1. Psychosocial support for IDUs and effects on HCV treatment Bernd Schulte

2. Determinants for heath care utilisation Andersen 1995 Health care system External environment Predisposing characteristics Enabling resources Need Personal health practices Use of health services Perceived health status Evaluated health status Consumer satisfaction EnvironmentPopulation characteristicsOutcomes Health behaviour

3. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

4. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

5. Knowledge Improvement Among MMT Clients in a Hepatitis Intervention Program  RCT: 256 alcohol drinking MMT clients  Interventions: MI-Individual vs. MI-Group vs. Nurse-led HHP  Measures: – 6-item HBV & 7-item HCV “Knowledge & Attitudes towards Hepatitis tool” – Baseline and 6-month follow-up Nyamathi et al. 2010

6. Improvement Among MMT Clients in a Hepatitis Intervention Program  Overall, knowledge of HCV/HBV increased significantly from pretest to posttest (P <.0001) Nyamathi et al. 2010 Program type Improvement in knowledge mean (SE) HBVHCV MI-I3.08 (0.36)3.78 (0.42) MI-G2.62 (0.44)4.17 (0.36) NL-HHP3.33 (0.42)4.24 (0.42)

7. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

8. Managed care networks (MCN) to improve access to HCV specific care  Majority of HCV + individuals referred by medical staff (i.e. GPs), most of them not attending HCV clinic  Single mode of referral is not effective enough  Interventions: Managed care networks (MCN) – Incorporation of relevant stakeholders – Referral protocol, educational sessions – Referral pathway including nonmedical referrals – Outreach clinics in drug treatment- and prison clinics. Tait et al. 2009

9. Managed care networks (MCN) to improve access to HCV specific care  Total access to care increased from 61% to 82% Tait et al. 2009

10. Managed care networks (MCN) to improve access to HCV specific care Tait et al. 2009

11. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

12. 20-minute educational program to accept HCV treatment Gupta et al. 2009

13. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  HCV treatment uptake  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

14. HCV self-management programme  RCT: 132 HCV + patients  Intervention: 6-weeks HCV self-management programme (2-h weekly) vs. information-only  Main measures at baseline and 6 weeks later: – HRQOL: SF-36; HQLQ – HCV knowledge: 15 item questionnaire – Self-efficacy: HCV-specific self-efficacy questions Groessl et al. 2010

15. HCV self-management programme  Self-management programmes can improve HCV disease knowledge and HRQOL Groessl et al. 2010

16. HCV self-management programme: 1 year follow-up Groessl et al. 2013

17. HCV self-management programme and SVR Groessl et al. 2013

18. Influenceable variables for HCV treatment success  Knowledge  Access to HCV care  Readiness for HCV treatment  HCV treatment uptake  Improved HCV treatment outcomes – Health related quality of life – Sustained virological response (SVR)

19. Nurse-led psychoeducation and SVR  RCT: 244 HCV + GT1 patients  Intervention: Medical consultation + systematic nurse-led PE vs. medical consultation  Measure: SVR evaluated at 12 and 24 weeks after the end of treatment Larrey et al. 2011

20. Nurse-led psychoeducation and SVR Larrey et al. 2011

21. Multidisciplinary support programme increases the efficiency of HCV treatment  RCT: 447 patients in antiviral HCV treatment  Intervention: – Multidisciplinary support programme (MSP): (Hepatologist/Nurse, Psychologist, Pharmacists, Psychiatrist) – Treatment as usual (TAU) ( Hepatologist/Nurse) – 3 groups: MSP, TAU, MSP validation group  Measures: – Impact of MSP on adherence to HCV treatment – Efficacy (SVR) Carrion et al. 2013

22. MSP increases efficiency of HCV treatment Carrion et al. 2013

23. MSP increases efficiency of HCV treatment Rates of SVR according to HCV- genotype in the MSP, control, and MSP-validation groups. AllGT1GT2/3GT4 Carrion et al. 2013

24. Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution  Controlled, Prospective Multicenter Trial with 189 OST patients in antiviral HCV treatment  HCV specific PE (group) intervention vs. TAU – Module 1: HCV infection, risk factors, etc. – Module 2: HCV treatment, side effects, etc. – Module 3: Coping strategies, self-help, etc.  PE sessions and follow-ups – GT1/4: 12 + 10 – GT2/3: 12 PE + 5 Reimer et al. 2013

25. Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution Figure 2: Completion of treatment depending on GT and PE Figure 1: Completion of treatment depending on GT and PE Reimer et al. 2013

26. Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution Figure 2: Completion of treatment depending on GT and PE Figure 2: SVR depending on GT and the number of attended PE sessions Reimer et al. 2013

27. Psychoeducation Improves Hepatitis C Virus Treatment in Opioid Substitution Figure 2: Completion of treatment depending on GT and PE Figure 3: Completion per protocol depending on GSI score and PE Reimer et al. 2013

28. Determinants for heath care utilisation Andersen 1995 Health care system External environment Predisposing characteristics Enabling resources Need Personal health practices Use of health services Perceived health status Evaluated health status Consumer satisfaction EnvironmentPopulation characteristicsOutcomes Health behaviour KNOWLEDGE and COMPETENCE COSTS MOTIVATION SVR HRQOL

29. Thank you for your attention! B.Schulte@uke.de