Community-based HCV screening: knowledge and attitudes in a high risk urban population

BMC Infectious Diseases

Jason E Stout²  Susanna Naggie²  Anneka Landgraf³  Kim M Huffman⁴  Neela D Goswami²  Emily J Hecker²  Sarah H Timberlake³  Corrine I Voils¹  Brianna L Norton² 

[1] Durham VA Medical Center and Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA;Division of Infectious Diseases and International Health, Duke University Medical Center, Box 102358, Durham, NC 27710, USA;School of Nursing, Duke University Medical Center, Durham, NC, USA;Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA

关键词: Screening;    Patient education;    Hepatitis C;    Healthcare disparities;    Behaviors;    Attitudes;    Health knowledge;   

Others  :  1134703
DOI  :  10.1186/1471-2334-14-74

 received in 2013-08-28, accepted in 2014-01-28,  发布年份 2014

【 摘 要 】

Background

In an attempt to curtail the rising morbidity and mortality from undiagnosed HCV (hepatitis C virus) in the United States, screening guidelines have been expanded to high-risk individuals and persons born 1945–1965. Community-based screening may be one strategy in which to reach such persons; however, the acceptance of HCV testing, when many high-risk individuals may not have access to HCV specific medications, remains unknown.

Methods

We set out to assess attitudes about HCV screening and knowledge about HCV disease at several community-based testing sites that serve high-risk populations. This assessment was paired with a brief HCV educational intervention, followed by post-education evaluation.

Results

Participants (n = 140) were surveyed at five sites; two homeless shelters, two drug rehabilitation centers, and a women’s "drop-in" center. Personal acceptance of HCV testing was almost unanimous, and 90% of participants reported that they would still want to be tested even if they were unable to receive HCV treatment. Baseline hepatitis C knowledge was poor; however, the brief educational intervention significantly improved knowledge and increased acceptability of testing when medical access issues were explicitly stated.

Conclusions

Despite inconsistencies in access to care and treatment, high-risk communities want to know their HCV status. Though baseline HCV knowledge was poor in this population, a brief on-site educational intervention improved both knowledge and acceptability of HCV testing and care. These data support the establishment of programs that utilize community-based screening, and also provide initial evidence for acceptance of the implementation of the recently expanded screening guidelines among marginalized communities.

