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Assessment of Hepatitis C Virus Attitudes Towards Treatment Among Methadone Maintenance Treatment Program Staff
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Reported by Jules Levin, AASLD Nov 2 2010 Boston
Andrew H. Talal1, Rositsa Dimova1, Randy Seewald2, Raymond Peterson1, Marija Zeremski1, David Perlman2, Don C. Des Jarlais3
1Center for the Study of Hepatitis C and Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY; 2Department of Medicine and 3Baron Edmond de Rothschild Chemical Dependency
Institute, Beth Israel Medical Center, New York, NY
ABSTRACT
Background & Aims: Although injection drug use is the leading risk factor for
hepatitis C virus (HCV) acquisition, treatment uptake remains exceedingly low due in part to limited HCV-related knowledge among both drug users and drug treatment staff. Staff at methadone maintenance treatment programs (MMTP) may play a crucial role in engaging their patients in HCV treatment. We assessed staff's perceived barriers and willingness to engage in onsite treatment of HCV at Beth Israel Medical Center's MMTP. This program is the largest MMTP in the United States, and it presently refers patients offsite for HCV evaluation.
Methods: We distributed a 25-item, self-administered questionnaire to MMTP personnel and collected it anonymously during staff meetings. Questions concerned three separate domains: HCV management, staff comfort with HCV treatment, and personal information.
Results:
Out of 80 study participants, 64% were aged 46-65 years, 65% were female, 41% were African-American, 69% were non-Hispanic, 39% and 29% had a bachelor's or higher degree, respectively. One half of respondents were counselors and 24% were directly involved in either referring or testing patients for HCV. Although 92% of MMTP staff indicated that they discuss HCV evaluation and treatment with clinic patients at least annually, 70% of the personnel perceived that less than 25% of the patients accept referral for HCV treatment and attend their initial appointment.
The majority of MMTP employees surveyed supported the possibility of onsite evaluation and treatment for HCV (66%), while 19% were unsure, and only 5% responded that HCV management should be offered offsite. Individuals with more education were more likely to endorse onsite HCV management (p = 0.051).
Most staff felt that lack of infrastructure was the biggest obstacle to onsite HCV treatment. Significantly more personnel with medical training (nurses, nurse practitioners, and physician assistants) thought that they are currently able to support patients on HCV therapy when compared to counselors (72% versus 38%, p=0.033). Educational efforts about HCV treatment and its side effects that would target both staff and patients were frequently cited as a requirement for HCV treatment within MMTP.
Conclusions: MMTP staff support onsite HCV evaluation and treatment. Educational interventions about HCV appropriately tailored to different levels of background education and training, targeted to both MMTP patients and staff, are likely to be a necessary prerequisite to achieve maximal participation and optimal therapeutic outcomes.
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