Report on the SRDC’s Program of Social and Behavioural
                    Research into Hepatitis C
The National Health a...
Part of the Working Committee’s role was to ensure that the specific needs and issues of the
wider community, including wo...
Findings of the Research Program
Living with hepatitis C
The Program of Social and Behavioural Research into Hepatitis C w...
Professor Gifford’s study also found that current -injecting drug users were more likely to
report negative treatment by h...
A common theme emerging from the research was that there is a lack of culturally and
contextually appropriate information ...
The study found that only 82% of tattooists, 56% of beauty therapists and 32% of
hairdressers had received them. Although ...
Appendix

Summary of the projects funded by the Social and Behavioural Research
into Hepatitis C Program
1. An interventio...
3. Prevention of HCV Infection amongst intravenous drug users of Vietnamese
Ethnicity.

Chief investigator : Dr Nick Croft...
The project was successful in terms of its design and process, and the partnership with the
Victorian AIDS Council/Gay Men...
§   To examine the self-reported incidence and risk factors and health impacts for Hep A and
    Hep B; and
§   To identif...
knowledge of HCV and HIV/AIDS transmission; current patterns of drug use and injecting
practice.

The researchers examined...
3. To disseminate and apply the findings of this research extensively to inform national
   prevention and education initi...
12. A feasibility study of non-injecting routes of administration among intravenous drug
users

Chief Investigator Dr Alex...
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  1. 1. Report on the SRDC’s Program of Social and Behavioural Research into Hepatitis C The National Health and Medical Research Council The National Health and Medical Research Council is a statutory body that provides advice on all aspects of health and health care delivery in Australia, from health and medical research to ethical issues. In accordance with its statutory obligations, the NHMRC has responsibilities ranging from basic medical and public health research and training to the provision of comprehensive advice on the most complex and important matters affecting the nation’s health. The Strategic Research Development Committee Until the 1997-2000 triennium, the NHMRC relied on researchers to determine the direction of the research it funded. While this generally produced a balanced coverage of research fields, it became increasingly apparent that Australia needed to improve its ability to respond more effectively to health and medical research issues that may not have been addressed as adequately, effectively or expeditiously as desired. To address this the Strategic Research Development Committee (SRDC) was established as a principal committee of the NHMRC in April 1997. The stated objective of the SRDC is to develop strategic research in specific areas where there is potential for improved health outcomes, within a reasonable timeframe. To fulfil its aims, the SRDC was specifically constituted to have a wide perspective and range of expertise. Its membership covers many different disciplines – not only from the biomedical community, but also economics, business and the media. Besides providing a useful mechanism by which the NHMRC is able to target research funding, the SRDC, through its own small budget, has the capacity to determine broad areas needing a strategic research focus. The SRDC is able to commission work in these areas. One area that the SRDC identified as important was social and behavioural research into hepatitis C. The Social and Behavioural Research into Hepatitis C Program Funding of $1 million for social and behavioural research into hepatitis C was announced by the then Federal Minister for Health and Family Services, Dr Michael Wooldridge, in February 1998, following its identification as a priority by the Australian National Council for AIDs and Related Diseases (ANCARD). The program was administered by the SRDC using funds from within its budget. Priority areas for research were determined by a joint SRDC/ANCARD Working Committee set up to identify the research priorities and to oversee the subsequently funded research. The Working Committee comprised: Ms Genevieve Cantwell (Chair, SRDC member, public health consultant) Emeritus Professor Lois Bryson (Royal Melbourne Institute of Technology) Professor John Finlay-Jones (Flinders University of SA) Ms Michele Kosky (Consumer’s Health Forum of Australia) Dr Ian Anderson (SRDC member to 2000)
  2. 2. Part of the Working Committee’s role was to ensure that the specific needs and issues of the wider community, including women, people from diverse language and cultural backgrounds, youth, injecting drug users and gay men were considered. The aim of the SRDC’s program in hepatitis C research was to: · make a difference in reducing the spread of hepatitis C; or · improve the quality of life for people with hepatitis C by minimising the personal and social impact of the disease. In July 1998, a call for research was advertised nationally. Sixty-eight expressions of interest were received, of which 31 were short-listed. Full applications were assessed by a minimum of three external assessors based on the relevance of the proposal to the objectives of the program, scientific merit, track record of the investigators and collaborating agencies as well as the balance of research effort across areas. Twelve projects were funded from March 1999. The projects recommended for funding are outlined in Appendix A. They included a focus on a range of data collection methodologies, the development of appropriate interventions for specific target groups and educational approaches appropriate for the client groups and health professionals, including general practitioners. Two-thirds of the projects involved research with injecting drug users and aimed to explore behaviours that may reduce transmission risks. The Social and Behavioural Research into Hepatitis C Workshop The SRDC hosted a workshop on social and behavioural research into hepatitis C at the Melbourne Business School, University of Melbourne on 9 November 2001. The aim of the workshop was to provide an opportunity for the SRDC to evaluate the success of its Program of Social and Behavioural Research into Hepatitis C. The purpose of the workshop was to evaluate what each project had accomplished and to assess the relevance of the findings for public policy. It was envisaged that the SRDC could incorporate the lessons learnt from conducting the program to improve its processes. Social and behavioural research broadens the traditional focus of NHMRC funded research, so the SRDC is particularly interested in the most effective ways to conduct effective sociological and behavioural health research. The workshop comprised a series of presentations from chief investigators of the funded projects, small group discussion and a final plenary session that provided an opportunity to reflect on the implications for social and behavioural research into hepatitis C. The remainder of this paper considers the deliberations of the workshop and subsequent discussion of the outcomes by the SRDC’s Hepatitis C Working Committee on 19 November 2001.
