About the Project
This project is designed to investigate the impact of a Healthy Liver Campaign on liver disease knowledge, assessment and treatment. An important part of this study is the development of the messaging and creation of a resource to support the campaign. This campaign is intended for the opiate pharmacotherapy setting, for people with a history of injection drug use.
Liver disease kills nearly 1,500 Australians every year. Many of these deaths could be avoided as the main causes of liver disease are treatable. However, patients with liver disease are often from highly marginalized groups, specifically injecting drug users and people on opiate replacement therapy. These groups have great difficulty accessing healthcare services. This project will raise awareness and encourage treatment of liver disease by providing liver health education & non-invasive liver screening in five opiate substitution clinics over three years. The project's impact will be closely tracked and its results used to encourage policy makers to provide necessary health facilities and services for people living with liver disease.
1. To develop and distribute educational materials and provide peer based trainingon liver disease to injecting drug users and people receiving opiate therapy. Peer based training has proved to be the most effective means of improving health literacy in this population. The project will evaluate whether training improves participants' knowledge of liver disease.
2. Use existing infrastructure and healthcare professionals at five opiate substitution clinics. It will also provide access to non-invasive liver screening equipment which will increase the healthcare professionals ' ability to diagnose & counsel patients with liver disease.
3. Raise awareness of the burden of liver disease and demonstrate the effectiveness of education and screening in reducing this burden.
Design & Method
In this pilot study, participation of five opiate substitution clinics is anticipated. Clinic selection is based on their existing infrastructure (e.g. an examination couch on which to perform non-invasive liver screening, availability of pathology services for blood tests), the involvement of peer support workers to facilitate the campaign, and availability of clinicians for the follow up appointments. A current network of eight New South Wales (NSW) opiate substitution clinics exists through the ETHOS project an NHMRC-funded partnership grant that is examining a model of hepatitis C treatment delivery. Thus, the ETHOS network will facilitate site selection and provides infrastructure components (Clinical Hepatology nurses) that will not require specific funding for the “Healthy Liver” project.
Educational materials will be designed in conjunction with community-based organizations (the New South Wales Users and Aids Association (NUAA) and the Australian Injecting & Illicit Drug Users League (AIVL)) based around existing hepatitis C materials. The new materials will incorporate broad concepts of chronic liver disease and the Healthy Liver.
Peer support workers will be supervised through NUAA and have training sessions related to conduct of the health promotion campaign. They will also receive training in the use of the self-administered surveys to enable them to assist participants if necessary.
A lead-in period at each clinic will be directed at raising awareness of the upcoming campaign. “Healthy Liver” promotion days will undertaken one day per month over a three month period. A range of activities will be incorporated on the “Healthy Liver” days, including: 1) distribution of “Healthy Liver” promotion materials; 2) “Healthy Liver” food distribution; 3) peer-support based discussion; 4) clinical nurse availability for liver disease screening assessments; and 5) assessment of liver fibrosis by non-invasive liver scanning.
After the first cycle is completed, data analysis will be performed looking at demographic information, prevalence of chronic liver disease, and at the impact of “Healthy Liver” Campaign attendance on knowledge of chronic liver disease. Further analyses will be undertaken in year 2 and 3 regarding changes in risk factors, uptake of treatment, and impact on liver clinic attendance.
The ultimate objective of this project is to demonstrate how targeted education and screening can increase uptake of effective interventions for prevention of liver disease. If the project succeeds in achieving this objective, the next step will be to share these results with policy makers and the public so that liver disease receives the attention and ultimately the funding that it requires. For this project, outcomes would include the amount of media coverage that the project's communications activities deliver and the level and results of engagements with policy makers. The participation of NSW Health in the ETHOS partnership grant project, including close working relationships with NCHECR and NUAA, will facilitate the potential impact a successful “Healthy Liver” Campaign project will have on public health policy development.
If this project leads to a significant increase in the number of people receiving treatment for liver disease, it is quite likely that the project's key components – i.e. peer-based education and non-invasive scanning – could become standard practice, not only in the five clinics that the project covers, but in the many institutions that serve the 43,445 people currently receiving opiate substitution in Australia.
The decision to fund these services would rest with the state and other health services that support opiate substitution clinics. However, the information generated through this project will hopefully generate data demonstrating the cost-effectiveness of these services in this setting relative to the cost of treating advanced liver disease.
Professor and Program Head
Ph 02 9385 0900
Senior Research Fellow (UNSW)
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Clinical Project Coordinator
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Clinical Trials Manager
Ph +61 (0)2 9385 0886
Ms Nicky Bath: NSW Users & AIDS Association (NUAA)
Mr Sione Crawford: NSW Users & AIDS Association (NUAA)
Mr Paul Harvey: Hepatitis NSW
Ms Jude Byrne: Australian Injecting & Illicit Drugs Users League (AIVL)
Ms Debbie Ann Wilson: St Vincent’s Hospital
A/Professor Carla Treloar: National Centre in HIV Social Research, University of New South Wales
Professor Sandra Jones: Centre for Health Initiatives, University of Wollongong
Ms Joanne Telenta: Centre for Health Initiatives, University of Wollongong
Ms Alicia Baxter: Immunology & Infectious Disease, St Vincent’s Hospital
Dr Adrian Dunlop: Drug and Alcohol Clinical Services, Hunter New England Local Health Network
Project Collaborators: External
NSW Users & Aids Association (NUAA)
Australian Injecting & Illicit Drugs Users League (AIVL)
Centre for Health Initiatives, University of Wollongong
National Centre in HIV Social Research, University of New South Wales