Viral Hepatitis Prevention Project (VHPP) in Massachusetts Curriculum Development and Evaluation Kathleen Gilmore, MS Massachusetts Department of Public Health

VHPP in Massachusetts Funded by CDC in 2000 Integrate viral hepatitis prevention into existing HIV counseling & testing programs HAV, HBV, and HCV testing Immunization for HAV & HBV Five pilot sites Curriculum developed as educational tool and resource manual

MDPH Objectives Develop educational curriculum to support VHPP integration Develop assessment tool Provide training program using the manual Evaluate results of training

VHPP Manual Development Hepatitis C Curriculum Workgroup Epidemiologists Health Educators HIV & Substance Abuse Services staff Hepatitis C Advisory Committee Texas Department of Health Erie County Health Department A curriculum workgroup was convened to develop the content for the VHPP Manual. MDPH thanks the Texas Department of Health and the Erie County Health Department for sharing their existing curricula with us, as it made our task much easier. The content of the curriculum was reviewed and approved by our state-wide Advisory Committee.

VHPP Manual A Guide to Integration “Train the trainer” curriculum Powerpoint presentation included Resource Guide for health & human service providers User registry for updates Order card for other materials Available on website www. masshepc.org The manual was developed to be used as 1. A “train the trainer” educational curriculum with a power point presentation inserted; and 2. As an resource guide for agencies wanting to integrate HCV into their work. It also includes a registry card so that users may receive updates and it is available on our website.

VHPP Assessment JSI Research & Training Institute, Inc. (JSI) Purpose Describe 3 month “experience” of counselors at VHPP pilot sites In terms of: Hepatitis knowledge over time Opinions of MDPH training Experience of integration Evaluation is qualitative The purpose of the evaluation is to describe the early (3 month) experience of counselors and administration from VHPP pilot sites. Their experience is described in terms of hepatitis knowledge over time, opinions about MDPH training, and their experience of integration over time. Given the pilot nature of the program and the small number of participating sites and staff, the report is semi-quantitative and descriptive in nature.

VHPP Assessment – JSI Tools VHPP Manual Pre-training evaluation Post- training evaluation 3 month follow-up evaluation

VHPP Assessment – JSI Methods Training - 2 days day 1 - all MDPH HCV programs day 2 – VHPP sites only 3 months – VHPP sites only All sites completed hepatitis knowledge training satisfaction questions. VHPP sites also given “integration” questions 48 pre-tests and 53 post-tests completed A 1 day training was held in February for all MDPH funded sites. The next day VHPP sites returned to review data collection, informed consent and issues specific to the pilot program. All attendees answered 23 hepatitis knowledge questions and training satisfaction questions. VHPP sites were asked to answer integration questions. In May 2002, an identical assessment was sent to15 VHPP attendees. The purpose was to ascertain if they retained the knowledge learned at the training and to gather information about integration at the sites. 48 pre-tests and 53 post-tests were completed.

Results – Hepatitis Knowledge Responses Mean % (correct) Standard deviation VHPP Pre Post 3 month 11 18 14 83.2 83.6 83.4 8.8 11.6 12.6 Non- VHPP Pre 37 35 69.8 75.2 13.7 22.8 VHPP attendees on average were already knowledgeable about hepatitis prior to the training, and maintained the knowledge over 3 months. VHPP average scores were 13.4 points higher than non-VHPP attendees on the pre-test, and 7.8 points higher on the post-test.

Results – Opinion of MDPH Training Training objectives were met: 94% - 100% Satisfaction with training: 72% - 77% Logical presentation Improve job efficiency Client satisfaction Manual is useful Presenter was effective Among VHPP respondents to the post-test given at the conclusion of the training, there was unanimous agreement that the course objectives were met. The objectives were: Able to differentiate viral hepatitis types Able to educate clients on the epidemiology of hepatitis C Determine clients at risk Recommend appropriate testing Integrate hepatitis messages into their work And coordinate client services In terms of satisfaction, results were consistent across all aspects of content and presentation – 72 – 77%.

Results – Views on Integration I often address HAV with clients pre-training 29% 3 month f/u 54% I often address HBV with clients pre-training 29% 3 month f/u 69% I often address HCV with clients pre-training 71% 3 month f/u 92% On pre-training questionaire, 29% of respondents said they often address HAV and HBV; and 71% often address HCV with clients. 3 months later, rates improved: 54%, 69%, and 92% respectively, in their interactions with HIV clients.

Results – Services Offered Service % responding “most of the time” Pre-test 3 months Distribute materials 56% 64% Provide immunizations 22% 71% Provide HCV testing 25% 79% Referral to medical care 50% 64% In terms of service , there were substantial gains during the 3 months of program implementation. These results suggest that clients are 3 times more likely to receive immunization or testing under the VHPP program than they were prior to it’s implementation. Also, a high percent of respondents (93%) reported that the average initial counseling session lasted 30 minutes or more, with 64% stating the average was 60-90 minutes.The length of follow-up visits was more variable.

Results – VHPP Program Administration Questions % agreed A, B, and C tests are easy to understand 92% Receive result in a timely manner 83% Challenges with forms 50% Take away from counseling 38% Recommend non-english 75% Too long 54% A series of question about program administration were asked. Nearly all respondents agreed hepatitis A, B and C tests were easy to understand. They also received results in a timely manner. Half of the respondents noted challenges with HIV/HCV forms. 38% think they take away from the counseling session, 75% recommended non- English forms, and 54% thought they were too long.

Conclusions Integration is possible – the manual helped the programs make the transition VHPP staff are knowledgeable Clear increase in services in 3 months