ETHOS Cohort (Enhanced Treatment for Hepatitis C in Opioid Substitution Settings)

Date Commenced:
January 2009
Project Status
Completed
Expected Date of Completion:
June 2014
Project Supporters

This study was supported by the National Health and Medical Research Council (568985) and New South Wales Health.

Currently recruiting
No
image - Ethos 284x284

About the Project

The purpose of the study is to examine HCV treatment uptake, response to therapy andreinfectionfollowing successful treatment among patients with chronic HCV infection and a history of injection drug use.  Factors that influence treatment uptake and response to therapy among this group will be examined prospectively. The standard HCV treatment efficacy parameters of rapid virological response (RVR), early virological response (EVR), end-of-treatment response (ETR), and sustained virological response (SVR) will be examined. Among subjects achieving an SVR, the rate of re-infection will also be prospectively evaluated. In addition, this study will evaluate the expected cost-effectiveness of providing assessment and treatment for chronic HCV infection in the opiate pharmacotherapy setting.

Aims

The specific objectives of this study are to examine:

  1. Assessment and treatment of HCV in a prospective cohort study, including uptake and response of HCV treatment and associated factors.
  2. Patient and provider attitudes and barriers towards the provision of services for assessment and treatment of HCV infection.
  3. Peer based support as a strategy for enhancing knowledge and uptake of treatment for HCV infection.
  4. Cost effectiveness of providing assessment and treatment for HCV infection in the opiate substitution setting.
Design & Method

The ETHOS Cohort is a prospective observational study developed to examine uptake of HCV treatment, response to HCV treatment and incidence of re-infection following SVR in people with chronic HCV and a history of IDU.

A network of clinics (primarily opiate pharmacotherapy clinics) was established in 2008 and the cohort began enrolling participants in 2009.  The partnership grant has allowed expansion of the cohort to include additional clinics, increase recruitment and greater length of follow up of participants.

Specialised HCV services have been established on-site at each participating clinic, run by nursing staff with support from specialist physicians.  At baseline and each 6-monthly follow-up visit, comprehensive standardised data is collected via patient and practitioner administered surveys, case note review and pathology tests.  Data collected includes demographics, medical and psychiatric history, current/previous drug and alcohol use, markers of liver disease, history of HCV assessment and treatment, willingness to receive treatment, social functioning and psychological health.  HCV treatment details and standard HCV treatment efficacy parameters are collected for those participants who commence HCV treatment.

Both patient and provider attitudes and barriers towards the provision of services for assessment and treatment of HCV infection and peer based support, as a strategy for enhancing knowledge and uptake of treatment for HCV infection, were also evaluatedby qualitative methods.

One of the most innovative components of the ETHOS project is the use of peer‐based support to improve knowledge and enhance HCV treatment uptake and completion. The partnership with community‐based organisations is crucial to the development and evaluation of the peer‐based support.

Progress/Update

The ETHOS Cohort is a prospective observational study developed to examine uptake of HCV treatment, response to HCV treatment and incidence of re-infection following SVR in people with chronic HCV and a history of IDU.

A total of 415 participants were enrolled in the ETHOS Cohort and 111 commenced HCV treatment.

Benefits

Increasing the proportion of HCV infected illicit drug users assessed and treated for HCV infection is a crucial and necessary component towards reducing the future disease and cost burden of HCV in the developed world.Understanding HCV treatment uptake, response to therapy and subsequent re-infection risks in this population will be paramount in further advancing these goals.

Output

 

Type

Journal

Title

Authors

Manuscript

Drug and Alcohol Review, 2012 May; 31 Issue 7; pg 918-24

Knowledge and barriers associated with assessment and treatment for hepatitis c virus infection among people who inject drugs.

