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Waling A, Lyons A, Alba B, Minichiello V, Barrett C, Hughes M, Fredriksen-Goldsen K, Edmonds S, Bath N. Experiences of informal caregiving among older lesbian and gay adults in Australia. Australas J Ageing 2022; 41:424-430. [PMID: 35560859 PMCID: PMC9544417 DOI: 10.1111/ajag.13076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
Objective This study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving. Methods Interviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach. Results Most participants were caring for a friend or partner and regarded caregiving as a form of love and did not seek external support despite noting several impacts. Some participants found that they too were beginning to require care. For some, formal care was being considered, but with a degree of reluctance. Conclusions Older lesbian and gay adult caregivers experience a range of challenges and support needs in relation to their experiences with the caregiving role. This research highlights a need for ensuring that caregiving policies and practices be responsive to the experiences and challenges faced by older lesbian and gay people.
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Affiliation(s)
- Andrea Waling
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony Lyons
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Beatrice Alba
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Victor Minichiello
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,School of Justice, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Mark Hughes
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | | | | | - Nicky Bath
- LGBTIQ+ Health Australia, Sydney, New South Wales, Australia
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2
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Bath N. Ageing management: international developments and German activities. KERNTECHNIK 2022. [DOI: 10.1515/kern-2002-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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3
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Bavinton BR, Chan C, Hammoud MA, Maher L, Haire B, Degenhardt L, Holt M, Lea T, Bath N, Storer D, Jin F, Grulich AE, Bourne A, Saxton P, Prestage GP. Increase in Depression and Anxiety Among Australian Gay and Bisexual Men During COVID-19 Restrictions: Findings from a Prospective Online Cohort Study. Arch Sex Behav 2022; 51:355-364. [PMID: 35039984 PMCID: PMC8763302 DOI: 10.1007/s10508-021-02276-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 06/02/2023]
Abstract
We examined depression and anxiety prior to and during COVID-19 restrictions in Australian gay and bisexual men (GBM). In an online cohort, a COVID-19-focused survey was conducted in April 2020. During 2019 and in April 2020, 664 GBM completed the Patient Health Questionnaire (PHQ-9, measuring depression) and Generalized Anxiety Disorder Assessment (GAD-7, measuring anxiety). Increased depression and anxiety were defined as a ≥ 5 point increase on the respective scales. Mean PHQ-9 and GAD-7 scores increased between 2019 and 2020 (PHQ-9: from 5.11 in 2019 to 6.55 in 2020; GAD-7: from 3.80 in 2019 to 4.95 in 2020). The proportion of participants with moderate-severe depression (PHQ-9 ≥ 10) increased from 18.8% (n = 125) to 25.5% (n = 169), while the proportion of participants with moderate-severe anxiety (GAD-7 ≥ 10) increased from 12.7% (n = 84) to 17.3% (n = 115). Almost one-quarter of participants (n = 158, 23.8%) had increased depression; in these men, mean PHQ-9 increased from 2.49 in 2019 to 11.65 in 2020 (p < 0.001). One-in-five (20.6%) participants (n = 137) had increased anxiety; among these men, mean GAD-7 increased from 2.05 in 2019 to 10.22 in 2020 (p < 0.001). Increases were associated with concerns about job security, reduction in social and sexual connections and opportunities, and being personally concerned about COVID-19 itself. COVID-19 appeared to have a sudden and pronounced impact on depression and anxiety in Australian GBM, with a significant minority showing sharp increases. Ongoing monitoring is required to determine longer-term impacts and GBM need access to appropriate and sensitive supports both during and after the COVID-19 pandemic.