【 授权许可】

   
2014 Norton et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ: The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006, 144(10):705-714.
• [2]US Department of Health and Human Services: Combating the Silent Epidemic of Viral Hepatitis (Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis). 2011.
• [3]Verna EC, Brown RS Jr: Hepatitis C virus and liver transplantation. Clin Liver Dis 2006, 10(4):919-940.
• [4]Mitchell AE, Colvin HM, Palmer Beasley R: Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology 2010, 51(3):729-733.
• [5]Hagan H, Campbell J, Thiede H, Strathdee S, Ouellet L, Kapadia F, Hudson S, Garfein RS: Self-reported hepatitis C virus antibody status and risk behavior in young injectors. Public Health Rep 2006, 121(6):710-719.
• [6]Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD: The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med 2012, 156(4):271-278.
• [7]Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW: Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology 2010, 138(2):513-521. 521 e511-516
• [8]Rein DB, Wittenborn JS, Weinbaum CM, Sabin M, Smith BD, Lesesne SB: Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States. Dig Liver Dis 2011, 43(1):66-72.
• [9]Centers for Disease Control and Prevention: Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Recomm Rep 1998, 47(RR-19):1-39.
• [10]Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Ward JW: Hepatitis C virus testing of persons born during 1945–1965: recommendations from the Centers for Disease Control and Prevention. Ann Intern Med 2012, 157(11):817-822.
• [11]Moyer VA: Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2013.
• [12]Guerrero HJ GW, Fullmer C: A Novel Method of Reaching at-Risk Populations in Community Outreach Hepatitis Screening Programs. San Fransisco, CA: AASLD; 2008.
• [13]Subiadur J, Harris JL, Rietmeijer CA: Integrating viral hepatitis prevention services into an urban STD clinic: Denver, Colorado. Public Health Rep 2007, 122(Suppl 2):12-17.
• [14]Gunn RA, Murray PJ, Ackers ML, Hardison WG, Margolis HS: Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services. Sex Transm Dis 2001, 28(3):166-170.
• [15]Hadley J, Cunningham P: Availability of safety net providers and access to care of uninsured persons. Health Serv Res 2004, 39(5):1527-1546.
• [16]Gunn RA, Murray PJ, Brennan CH, Callahan DB, Alter MJ, Margolis HS: Evaluation of screening criteria to identify persons with hepatitis C virus infection among sexually transmitted disease clinic clients: results from the San Diego Viral Hepatitis Integration Project. Sex Transm Dis 2003, 30(4):340-344.
• [17]McCusker M: Influence of hepatitis C status on alcohol consumption in opiate users in treatment. Addiction 2001, 96(7):1007-1014.
• [18]Dieperink E, Ho SB, Heit S, Durfee JM, Thuras P, Willenbring ML: Significant reductions in drinking following brief alcohol treatment provided in a hepatitis C clinic. Psychosomatics 2010, 51(2):149-156.
• [19]Ghany MG, Strader DB, Thomas DL, Seeff LB: Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009, 49(4):1335-1374.
• [20]Zeuzem S: Heterogeneous virologic response rates to interferon-based therapy in patients with chronic hepatitis C: who responds less well? Ann Intern Med 2004, 140(5):370-381.
• [21]Davis GL, Lau JY: Factors predictive of a beneficial response to therapy of hepatitis C. Hepatology 1997, 26(3 Suppl 1):122S-127S.
• [22]Cheng WS, Roberts SK, McCaughan G, Sievert W, Weltman M, Crawford D, Rawlinson W, Marks PS, Thommes J, Rizkalla B, et al.: Low virological response and high relapse rates in hepatitis C genotype 1 patients with advanced fibrosis despite adequate therapeutic dosing. J Hepatol 2010, 53(4):616-623.
• [23]Jacobson IM, Gordon SC, Kowdley KV, Yoshida EM, Rodriguez-Torres M, Sulkowski MS, Shiffman ML, Lawitz E, Everson G, Bennett M, et al.: Sofosbuvir for hepatitis C genotype 2 or 3 in patients without treatment options. N Engl J Med 2013, 368(20):1867-1877.
• [24]Lawitz E, Mangia A, Wyles D, Rodriguez-Torres M, Hassanein T, Gordon SC, Schultz M, Davis MN, Kayali Z, Reddy KR, et al.: Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013, 368(20):1878-1887.
• [25]Hunt D, Pockros P: What are the promising new therapies in the field of chronic hepatitis C after the first-generation direct-acting antivirals? Curr Gastroenterol Rep 2013, 15(1):303.
• [26]Litwin AH, Soloway I, Gourevitch MN: Integrating services for injection drug users infected with hepatitis C virus with methadone maintenance treatment: challenges and opportunities. Clin Infect Dis 2005, 40(Suppl 5):S339-345.
• [27]Litwin AH, Smith BD, Drainoni ML, McKee D, Gifford AL, Koppelman E, Christiansen CL, Weinbaum CM, Southern WN: Primary care-based interventions are associated with increases in hepatitis C virus testing for patients at risk. Dig Liver Dis 2012, 44(6):497-503.
• [28]Drainoni ML, Litwin AH, Smith BD, Koppelman EA, McKee MD, Christiansen CL, Gifford AL, Weinbaum CM, Southern WN: Effectiveness of a risk screener in identifying hepatitis C virus in a primary care setting. Am J Public Health 2012, 102(11):e115-121.
• [29]Litwin AH, Harris KA Jr, Nahvi S, Zamor PJ, Soloway IJ, Tenore PL, Kaswan D, Gourevitch MN, Arnsten JH: Successful treatment of chronic hepatitis C with pegylated interferon in combination with ribavirin in a methadone maintenance treatment program. J Subst Abuse Treat 2009, 37(1):32-40.
• [30]Proeschold-Bell RJ, Hoeppner B, Taylor B, Cohen S, Blouin R, Stringfield B, Muir AJ: An interrupted time series evaluation of a hepatitis C intervention for persons with HIV. AIDS Behav 2011, 15(8):1721-1731.
• [31]O’Brien S, Day C, Black E, Dolan K: Injecting drug users’ understanding of hepatitis C. Addict Behav 2008, 33(12):1602-1605.
• [32]Proeschold-Bell RJ, Blouin R, Reif S, Amana A, Rowland BJ, Lombard F, Stringfield B, Muir AJ: Hepatitis C transmission, prevention, and treatment knowledge among patients with HIV. South Med J 2010, 103(7):635-641.
• [33]Krauskopf K, McGinn TG, Federman AD, Halm EA, Leventhal H, McGinn LK, Gardenier D, Oster A, Kronish IM: HIV and HCV health beliefs in an inner-city community. J Viral Hepat 2011, 18(11):785-791.
• [34]Treloar C, Hull P, Dore GJ, Grebely J: Knowledge and barriers associated with assessment and treatment for hepatitis C virus infection among people who inject drugs. Drug Alcohol Rev 2012, 31(7):918-924.
• [35]Mehta SH, Genberg BL, Astemborski J, Kavasery R, Kirk GD, Vlahov D, Strathdee SA, Thomas DL: Limited uptake of hepatitis C treatment among injection drug users. J Community Health 2008, 33(3):126-133.
• [36]Surjadi M, Torruellas C, Ayala C, Yee HF Jr, Khalili M: Formal patient education improves patient knowledge of hepatitis C in vulnerable populations. Dig Dis Sci 2011, 56(1):213-219.
• [37]Doab A, Treloar C, Dore GJ: Knowledge and attitudes about treatment for hepatitis C virus infection and barriers to treatment among current injection drug users in Australia. Clin Infect Dis 2005, 40(Suppl 5):S313-320.
• [38]Lubega S, Agbim U, Surjadi M, Mahoney M, Khalili M: Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response. Liver Int 2013, 33(7):999-1007.
• [39]Hawthorne K, Robles Y, Cannings-John R, Edwards AG: Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008, 3:CD006424.
• [40]Kiene SM, Barta WD: A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior. J Adolesc Health 2006, 39(3):404-410.