Aboriginal people with chronic HCV: The role of community health nurses for improving health-related quality of life

Introduction: There is a lack of knowledge about Health-Related Quality of Life (HRQL) of Aboriginal Australians with self-reported hepatitis C infection in Western Australia. This marginalised group of people is disproportionally affected by the hepatitis C virus (HCV) for which there is no preventative vaccine. This study provides data that help understand the long-term consequences of living with HCV infection within the Aboriginal community. It outlines opportunities for nursing interventions for hepatitis care that focus on supporting mental health and drug and alcohol issues within this population. Methods: We surveyed 123 Aboriginal people living with HCV in a community setting. Survey data included demographics, drug use history, length of time since diagnosis, changes in lifestyle since diagnosis, fatigue, social support, alcohol consumption, and physical and mental health measures. Results: Most participants reported amphetamine injecting frequently in the last six months and their duration of injecting drug ranged from 8 to more than 11 years. Additionally, half of the participants were classified as high-risk alcohol users. Overall 52% of participants were in poor physical and 60% of participants were in poor mental health. Discussion: This survey of Aboriginal people with self-reported hepatitis C infection indicates substantial problems of mental and physical comorbidities among this population. Conclusion: There is a need for the development of HCV community clinics in Aboriginal health care settings with trained Aboriginal community health nurses to reduce problematic alcohol consumption, assess liver health and subsequently provide HCV treatment in a culturally appropriate way

The long winding road of opioid substitution therapy implementation in South-East Asia: challenges to scale up

In South-East Asia Region (SEAR) there were an estimated 400, 000 - 500,000 people who inject drugs (PWID). HIV prevalence among PWID was commonly 20% and higher in Indonesia, Thailand, Myanmar, and some regions of India. Opioid substitution therapy (OST) has been implemented as an important HIV prevention intervention in the Region. Various key challenges and barriers to scale up of OST exist: pervasive stigma and discrimination towards PWID; crimilization of drug use overshadowing a public health response; lack of political will and national commitment; low financial investment; focus towards traditional treatment model of detoxification and rehabilitation; low dose of OST; and poor monitoring and evaluation of programmes.Local evidence has highlighted that OST can be successful within the Asian context. Such evidence should be utilized more widely to advocate for policy and increased political commitment to ensure OST reaches a substantial greater number of drug users than currently exists

Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: A mixed-methods study

Objective: The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. Methods: This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. Results: Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. Conclusion: This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic? Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add? This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners? Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment

Transitions to Injecting and Risk of Hepatitis C Transmission among Ethnic Vietnamese Heroin Smokers in Melbourne, Australia

Background and Aims: To examine factors associated with transition from non-injecting to injecting routes of drug administration and testing antibody positive to hepatitis C virus (HCV) among ethnic Vietnamese heroin users in Melbourne, Australia. Methods: In a cross-sectional convenience survey, sample recruited by peer-workers using snowball sampling technique with a finger prick blood collection. Two-hundred ethnic Vietnamese heroin users were recruited and interviews conducted mainly in Footscray, an area of high ethnic Vietnamese residency with a prominent street based drug market. A structured questionnaire was administered. Measures included patterns of drug use, transition from smoking to injecting and vice versa, injection related risk behaviours and HCV sero-status. Results: Ninety-three percent of the sample commenced drug use by non-injecting routes of administration. More than a half had made the transition from smoking to injecting and almost two thirds of participants had ever injected. The factors associated with making this transition included being male and a longer duration of use. Prevalence of exposure to HCV among injectors was over 50%. Factors associated with being HCV positive were longer duration of injecting, sharing injecting equipment and being older. Conclusions: Smoking heroin is a common route of drug administration among heroin users of Vietnamese ethnicity in this study. The transition from smoking to injecting was very common in the sample. The need for targeted harm reduction initiatives is indicated, and these must take into account patterns of heroin use as well as the social context of drug use if we are to work effectively with heroin users of Vietnamese ethnicity

Experiences of and attitudes towards injecting drug use among marginalised African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterised as unnatural, risky and immoral. IDU was highly stigmatised and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use, in order to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalised

Barriers to receiving hepatitis C treatment for people who inject drugs: Myths and evidence

Background: Alcohol consumption, current injecting drug use, and pre-existing mental illness have been identified as 3 of the main reasons for excluding patients from treatment for hepatitis C. Objectives: We reviewed the literature to obtain an evidence base for these common exclusion criteria. Materials and Methods: We reviewed original research and meta-analyses investigating the effects of alcohol consumption, current injecting drug use, and pre-existing mental illness. Results: We identified 66 study reports relevant to the review, but found only limited evidence to support withholding of treatment on the basis of the 3 previously mentioned exclusion criteria. Conclusions: Currently, there is a lack of evidence for many of the barriers faced by patients in availing treatment for hepatitis C. Adherence to treatment routine was found to be a better predictor of sustained virological response than injecting drug or alcohol consumption during treatment period or the presence of a pre-existing mental disorder. Although several challenges remain, we need to ensure that treatment decisions are based on the best available evidence and the treatment is performed appropriately on a case-by-case basis. © 2011 Kowsar M.P.Co. All rights reserved