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Affiliation(s)
- Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Mohamed A Hammoud
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Bridget Haire
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Nicky Bath
- National LGBTI Health Alliance, Sydney, NSW, Australia
| | - Daniel Storer
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Fenyi Jin
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Andrew E Grulich
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Peter Saxton
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Garrett P Prestage
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Bath N, Braun H, Görtz R. Emergency preparedness in Germany: recent progress in on-site accident management and off-site emergency response / Emergency preparedness in Germany: recent progress in on-site accident management and off-site emergency response. KERNTECHNIK 2021. [DOI: 10.1515/kern-2000-655-620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bajis S, Grebely J, Hajarizadeh B, Applegate T, Marshall AD, Ellen Harrod M, Byrne J, Bath N, Read P, Edwards M, Gorton C, Hayllar J, Cock V, Peterson S, Thomson C, Weltman M, Jefferies M, Wood W, Haber P, Ezard N, Martinello M, Maher L, Dore GJ. Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre- and post-universal access to direct-acting antiviral treatment in Australia: The LiveRLife study. J Viral Hepat 2020; 27:281-293. [PMID: 31698545 DOI: 10.1111/jvh.13233] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct-acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole-blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre-DAA era to 38% in the DAA era. Significant liver fibrosis (F2-F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18-7.04) and attending a clinical follow-up with nurse (aOR, 3.19; 95% CI, 1.61-6.32) or physician (aOR, 11.83; 95% CI, 4.89-28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.
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Affiliation(s)
- Sahar Bajis
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jude Byrne
- Australian Injecting and Illicit Drug Users League, Canberra, ACT, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Sydney, NSW, Australia
| | | | - Michael Edwards
- South Western Sydney Local Health District Drug Health Services, Sydney, NSW, Australia
| | - Carla Gorton
- Cairns Sexual Health Service, Cairns, QLD, Australia
| | - Jeremy Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Victoria Cock
- Drug and Alcohol Services of South Australia, Adelaide, SA, Australia
| | | | - Claire Thomson
- Bayside Alcohol and Drug Services, Cleveland, QLD, Australia
| | | | | | - William Wood
- Sydney Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Paul Haber
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, NSW, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Burnet Institute, Melbourne, Vic, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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6
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Lea T, Hammoud M, Bourne A, Maher L, Jin F, Haire B, Bath N, Grierson J, Prestage G. Attitudes and Perceived Social Norms toward Drug Use among Gay and Bisexual Men in Australia. Subst Use Misuse 2019; 54:944-954. [PMID: 30648480 DOI: 10.1080/10826084.2018.1552302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gay and bisexual men (GBM) report distinctive patterns and contexts of drug use, yet little has been published about their attitudes toward drug use. OBJECTIVES We developed measures of attitudes and perceived social norms toward drug use, and examined covariates of more accepting attitudes and norms among GBM in Australia. METHODS We analyzed baseline data from the Following Lives Undergoing Change (Flux) study. Flux is an online prospective observational study of drug use among Australian GBM. We used principal components factor analysis to generate two attitudinal scales assessing "drug use for social and sexual enhancement" and "perceptions of drug risk." A third perceived social norms scale examined "acceptability of drug use among gay friends." RESULTS Among 2,112 participants, 61% reported illicit drug use in the preceding six months. Stronger endorsement of drug use for social and sexual engagement and lower perceptions of drug risk were found among men who were more socially engaged with other gay men and reported regular drug use and drug use for sex. In multivariate analyses, all three scales were associated with recent drug use (any use in the previous six months), but only the drug use for social and sexual enhancement scale was associated with regular (at least monthly) use. CONCLUSIONS Drug use and sex are difficult to disentangle for some GBM, and health services and policies could benefit from a better understanding of attitudinal and normative factors associated with drug use in gay social networks, while recognizing the role of pleasure in substance use.
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Affiliation(s)
- Toby Lea
- a German Institute for Addiction and Prevention Research (DISuP) , Catholic University of Applied Sciences , North Rhine-Westphalia , Germany.,b Centre for Social Research in Health , UNSW Sydney , New South Wales , Australia
| | - Mohamed Hammoud
- c The Kirby Institute , UNSW Sydney , New South Wales , Australia
| | - Adam Bourne
- d Australian Research Centre in Sex , Health & Society, La Trobe University, Melbourne , Australia
| | - Lisa Maher
- c The Kirby Institute , UNSW Sydney , New South Wales , Australia
| | - Fengyi Jin
- c The Kirby Institute , UNSW Sydney , New South Wales , Australia
| | - Bridget Haire
- c The Kirby Institute , UNSW Sydney , New South Wales , Australia
| | - Nicky Bath
- e National LGBTI Health Alliance , Sydney , Australia
| | - Jeffrey Grierson
- f Faculty of Health, Social Care & Education , Anglia Ruskin University , Cambridge , UK
| | - Garrett Prestage
- c The Kirby Institute , UNSW Sydney , New South Wales , Australia
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7
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Bui H, Zablotska-Manos I, Hammoud M, Jin F, Lea T, Bourne A, Iversen J, Bath N, Grierson J, Degenhardt L, Prestage G, Maher L. Prevalence and correlates of recent injecting drug use among gay and bisexual men in Australia: Results from the FLUX study. International Journal of Drug Policy 2018; 55:222-230. [DOI: 10.1016/j.drugpo.2018.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/12/2018] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
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8
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Hammoud MA, Jin F, Degenhardt L, Lea T, Maher L, Grierson J, Mackie B, Pastorelli M, Batrouney C, Bath N, Bradley J, Prestage GP. Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia. Int J Drug Policy 2017; 41:41-50. [PMID: 28081482 DOI: 10.1016/j.drugpo.2016.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). OBJECTIVE This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. METHODS Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. RESULTS Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. CONCLUSION Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia.
