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

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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.

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Notes

  1. For all subsequent analyses, sensitivity analyses were conducted, where the same analyses were conducted with and without patients of American Indian/Alaskan Native background. The absence or presence of these patients did not alter substantive conclusion of the analyses, and thus the full sample analyses are reported here.

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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.

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Authors and Affiliations

  1. Duke University Global Health Institute, Duke University Center for Health Policy, Duke University, Box 90392, Durham, NC, USA

    Rae Jean Proeschold-Bell

  2. Center for Addiction Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Bettina Hoeppner

  3. North Carolina Consortium for South Asian Studies, Duke University, Durham, NC, USA

    Baishakhi Taylor

  4. Duke Health Inequalities Program, Duke University, Durham, NC, USA

    Sarah Cohen & Rachel Blouin

  5. Duke University Center for Health Policy, Piedmont HIV Health Care Consortium, Durham, NC, USA

    Beth Stringfield

  6. Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, NC, USA

    Andrew J. Muir

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  1. Rae Jean Proeschold-Bell
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  2. Bettina Hoeppner
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  3. Baishakhi Taylor
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  4. Sarah Cohen
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  5. Rachel Blouin
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  6. Beth Stringfield
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  7. Andrew J. Muir
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Correspondence to Rae Jean Proeschold-Bell.

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Proeschold-Bell, R.J., Hoeppner, B., Taylor, B. et al. An Interrupted Time Series Evaluation of a Hepatitis C Intervention for Persons with HIV. AIDS Behav 15, 1721–1731 (2011). https://doi.org/10.1007/s10461-010-9870-1

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