AIDS and Behavior

, Volume 15, Issue 8, pp 1721–1731 | Cite as

An Interrupted Time Series Evaluation of a Hepatitis C Intervention for Persons with HIV

  • Rae Jean Proeschold-Bell
  • Bettina Hoeppner
  • Baishakhi Taylor
  • Sarah Cohen
  • Rachel Blouin
  • Beth Stringfield
  • Andrew J. Muir
Original Paper

Abstract

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.

Keywords

HIV Hepatitis C Intervention research Prevention Interrupted Time Series 

Notes

Acknowledgments

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.

References

  1. 1.
    UNAIDS. Report on the global AIDS epidemic. Geneva: UNAIDS; 2008.Google Scholar
  2. 2.
    Hall HI, Song R, Rhodes P. Estimation of HIV incidence in the United States. JAMA. 2008;300(5):520–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the US. JAMA. 2008;300:520–9.PubMedCrossRefGoogle Scholar
  4. 4.
    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):705–14.PubMedGoogle Scholar
  5. 5.
    Vandelli C, Renzo F, Romano L, et al. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol. 2004;99(5):855–9.PubMedCrossRefGoogle Scholar
  6. 6.
    van de Laar TJ, van der Bij AK, Prins M, et al. Increase in HCV incidence among men who have sex with men in Amsterdam most likely caused by sexual transmission. J Infect Dis. 2007;196(2):230–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Verna EC, Brown RS. Hepatitis C virus and liver transplantation. Clin Liver Dis. 2006;10(4):919–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Rockstroh JK, Mocroft A, Soriano V, et al. Influence of hepatitis C virus infection on HIV-1 disease progression and response to highly active antiretroviral therapy. J Infect Dis. 2005;192(6):992–1002.PubMedCrossRefGoogle Scholar
  9. 9.
    Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med. 2001;345(1):41–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Sherman KE, Rouster SD, Chung RT, Rajicic N. Hepatitis C virus prevalence among patients infected with Human Immunodeficiency Virus: a cross-sectional analysis of the US adult AIDS Clinical Trials Group. Clin Infect Dis. 2002;334:831–7.CrossRefGoogle Scholar
  11. 11.
    Verucchi G, Calza L, Manfredi R, Chiodo F. Human immunodeficiency virus and hepatitis C virus coinfection: epidemiology, natural history, therapeutic options and clinical management. Infection. 2004;32(1):33–46.PubMedCrossRefGoogle Scholar
  12. 12.
    Weber R, Sabin CA, Friis-Møller N, et al. Liver-related deaths in persons infected with the Human Immunodeficiency Virus: the D:A:D study. Ann Intern Med. 2006;166(15):1632–41.CrossRefGoogle Scholar
  13. 13.
    Lima VD, Harrigan R, Bangsberg DR. The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009;50(5):529–36.PubMedCrossRefGoogle Scholar
  14. 14.
    Cribier B, Rey D, Schmitt C, Lang JM, Kirn A, Stoll-Keller F. High hepatitis C viraemia and impaired antibody response in patients coinfected with HIV. AIDS. 1995;9(10):1131–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Soriano V, Sulkowski M, Bergin C, et al. Care of patients with chronic hepatitis C and HIV co-infection: recommendations from the HIV-HCV International Panel. AIDS. 2002;16(6):813–28.PubMedCrossRefGoogle Scholar
  16. 16.
    Sánchez-Quijano A, Andreu J, Gavilán F, et al. Influence of HIV type 1 infection on the natural course of chronic parenterally acquired hepatitis C. Eur J Clin Microbiol Infect Dis. 1995;14(11):949–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Soto B, Sánchez-Quijano A, Rodrigo L, et al. Human immunodeficiency virus infection modified the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol. 1997;26(1):1–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Bica I, McGovern B, Dhar R, et al. Increasing mortality due to end-stage liver disease in patients with Human Immunodeficiency Virus infection. Clin Infect Dis. 2001;32(3):492–7.PubMedCrossRefGoogle Scholar
  19. 19.
    García-Samaniego J, Rodríguez M, Berenguer J, et al. Hepatocellular carcinoma in HIV-infected patients with chronic hepatitis C. Am J Gastroenterol. 2001;96(1):179–83.PubMedGoogle Scholar