  3. 3. Findings of the Research Program Living with hepatitis C The Program of Social and Behavioural Research into Hepatitis C was groundbreaking because it is the first time that the psychosocial aspects of living with hepatitis C have been targeted. Previous studies of the quality of life of people living with hepatitis C have tended to reflect the clinician’s perspective on hepatitis C issues. Symptoms such as fatigue, nausea and muscle/joint pain are well known in association with hepatitis C infection. What has not been identified before, however, is the occurrence of ‘hep C attacks’ – clusters or ‘episodes’ of multiple symptoms, typically comprising overwhelming fatigue, hypersensitivity, irritability, pain and depression/mood swings. Exploring the experiences of people living with chronic hepatitis C infection, Michael Dunne (Queensland University of Technology) found that over half the people he interviewed for his study experienced ‘hep C attacks’. They varied widely in the time of onset and duration. However, apart from fatty foods and alcohol (which induce nausea and abdominal pain) no triggers were identified. These ‘hep C attacks’ had a major effect on the quality of life for people living with hepatitis C because of the uncertainty caused by not being able to predict their onset or severity. Other factors contributing to this feeling of uncertainty were heightened by doubt about the origin of symptoms, fear that the illness is a long term disability or will shorten life, and lack of social acceptance. Pyschosocial factors such as these feelings of uncertainty and depression experienced by many people living with hepatitis C need to be taken into account by health professionals working with people who have hepatitis C. “Although general practitioners are confident about the clinical management of hepatitis C, they are somewhat less confident about the psychosocial aspects of care,” said Leena Gupta (Central Sydney Area Health Service). Dr Gupta conducted a national survey of the needs, outcomes and patterns of care for general practitioners in diagnosing and managing hepatitis C. Almost one-third of general practitioners reported that they would like to acquire better skills in pre- and post-test counselling for hepatitis C. Sadly, despite its importance where the test result is positive and although testing services report that they offer pre- and post-test counselling, many people living with hepatitis C report that they do not receive either. A study conducted by Wendy Loxley (Curtin University of Technology) found that three-quarters of injecting drug users attending a testing service in Western Australia said they had not received any pre-test counselling and less than 20% had post-test counselling. This was despite the testing services stating that they provide pre- and post-counselling. A similar picture was found among Victorian women living with hepatitis C where Sandy Gifford (Deakin University) found that 77% of women did not receive any pre-test counselling and 51% of women did not receive any post-test counselling at time of diagnosis. Almost one quarter of women participating in the study did not know that there is treatment available for hepatitis C. [A more detailed article on Sandy Gifford's work appears in Australian Hepatitis Council Chronicle - Issue 8.] Interestingly, the same study found that levels of satisfaction with the way they were told about their diagnosis were strongly associated with the length of consultation time rather than the person, place or way that the results were given. Pre- and post-test discussion is vitally important for people living with hepatitis C.