Carla Treloar, Peter Hull, Gregory Dore & Jason Grebely

Manuscript

Clinical Infectious Diseases, 2013 Aug; 57 Suppl 2; S62-9

Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opiate substitution setting: the ETHOS study

Maryam Alavi, Jason Grebely, Michelle Micallef, Adrian J. Dunlop, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore; for the ETHOS Cohort Study Group

Manuscript

Drug and Alcohol Dependence, 2013; Vol 133; Iss3; 529-34

Client and staff experiences of a co-located service for the assessment and treatment of hepatitis C virus infection in the opioid substitution treatment setting: the ETHOS study

Carla Treloar,Jake Rance, Jason Grebely, Gregory J Dore on behalf of ETHOS group

Manuscript

International Journal on Drug Policy (In press), Jan 2014

How to build trustworthy hepatitis C services in an opioid treatment clinic?: A qualitative study of clients and health workers in a co-located setting

Carla Treloar &Jake Rance on behalf of the ETHOS study group

Manuscript

Addiction, 2013; Vol 109 Issue 3, 452-459

'Not just Methadone Tracy': Transformations in service-user identity following the introduction of hepatitis C treatment into Australian opiate substitution settings.

Jake Rance& Carla Treloar on behalf of the ETHOS Study Group

Manuscript

Journal of Viral Hepatitis, 2014 Aug; 21 Suppl 8; 560-67

Barriers and facilitators for assessment and treatment of hepatitis C virus infection in the opioid substitution treatment setting: insights from the ETHOS study

Carla Treloar, Jake Rance, Gregory J Dore, Jason Grebely on behalf of the ETHOS Study Group

Manuscript

Accepted: Journal of Viral Hepatitis

Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: The ETHOS Study

Maryam Alavi, Jason Grebely, Michelle Micallef, Adrian J. Dunlop, Annie C. Balcomb, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore; for the ETHOS Cohort Study Group

Manuscript

Submitted: International Journal on Drug Policy

Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia

Carla Treloar,Jake Rance, Nicky Bath, Hope Everingham, Michelle Micallef, Carolyn Day, Sue Hazelwood, Jason Grebely, Greg Dore

Article

Users News Magazine

ISSUE 58 Spring 2009

Should YOU be thinking about hepatitis C treatment?

Alexa Gillman and Marianne Jauncey

Article

Hep Review December 2009, Edition 67, pg. 22

Treating Hep C in methadone clinics:  does it work?

Alexa Gillman and Marianne Jauncey

Article

Hep Review feature article June 2012, Edition 77, pg. 36-39

Taking hep C treatment to the people: The Newcastle Pharmacotherapy Service

Peter Lavelle

Report

Presented at: 8th Australasian Viral Hepatitis Conference, 10-12 September 2012, Auckland, New Zealand

Integrating treatment: Key findings from a qualitative evaluation of the Enhancing Treatment of Hepatitis C in Opiate Substitution Settings (ETHOS) study.

Jake Rance& Carla Treloar

 

Project Members
image - 1347600903 Greg Dore
Professor and Program Head
Ph 02 9385 0900
image - 1343955913 Jason Grebely Replace
Senior Lecturer
Ph 02 9385 0957
image - 1344994328 Michelle Micallef2
Clinical Project Coordinator
Ph +61 (0)2 9385 0878
image - 1338781169 Pip Marks
Clinical Trials Manager
Ph +61 (0)2 9385 0886
image - 1338774870 Amanda Erratt
Clinical Project Coordinator
Project Attachment
Other Investigators
  • Dr Carolyn Day: Discipline of Addiction Medicine, University of Sydney, NSW Australia
  • Professor Paul Haber: Drug Health Service, Royal Prince Alfred Hospital, NSW, Australia
  • Professor Carla Treloar: Centre for Social Research in Health (CSRH), UNSW Australia
  • Ms Nicky Bath: NSW Users & Aids Association (NUAA), NSW Australia
  • Mr Stuart Loveday: Hepatitis NSW, NSW Australia
  • Dr Murray Krahn & Dr Rosie Thein: University of Toronto, Canada
  • Mr Victor Tawil: NSW Department of Health, Australia
Project Collaborators: External

Clinic 36: Royal Prince Alfred Hospital & University of Sydney

Centre for Addiction Medicine: Sydney West Area Health Service

Kite Street Community Health Centre: Greater Western Area Health Service

Gateway Clinic: Nepean & Blue Mountains Local Health Network

Rankin Court Treatment Centre: St Vincent’s Hospital

Regent House: Royal Prince Alfred Hospital

Aboriginal Medical Service: Western Sydney

Kirketon Road Centre: South Eastern Sydney and Illawarra Health Service

Project Contacts

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