  20. 20.
    Rosenthal E, Poiree M, Pradier C, et al. Mortality due to hepatitis C-related liver disease in HIV-infected patients in France (Mortavic 2001 study). AIDS. 2003;17(12):1803–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Chou R, Clark M, Helfand M. Screening for hepatitis C virus infection: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140(6):465–79.PubMedGoogle Scholar
  22. 22.
    McGinn T, O’Connor-Monroe N, Alfandre D, Gardenier D, Wisnivesky J. Validation of a hepatitis C screening tool in primary care. AMA Arch Intern Med. 2008;168(18):2009–13.PubMedCrossRefGoogle Scholar
  23. 23.
    Weaver MF, Cropsey KL, Fox SA. HCV prevalence in methadone maintenance: self-report versus serum test. Am J Health Behav. 2005;29(5):387–94.PubMedGoogle Scholar
  24. 24.
    Walley AY, White MC, Kushel MB, Song YS, Tulsky JP. Knowledge of and interest in hepatitis C treatment at a methadone clinic. J Subst Abuse Treat. 2005;28:181–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Carey J, Perlman DC, Friedmann P, et al. Knowledge of hepatitis among active drug injectors at a syringe exchange program. J Subst Abuse Treat. 2005;29:47–53.PubMedCrossRefGoogle Scholar
  26. 26.
    Heimer R, Clair S, Grau LE, Blumenthal RN, Marshall PA, Singer M. Hepatitis-associated knowledge is low and risks are high among HIV-aware injection drug users in three US cities. Addiction. 2002;97:1277–87.PubMedCrossRefGoogle Scholar
  27. 27.
    McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.PubMedCrossRefGoogle Scholar
  28. 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. 29.
    Shadish W, Cook TD, Campbell D. Experimental and quasi-experimental designs for generalized causal inference. New York: Houghton Mifflin Company; 2002.Google Scholar
  30. 30.
    Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prev Sci. 2000;1(1):31–49.PubMedCrossRefGoogle Scholar
  31. 31.
    Proeschold-Bell RJ, Heine A, Pence BW, McAdam K, Quinlivan EB. A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program. AIDS Patient Care STDs. 2010;24(10):651–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Proescholdbell RJ, Blouin R, Reif S, et al. Hepatitis C transmission, prevention, and treatment knowledge among patients with HIV. South Med J. 2010;103(7):635–41.CrossRefGoogle Scholar
  33. 33.
    Amemiya T. Tobit models: a survey. J Econom. 1984;24:3–61.CrossRefGoogle Scholar
  34. 34.
    Schafer JL, Graham JW. Missing data: our view of the state of the art. Psychol Methods. 2002;7(2):147–77.PubMedCrossRefGoogle Scholar
  35. 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. 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.
  37. 37.
    Scott JD, Wald A, Kitahata M, et al. Hepatitis C Virus is infrequently evaluated and treated in an urban HIV clinic population. AIDS Patient Care STDs. 2009;23(11):925–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–87.PubMedCrossRefGoogle Scholar
  39. 39.
    Beyrer C, Malinowska-Sempruch K, Kamarulzaman A, Kazatchkine M, Sidibe M, Strathdee SA. Time to act: a call for comprehensive responses to HIV in people who use drugs. Lancet. 2010;376:551–63.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rae Jean Proeschold-Bell
    • 1
  • Bettina Hoeppner
    • 2
  • Baishakhi Taylor
    • 3
  • Sarah Cohen
    • 4
  • Rachel Blouin
    • 4
  • Beth Stringfield
    • 5
  • Andrew J. Muir
    • 6
  1. 1.Duke University Global Health Institute, Duke University Center for Health PolicyDuke UniversityDurhamUSA
  2. 2.Center for Addiction Medicine, Massachusetts General HospitalHarvard UniversityBostonUSA
  3. 3.North Carolina Consortium for South Asian StudiesDuke UniversityDurhamUSA
  4. 4.Duke Health Inequalities ProgramDuke UniversityDurhamUSA
  5. 5.Duke University Center for Health PolicyPiedmont HIV Health Care ConsortiumDurhamUSA
  6. 6.Duke Clinical Research Institute, Duke University School of MedicineDuke UniversityDurhamUSA

Personalised recommendations