| | - Fengyi Jin
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Australia, Kensington, NSW 2052, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus, Cambridge CB1 1PT, United Kingdom
| | - Brent Mackie
- ACON NSW, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | | | - Colin Batrouney
- Victorian AIDS Council, 6 Claremont St, South Yarra, VIC 3141, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, 5, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - Jack Bradley
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
| | - Garrett P Prestage
- The Kirby Institute, UNSW Australia, Level 6, Wallace Wurth Building, Kensington, NSW 2052, Australia
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9
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Grebely J, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Phung N, Weltman MD, Day CA, Treloar C, Bath N, Haber PS, Dore GJ. Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: the ETHOS Study. Addiction 2016; 111:311-9. [PMID: 26451534 DOI: 10.1111/add.13197] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 06/02/2015] [Accepted: 09/30/2015] [Indexed: 12/12/2022]
Abstract
AIMS To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. DESIGN Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48 weeks (genotype 1, G1). SETTING Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia. PARTICIPANTS Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female). MEASUREMENTS Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24 weeks post-treatment). FINDINGS Among 101 treated, 37% (n = 37) had recently injected drugs (past 6 months) and 62% (n = 63) were receiving OST. Adherence ≥ 80% was 86% (n = 87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age < 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval (CI) = 1.47, 17.40] and on-treatment adherence ≥ 80% independently predicted SVR (aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. CONCLUSIONS People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Maryam Alavi
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | | | - Adrian J Dunlop
- University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Anne C Balcomb
- Clinic 96, Kite St Community Health Centre, Orange, NSW, Australia
| | - Nghi Phung
- Drug Health Services, Western Sydney Local Health District, NSW, Australia
| | - Martin D Weltman
- Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carolyn A Day
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Sydney, NSW, Australia
| | | | - Paul S Haber
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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10
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Fortier E, Alavi M, Micallef M, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Bruneau J, Grebely J. The effect of social functioning and living arrangement on treatment intent, specialist assessment and treatment uptake for hepatitis C virus infection among people with a history of injecting drug use: The ETHOS study. International Journal of Drug Policy 2015; 26:1094-102. [DOI: 10.1016/j.drugpo.2015.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/11/2015] [Accepted: 06/02/2015] [Indexed: 12/11/2022]
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11
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Alavi M, Micallef M, Fortier E, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ, Grebely J. Effect of treatment willingness on specialist assessment and treatment uptake for hepatitis C virus infection among people who use drugs: the ETHOS study. J Viral Hepat 2015; 22:914-25. [PMID: 25996567 DOI: 10.1111/jvh.12415] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
Abstract
Among people who inject drugs (PWID) with chronic HCV, the association between HCV treatment willingness and intent, and HCV specialist assessment and treatment were evaluated. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) is a prospective observational cohort. Recruitment was through six opioid substitution treatment clinics, two community health centres and one Aboriginal community controlled health organisation in Australia. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 67% were 'definitely willing' to receive HCV treatment and 70% reported plans to initiate therapy 12 months postenrolment. Those definitely willing to receive HCV treatment were more likely to undergo specialist assessment (64% vs 32%, P < 0.001) and initiate therapy (36% vs 9%, P < 0.001), compared to those with lower treatment willingness. Those with early HCV treatment plans were more likely to undergo specialist assessment (65% vs 27%, P < 0.001) and initiate therapy (36% vs 5%, P < 0.001), compared to those without early plans. In adjusted analyses, HCV treatment willingness independently predicted specialist assessment (aOR 3.06, 95% CI 1.90, 4.94) and treatment uptake (aOR 4.33, 95% CI 2.14, 8.76). In adjusted analysis, having early HCV treatment plans independently predicted specialist assessment (aOR 4.38, 95% CI 2.63, 7.29) and treatment uptake (aOR 9.79, 95% CI 3.70, 25.93). HCV treatment willingness was high and predicted specialist assessment and treatment. Strategies for enhanced HCV care should be developed with an initial focus on people willing to receive treatment and to increase treatment willingness among those less willing.