  4. 4. Professor Gifford’s study also found that current -injecting drug users were more likely to report negative treatment by health professionals. In many cases this led to confusion about hepatitis C and issues around pregnancy/breast feeding and, in some cases, women were advised not to go ahead with pregnancy because of their diagnosis. In other cases, sharing their positive hepatitis C status threatened custody or access to their children. The study concluded that the physical, mental, emotional and social impact of living with hepatitis C has been underestimated and, in keeping with Wendy Loxley’s findings, there is a need to improve information, support and referral before and after testing and at the time of diagnosis. Stigmatisation, relating to both the infectiousness of hepatitis C infection and its association with intravenous drug use, was also the most enduring aspect of living with hepatitis C infection found in Michael Dunne’s study. Stopping the spread of hepatitis C Access to hepatitis C testing and counselling services is essential to reduce the social and economic costs of hepatitis C infection. A study conducted by Nick Crofts and Michael Kerger (Centre for Harm Reduction, Macfarlane Burnet Centre) showed that injecting drug users are comfortable being tested and counselled by a peer in a familiar and convenient environment. Educational counselling received from a credible and empathetic peer was highly likely to be acted upon. “Needle and Syringe Programs need to be resourced to employ and train an extra staff member to deliver testing and counselling for hepatitis C and other blood-borne viruses and to deal with overdoses,” said Michael Kerger. “Such a development would be a useful initial step towards improved primary health care for drug users, and generate further information about modes of delivering service to this marginalised population.” Although most people injecting drugs are aware of the danger of contracting hepatitis C through shared needles and most actively avoided doing so, the Australian blood borne virus and injecting drug use study conducted by Craig Fry (Turning Point Drug and Alcohol Centre, Melbourne) found that more than one-third of participants regularly engage in practices, such as being assisted with injecting by someone who had just injected themselves. Such practices provide opportunities for contact with another person’s blood. Mr Fry found that injecting in a public place was a key determinant of higher risk practices because access to necessary facilities is limited and the injection itself occurs in hurried conditions. Other determinants included buying and using drugs in a group and being in a relationship where injection equipment was shared as an expression of trust. The study conducted by Erica Southgate (University of New South Wales) found that injecting drug users who knew their hepatitis C status had a better knowledge of the risk factors involved in hepatitis C transmission compared to those who did not know their hepatitis C status or are untested. However, those who knew their status also have higher levels of sharing fits and other equipment than those who did not know their status or were untested. It was suggested that this could be because they did not think that the messages applied to them as a group. The Southgate study also found that ‘speed’ users have riskier injecting practices than heroin users. Heroin use has been extensively studied and a shift to other injecting drugs due to the heroin drought has been noted. A profile for speed users compared to heroin is currently being developed by the research team.
  5. 5. A common theme emerging from the research was that there is a lack of culturally and contextually appropriate information available for injecting drug users. “Injecting drug users access different sources of health information to other people in the community,” Sandy Gifford said. Lack of creative, culturally informed resources for injecting drug users of Vietnamese ethnicity led a team headed by Nick Crofts and Peter Higgs (Centre for Harm Reduction, Macfarlane Burnet Centre) to develop resources for harm reduction in collaboration with Vietnamese injecting drug users. These resources included the development of activities including role-plays, discussions, agency visits, videos and guest facilitators. Similarly, lack of appropriate information about the transmission of blood borne viruses for high risk young people, led Susan Sawyer (Royal Children’s Hospital Research Institute, Victoria) to design and pilot a peer education strategy about hepatitis C for young injecting drug users aged 15 to 22 years, using a dynamic approach to recruitment. Young people attending a needle and syringe program over a 12-week period were given one-to-one education focussing on areas of knowledge of risk minimisation that are often misconstrued. Participants were invited to attend a follow up session during which they were invited to recruit and educate peers. Interested people were briefed on how to do this. On the other hand, a study of injecting drug use in Melbourne’s gay male community conducted by Gary Dowsett (Australian Research Centre in Sex, Health and Society, LaTrobe University) found that injecting drugs is not regarded by many in the gay community as an approved pastime. As a result, gay men in the community who inject drugs recreationally tend to do so in private or with a small circle of friends. Many gay men who inject have developed techniques to maintain safety in their injecting practices in relation to HIV but whose knowledge of hepatitis C transmission is patchy. No single pattern of injecting drug use was observed. It is important that gay men be included in the development of educational materials about hepatitis C prevention. A different approach was taken by Alex Wodax and his team from the National Drug and Alcohol Research Centre at the University of New South Wales. This study aimed to minimise risk of spreading hepatitis C and improve the quality of life of injecting drug users by shifting from injecting to non-injecting routes of administration (smoking, snorting, oral ingestion and shafting) using cognitive behaviour therapy. Although only small numbers were followed up, these participants showed a shift in route of administration with some participants no longer using heroin or amphetamines. Of course injecting drug use is not the only way that hepatitis C spreads. Any practice that involves “contact” with blood can transfer the hepatitis C virus. For this reason, each State has developed guidelines for use by operators involved in skin penetration. One of the projects funded under the Program looked at the knowledge and attitudes about safe skin penetration practices among tattooists, beauticians and hairdressers in New South Wales. A team from the University of Newcastle led by John Wiggers interviewed tattooists, beauticians and hairdressers to find out whether they had a copy of the guidelines and, if so, what their knowledge of the guidelines was. A second strand to the project was to assess the knowledge of the environmental health officers employed by local councils and public health units in administering the New South Wales guidelines.
