1. ETHOS Cohort
A network of clinics (primarily opiate substitution clinics) was established in 2008 and the cohort began enrolling participants in 2009. 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, will be evaluated by qualitative methods. The qualitative evaluation will include an examination to barriers of engagement in care, assessment and treatment for HCV infection among opiate substitution clients and practitioners.
2. Qualitative Analysis
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 will be evaluated by qualitative methods.
This evaluation will take place in four of the ETHOS clinics. Sites have been selected to include two sites currently providing peer support programs, and two sites which are not currently providing peer support programs.
In total sixty clients will be interviewed and participant groups for clients will include;
· People refusing assessment for HCV infection. That is, person was offered assessment but has not taken up this offer within 2 months.
· People enrolled in ETHOS cohort but not taking up treatment
· People enrolled in ETHOS cohort and progressing to treatment
3. Peer‐Based Support
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 component.
Peer‐based support may vary across the ten ETHOS clinics, but each clinic will form a peer‐based support group that will meet regularly (at least monthly). All patients with chronic HCV will be encouraged to attend, although a major focus of the support group will be support for those considering and on treatment. HCV treatment specific education materials will be developed by the community‐based partner organisations to be distributed across the six clinics. The evaluation of peer‐based support will involve the following components:
· Coverage of specific issues around peer‐based support collected within the qualitative research.
· Further qualitative research among patients who have received HCV treatment, including those with and without regular attendance at the peer‐based support group, and patients who have taken on a role as a peer‐based worker.
· Analyses within the ETHOS Cohort of the impact of peer‐based support on HCV treatment completion and outcomes including HRQoL change.
4. Cost Effectiveness Analysis
A proposal to evaluate the expected cost-effectiveness of providing assessment and treatment for chronic HCV infection in the opiate substitution setting has been developed. Variables required for this analysis will be available by performing data linkage with health registries and the collection of a quality of life instrument.