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Affiliation(s)
- M Alavi
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - M Micallef
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E Fortier
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Université de Montréal, Montréal, QC, Canada
| | - A J Dunlop
- University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - A C Balcomb
- Clinic 96, Kite St Community Health Centre, Orange, NSW, Australia
| | - C A Day
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - N Bath
- NSW Users & AIDS Association, Inc., Sydney, NSW, Australia
| | - P S Haber
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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12
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Keats J, Micallef M, Grebely J, Hazelwood S, Everingham H, Shrestha N, Jones T, Bath N, Treloar C, Dore GJ, Dunlop A. Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia. Int J Drug Policy 2015; 26:999-1006. [PMID: 26275578 DOI: 10.1016/j.drugpo.2015.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/15/2015] [Accepted: 07/07/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Among people who inject drugs (PWID), the prevalence of hepatitis C virus (HCV) infection is high; however HCV treatment uptake remains low. New models of care are needed to address the growing burden of HCV-related disease in PWID and to understand the barriers to assessment and treatment of HCV. This study evaluated assessment and treatment for HCV infection among PWID attending an opioid substitution treatment (OST) clinic with an integrated peer support worker model. METHODS Clients with a history of IDU and chronic HCV infection, attending the Newcastle Pharmacotherapy Service, Newcastle Australia, were recruited as part of a multisite prospective observational study (the ETHOS Cohort). Additional chart review was conducted for clients not enrolled in the ETHOS Cohort. A peer support worker was introduced to complement and extend services offered by the clinical team. Client contacts and assessments with a nurse and/or peer worker were evaluated, including those who commenced HCV treatment. RESULTS A total of 1447 clients attended the OST service during February 2009 and June 2014. Of these, 378 (26%) were assessed by a nurse and 242 (17%) by a clinician. HCV treatment was commenced by 20 (5%) participants and 15 (75%) achieved a sustained virological response (SVR). During May 2009 and July 2011, 332 nurse contacts and 726 peer worker contacts were evaluated. The nurse-led contacts were related to HCV treatment (50%) and review of pathology tests (34%), whereas peer worker contacts included discussion about HCV treatment (75%), education, counselling and/or support (53%) and general discussion about HCV infection (59%). CONCLUSION These data demonstrate that peer support workers facilitate broader discussion about HCV treatment, education and/or support, allowing nurses to focus on HCV-related assessment and treatment. HCV treatment uptake was very low in this cohort, but SVR was high. The integration of peer support workers in treatment programs within OST clinics may address barriers to HCV care, but further studies are needed to assess their impact on assessment and treatment outcomes.
