement of services: Hepatitis coordinator & hepatitis educator Provide on-site evaluation and treatment for HCV+ clients Client-centered support groups and peer education Hepatitis educational materials

VHIP Primary Evaluation Activities Non-Medical Staff Survey Medical Staff Survey Client Survey Hepatitis Service Tracking System Educational Materials Focus Groups

VHIP Non-Medical Staff Component Assess non-medical staff’s knowledge, beliefs and current practices regarding hepatitis screening, vaccination and treatment for current and former IDUs. Provide education through training to non-medical staff. Reassess knowledge, beliefs and practices regarding hepatitis screening, vaccination and treatment to measure change.

Non-Medical Staff Training Topics Introduction to hepatitis and the liver -Functions of the liver -What is hepatitis? Hepatitis A, B and C -Prevalence -Prevention -Transmission -Disease course -Diagnosis and testing -Treatment Integrating hepatitis services into substance use programs

Measures – Survey Instrument Confidential self-administered 15 minute baseline survey assessing: - Demographics; - Knowledge of hepatitis; - Beliefs regarding hepatitis; - HIV and hepatitis proficiency; - HIV and hepatitis prevention and screening practices in past 12 months.

Response Rate 165 out of 172 eligible non- medical staff from 3 agencies attended a 2-day training and completed the Non-Medical Staff Survey (96% response rate).

Description of Participants MMTP (n=116) SEP (n=48) Total (n=164) Mean age (n)42.4 (111)42.7 (48)42.5 (159) Gender (n) (p=0.028) Male30.4%48.9%35.7% Female69.6%51.1%64.3% Race/ethnicity (n) Hispanic30.7%35.4%32.1 % Non-Hispanic black43.9%43.8% Non-Hispanic white18.4%16.7%17.9% Non-Hispanic other or mixed race7.0%4.2%6.2 % Saw HCV+ clients in past 12 months (n)(101)(36)(137) Yes91.1%86.1%89.8% No 8.9%13.9%10.2%

Job Titles of Participants MMTP (n=116) SEP (n=47) Total (n=163) Counselor or harm reduction specialist 53.4%10.6%41.1% Educator or outreach worker4.3%34.0%12.9% Case worker/manager or health care coordinator 7.8%19.1%11.0% Administrator, program manager or supervisor 7.8%14.9%9.8% Social Worker10.3%4.3%8.6% Nurse7.8%0.0%5.5% Other8.6%17.0%11.0%

Knowledge of Hepatitis Risk Factors* *Statements are true. **SEP 45%, MMTP 25%, p=0.01

Knowledge of Hepatitis Prevention* *Statements are true unless otherwise indicated.

Knowledge of Hepatitis Disease* *Statements are true. **SEP 76%, MMTP 90%, p=0.03

Knowledge of Hepatitis Treatment* *Statements are true unless otherwise indicated.

Beliefs About Which Clients are Good Candidates for HCV Treatment *SEP 65%, MMTP 46%, p=0.04

Beliefs about HCV Treatment

Overall HCV and HIV Mean Proficiency

Mean Proficiency in Providing HCV versus HIV Services

Hepatitis & HIV Practices in Past 12 Months *SEP 41%, MMTP 16%, p=0.001; **SEP 46%, MMTP 22%, p=0.003 ***SEP 85%, MMTP 65%, p=0.02

Conclusions Our assessment demonstrated at baseline, as expected, non-medical staff who provide HIV services to IDUs have lower knowledge, less favorable attitudes and practices as well as lower self-rated proficiency levels towards HCV than they have towards HIV. These barriers were addressed by this grant through required training and are continuing to be addressed through on-going technical support. As part of the overall evaluation of this integration grant, staff’s knowledge, beliefs, proficiency and practices will be reassessed in 2007.

Acknowledgements Collaborating Partners: New York Harm Reduction Educators St. Ann’s Corner of Harm Reduction Albert Einstein College of Medicine