An Interrupted Time Series Evaluation of a Hepatitis C Intervention for Persons with HIV
- 233 Downloads
Accurate HCV knowledge is lacking among high-risk groups, including people with HIV/AIDS (PLWHA). Liver disease primarily due to HCV has emerged as a serious cause of mortality among PLWHA. We used an Interrupted Time Series design to evaluate a social-ecologically based intervention for PLWHA, where an infectious disease clinic serving a six-county intervention area was monitored before (7 months) and after (17 months) intervention onset. The intervention included education of PLWHA and medical providers, HIV/HCV support groups, and adaptation of the patient chart top sheet to include HCV test information. Clinic-level outcomes were assessed prospectively every other week for 2 years by interviewing patients (n = 259) with clinic appointments on assessment days. Abrupt, gradual and delayed intervention effects were tested. Weighted regression analyses showed higher average HCV knowledge and a higher prevalence of patients reporting HCV discussion with their medical providers after intervention onset. A delayed effect was found for HCV awareness, and a gradually increasing effect was found for knowing one’s HCV status. Other communities may consider adopting this intervention. Additional HCV interventions for PLWHA with HIV are needed.
KeywordsHIV Hepatitis C Intervention research Prevention Interrupted Time Series
This work was funded by a grant from the Healthy Community Access Program (HCAP) of the Bureau of Primary Health Care, of the Health Resources and Services Administration (HRSA), of the U.S. Department of Health and Human Services (G92CSO2237-02-02). We thank F. Lombard, MSW, for his leadership on this study. We thank Elizabeth Goacher, PA, Duke University Department of Medicine, Division of Gastroenterology, for assisting with the development of the HCV knowledge items, Nathan Thielman, MD, MPH, Duke University Department of Medicine, Division of Infectious Disease, for support in conducting research in the clinic, and Randall Pollard, LCSW, Duke Division of Infectious Disease, for assisting with participant recruitment and response rate data. The intervention could not have happened without Marc Kolman, Patrick Lee, Donna Tennyson, Teresa Hart, Xavier Purefoy, Betsy Barton, Robin Swift, Milford Evans, Tanya McNeill, and Kimberly Walker. We thank the many study interviewers, including Arit Amana, Christie Raulli, Carolyn Vance, Douglas Thomas, Josette Gbemudu, Sharon Abbruscato, and Brian Flores. Most importantly, we thank all the study participants.
- 1.UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2008.Google Scholar
- 28.Stokols D. The social ecological paradigm of wellness promotion. In: Jamner MS, Stokols D, editors. Promoting human wellness: new frontiers for research, practice, and policy. Berkeley, CA: University of California Press; 2000. p. 21–37.Google Scholar
- 29.Shadish W, Cook TD, Campbell D. Experimental and quasi-experimental designs for generalized causal inference. New York: Houghton Mifflin Company; 2002.Google Scholar
- 35.Centers for Disease Control and Prevention. National hepatitis C prevention strategy: a comprehensive strategy for the prevention and control of hepatitis C virus infection and its consequences. Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention; 2001. http://www.cdc.gov/hepatitis/HCV/Strategy/NatHepCPrevStrategy.htm#summary. Accessed 6 Oct 2010.
- 36.National Institutes of Health. Management of hepatitis C. National Institutes of Health Consensus Conference Statement; 2002. http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm. Accessed 27 Oct 2010.