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Affiliation(s)
- Julian Keats
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | | | - Jason Grebely
- The Kirby Institute, UNSW, Kensington, NSW, Australia
| | - Susan Hazelwood
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Hope Everingham
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Nikrant Shrestha
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Tracey Jones
- Department of Gastroenterology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Kensington, NSW, Australia
| | | | - Adrian Dunlop
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
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Marshall AD, Micallef M, Erratt A, Telenta J, Treloar C, Everingham H, Jones SC, Bath N, How-Chow D, Byrne J, Harvey P, Dunlop A, Jauncey M, Read P, Collie T, Dore GJ, Grebely J. Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study. Int J Drug Policy 2015; 26:984-91. [PMID: 26256938 DOI: 10.1016/j.drugpo.2015.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/19/2015] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess factors associated with baseline knowledge of HCV and liver disease, acceptability of transient elastography (TE) assessment (FibroScan(®)), and willingness and intent to receive HCV treatment among persons with a history of injection drug use participating in a liver health promotion campaign. METHODS The LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign implementation. Participants were enrolled in an observational cohort study with recruitment at four clinics - one primary health care facility, two OST clinics, and one medically supervised injecting centre - in Australia between May and October 2014. Participants received educational material, nurse clinical assessment, TE assessment, dried blood spot testing, and completed a knowledge survey. RESULTS Of 253 participants (mean age 43 years), 68% were male, 71% had injected in the past month, and 75% self-reported as HCV positive. Median knowledge score was 16/23. In adjusted analysis, less than daily injection (AOR 5.01; 95% CI, 2.64-9.51) and no daily injection in the past month (AOR 3.54; 95% CI, 1.80-6.94) were associated with high knowledge (≥16). TE was the most preferred method both pre- (66%) and post-TE (89%) compared to liver biopsy and blood sample. Eighty-eight percent were 'definitely willing' or 'somewhat willing' to receive HCV treatment, and 56% intended to start treatment in the next 12 months. Approximately 68% had no/mild fibrosis (F0/F1, ≥2.5 to ≤7.4kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4kPa), and 9% had cirrhosis (F4, ≥12.5kPa). CONCLUSION Liver disease and HCV knowledge was moderate. High acceptability of TE by PWID provides strong evidence for the inclusion of TE in HCV-related care, and could help to prioritise HCV treatment for those at greatest risk of liver disease progression.
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Affiliation(s)
- A D Marshall
- The Kirby Institute, UNSW Australia, NSW, Australia.
| | - M Micallef
- The Kirby Institute, UNSW Australia, NSW, Australia
| | - A Erratt
- The Kirby Institute, UNSW Australia, NSW, Australia
| | - J Telenta
- Centre for Health and Social Research, Australian Catholic University, VIC, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Australia, NSW, Australia
| | - H Everingham
- NSW Users and AIDS Association, Inc., NSW, Australia
| | - S C Jones
- Centre for Health and Social Research, Australian Catholic University, VIC, Australia
| | - N Bath
- NSW Users and AIDS Association, Inc., NSW, Australia
| | - D How-Chow
- St Vincent's Hospital Sydney, NSW, Australia
| | - J Byrne
- Australian Injecting and Illicit Drug Users League, ACT, Australia
| | | | - A Dunlop
- University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - M Jauncey
- Australian Injecting and Illicit Drug Users League, ACT, Australia
| | - P Read
- The Kirby Institute, UNSW Australia, NSW, Australia; Kirketon Road Centre, NSW, Australia
| | - T Collie
- Coffs Harbour Drug and Alcohol Service, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Australia, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Australia, NSW, Australia
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14
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Treloar C, Rance J, Bath N, Everingham H, Micallef M, Day C, Hazelwood S, Grebely J, Dore GJ. Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia. Int J Drug Policy 2015; 26:992-8. [PMID: 25697089 DOI: 10.1016/j.drugpo.2015.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/12/2014] [Accepted: 01/07/2015] [Indexed: 12/30/2022]
Abstract
AIM Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS. METHODS Semi-structured interviews were conducted in two clinics with three groups of participants: clients (n=31), staff (n=8) and peer workers (n=3) and examined the operation of the service in relation to process, outputs and impacts. RESULTS There was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing "feel" of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment. CONCLUSIONS The peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.
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Affiliation(s)
- Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Jake Rance
- Centre for Social Research in Health, UNSW, Sydney, NSW, Australia
| | - Nicky Bath
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | - Hope Everingham
- NSW Users and AIDS Association, Inc., Sydney, NSW, Australia
| | | | - Carolyn Day
- Drug Health Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Addiction Medicine, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Sue Hazelwood
- Newcastle Pharmacotherapy Service, Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Alavi M, Grebely J, Micallef M, Dunlop AJ, Balcomb AC, Day CA, Treloar C, Bath N, Haber PS, Dore GJ. Assessment and treatment of hepatitis C virus infection among people who inject drugs in the opioid substitution setting: ETHOS study. Clin Infect Dis 2014; 57 Suppl 2:S62-9. [PMID: 23884068 DOI: 10.1093/cid/cit305] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Access to hepatitis C virus (HCV) treatment remains extremely limited among people who inject drugs (PWID). HCV assessment and treatment was evaluated through an innovative model for the provision of HCV care among PWID with chronic HCV infection. METHODS Enhancing Treatment for Hepatitis C in Opioid Substitution Settings (ETHOS) was a prospective observational cohort. Recruitment was through 5 opioid substitution treatment (OST) clinics, 2 community health centers, and 1 Aboriginal community controlled health organization in New South Wales, Australia. RESULTS Among 387 enrolled participants, mean age was 41 years, 71% were male, and 15% were of Aboriginal ethnicity. Specialist assessment was undertaken in 191 (49%) participants, and 84 (22%) commenced interferon-based treatment. In adjusted analysis, HCV specialist assessment was associated with non-Aboriginal ethnicity (adjusted odds ratio [AOR], 4.02; 95% confidence interval [CI], 2.05-7.90), no recent benzodiazepine use (AOR, 2.06; 95% CI, 1.31-3.24), and non-1 HCV genotype (AOR, 2.13; 95% CI, 1.32-3.43). In adjusted analysis, HCV treatment was associated with non-Aboriginal ethnicity (AOR, 4.59; 95% CI, 1.49-14.12), living with the support of family and/or friends (AOR, 2.15; 95% CI, 1.25-3.71), never receiving OST (AOR, 4.40; 95% CI, 2.27-8.54), no recent methamphetamine use (AOR, 2.26; 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07; 95% CI, 1.67-5.64). CONCLUSIONS HCV treatment uptake was relatively high among this highly marginalized population of PWID. Potentially modifiable factors associated with treatment include drug use and social support.
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Affiliation(s)
- Maryam Alavi
- The Kirby Institute, University of New South Wales, Sydney, Australia.
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16
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Crawford S, Bath N. Peer support models for people with a history of injecting drug use undertaking assessment and treatment for hepatitis C virus infection. Clin Infect Dis 2014; 57 Suppl 2:S75-9. [PMID: 23884070 DOI: 10.1093/cid/cit297] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
People who inject drugs (PWID) are the group most affected by HCV; however, treatment uptake has been low. Engagement between PWID and healthcare workers has been characterized by mistrust and discrimination. Peer support for HCV is one way to overcome these barriers. Peer support models for chronic disease management have been successfully applied for other diseases. HCV peer support models have been implemented in various settings, but those that include opioid substitution treatment have been more common. Most models have been either service generated (provider led) or community controlled (peer led). Peer support models have been implemented successfully, with a range of outcomes including increased treatment knowledge and uptake and improved service provision. Genuine partnerships between peers and services were common across models and led to positive transformations for both clients and services. Further investigation of peer support for HCV treatment and its impact on both individuals and services is recommended.
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Affiliation(s)
- Sione Crawford
- New South Wales Users and AIDS Association, Sydney, Australia.
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Martin L, Crawford S, Knight V, Bath N, McNulty A. Poor uptake of community based sexually transmissible infection testing at an inner city needle and syringe program. Sex Health 2012; 10:183-4. [PMID: 23158773 DOI: 10.1071/sh12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 06/05/2012] [Indexed: 11/23/2022]
Abstract
Sydney Sexual Health Centre (SSHC) and the NSW Users and AIDS Association (NUAA), the NSW peer-based drug user organisation, pilot tested an outreach sexually transmissible infection (STI) testing station using self-collected urine and swabs in NUAA's needle and syringe program (NSP) space. The model was based on SSHC's established Xpress clinic. A needs assessment among NUAA clients was undertaken prior to commencement in order to ascertain potential uptake. A computer-assisted self interview was developed with data securely transferred to SSHC daily. During the 6 months from January to July 2011, almost 3000 occasions of service were recorded in the NSP from an estimated 375 clients. Four clients took advantage of NUAA Xpress during this time. Despite initial client interest, promotional efforts and the success of this methodology elsewhere, this outreach model did not have a successful uptake and was discontinued. This project provides value in considering the methodology and implementation of future outreach STI testing projects for people who inject drugs.
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Affiliation(s)
- Lynne Martin
- Sydney Sexual Health Centre, Sydney Hospital, GPO Box 1614, Sydney, NSW 2001, Australia
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Winstock AR, Lea T, Madden, A, Bath N. Knowledge about buprenorphine and methadone among those receiving treatment for opioid dependence. Drugs: Education, Prevention and Policy 2009. [DOI: 10.1080/09687630701425865] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bryant J, Saxton M, Madden A, Bath N, Robinson S. Consumers' and providers' perspectives about consumer participation in drug treatment services: is there support to do more? What are the obstacles? Drug Alcohol Rev 2008; 27:138-44. [PMID: 18264873 DOI: 10.1080/09595230701829405] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND AIMS Implementing consumer participation initiatives in Australian drug treatment services successfully is predicated on the support of those most centrally involved. This paper describes service providers' and consumers' (1) beliefs about and commitment to consumer participation; and (2) perceived barriers to conducting or participating in consumer participation. DESIGN AND METHODS Data were collected from 64 providers and 179 consumers of drug treatment services. RESULTS The data showed that almost all consumers (89.9%, n = 161) and providers (84.4%, n = 54) believed in the principle of consumer participation (that consumers' views should be included in service planning and delivery) and a large proportion would be willing to conduct or participate in consumer participation activities in future. Providers were less supportive of activities in which consumers would be involved in decision-making that relates directly to staff (such as staff training, recruitment and performance appraisal), and expressed concerns about the practicality of operationalising such activities, the inadequacy of consumers' skills, consumers' lack of interest and the appropriateness of having consumers involved in such decision-making. A small proportion of consumers also indicated that they did not want to participate, expressing beliefs that it was not their place to be involved and that they lacked the required skills. CONCLUSIONS Overall, these findings revealed that there was considerable support for the further development of consumer participation in drug treatment services, but the predominant obstacle was the view that it is not consumers' place to take part, and that they lack the interest and skills to do so.
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Affiliation(s)
- Joanne Bryant
- National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, Australia.
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Bryant J, Saxton M, Madden A, Bath N, Robinson S. Consumer participation in the planning and delivery of drug treatment services: the current arrangements. Drug Alcohol Rev 2008; 27:130-7. [PMID: 18264872 DOI: 10.1080/09595230701829397] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND AIMS Consumer participation in decision-making about service planning is common in certain health services in Australia but is thought to be largely underdeveloped in drug treatment services. This paper (1) describes the current practices within Australian drug treatment services that aim to include consumers in service planning and provision; and (2) determines how much consumers know about the existing opportunities for involvement. DESIGN AND METHOD Sixty-four randomly selected service providers (representing 64 separate services) completed interviews about the current arrangements for consumer participation within their services (response rate = 82%). A total of 179 consumers completed interviews assessing their knowledge of the consumer participation activities available at the service they attended. RESULTS Consumer participation activities were not uncommon in drug treatment services, although the existing activities were concerned largely with providing information to or receiving information from consumers. Activities that included consumers in higher forms of involvement, such as those in which consumers took part in decision-making, were largely uncommon. Consumers had a considerable lack of knowledge about the participation activities available to them, revealing a lack of communication between providers and consumers. CONCLUSIONS While service providers were making efforts to engage consumers in service planning and provision (despite the general lack of State or Commonwealth policy directives and extra funding to do so), these appear ineffectual because of poor communication between providers and consumers. As a starting point, a critical part of any meaningful consumer participation initiative must include systems to ensure that consumers know about available opportunities.
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Affiliation(s)
- Joanne Bryant
- National Centre in HIV Social Research, University of New South Wales, Australia.
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Law MG, Dore GJ, Bath N, Thompson S, Crofts N, Dolan K, Giles W, Gow P, Kaldor J, Loveday S, Powell E, Spencer J, Wodak A. Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001. Int J Epidemiol 2003; 32:717-24. [PMID: 14559738 DOI: 10.1093/ije/dyg101] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection. METHODS Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. RESULTS It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000-19 000). It was estimated that 6500 (5000-8000) people were living with HCV-related cirrhosis in 2001, that 175 (130-210) people developed HCV-associated liver failure, and that there were 50 (40-60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease. DISCUSSION Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.
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Affiliation(s)
- Matthew G Law
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, 376 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.
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Bath N, Fröhmel T, Görtz R. Nuclear emergency preparedness in Germany - an introduction / Nuklearer Notfallschutz in der Bundesrepublik Deutschland - Eine Einführung. KERNTECHNIK 1999. [DOI: 10.1515/kern-1999-640306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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