  6. 6. The study found that only 82% of tattooists, 56% of beauty therapists and 32% of hairdressers had received them. Although all environmental health officers had a copy of the guidelines, they had only a moderate knowledge of their contents. Of the three groups of operators, tattooists had the best overall knowledge of safe practices to prevent spreading hepatitis C and were more likely to comply with the guidelines. Conclusion As you can see, the Program covered a wide range of topic areas relating to living with hepatitis C and stopping the spread of hepatitis C. One objective of strategic research is to inform policy and practice, although in reality policy and practice are not always informed by research evidence. Similarly, much research endeavour is completely unrelated to the policy or practice environments, either as a means of creating a policy agenda or validating an existing policy or practice strategy - although it may be good science! One objective of the SRDC is to close this gap. In developing the Program, the SRDC sought to ensure that there was interaction between the researchers and the policy and practice environment. However, for research to successfully influence the policy and/or practice environments, the research outcomes must be sustainable outside a research setting and perhaps ideally transferable to other settings and conditions. The challenge before you, as consumers and service providers, is to implement the findings of this research program into policy and practice.
  7. 7. Appendix Summary of the projects funded by the Social and Behavioural Research into Hepatitis C Program 1. An intervention to improve compliance with skin penetration guidelines in tattooists, beauty therapists and hairdressers Chief investigator: Dr Jill Cockburn, Hunter Centre for Health Advancement, Newcastle The purpose of this project was to assess knowledge and attitudes regarding skin penetration practices among tattooists, body piercers, beauty therapists and hairdressers following the distribution of disease prevention guidelines. Environmental health officers (EHOs), from local councils and public health units, have responsibility for ensuring premises involved in skin penetration services comply with the prevention guidelines, and therefore improve infection control in the premises of the target group. Despite the introduction of guidelines, the study found that there is a continuing need to improve knowledge and skills regarding the prevention of blood-borne disease among tattooists, body piercers, beauty therapists, and hairdressers. Further research is required to identify improved methods of achieving this. There is a need to improve the knowledge and skills of EHOs involved in skin penetration inspections. 2. A pilot peer-based Hepatitis C counselling and testing service at a needle and syringe program Chief Investigator: Dr Nick Crofts, Centre for Harm Reduction, McFarlane Burnet Centre Over 200,000 Australians are estimated to have been infected Hepatitis. Many people who inject drugs have not been tested and counselled for Hepatitis C infection, despite being at very high risk. The objective of this research was to trial delivery of Hepatitis C testing and counselling services to injecting drug users by a trained peer counsellor located at a needle and syringe program. The researchers hypothesised that this mode of service would be favourably received by injecting drug users, be effective in reaching people previously untested for Hepatitis C exposure, and that meaningful behaviour change could be effected through counselling. The findings of the research suggest that a demand exists for Hepatitis C testing and counselling of injecting drug users in Melbourne’s western suburbs (and plausibly, elsewhere in Victoria and Australia), that testing and counselling improve injecting drug users’ ability to avoid harm, and that delivery of these services by a trained and experienced peer located at an NSP is an appropriate and effective model.
  8. 8. 3. Prevention of HCV Infection amongst intravenous drug users of Vietnamese Ethnicity. Chief investigator : Dr Nick Crofts, Centre for Harm Reduction, MacFarlane Burnet Centre The idea for the project came not only from the agencies that implemented it (The Centre for Harm Reduction and the School of Medical Education at UNSW), but also from Vietnamese welfare groups, the justice sector, youth based organisations and generic health and welfare agencies. Initial consultations in the project revealed that many workers in the field saw a great need to do more than just casework with their clients. Workers lamented the lack of creative, culturally informed resources for engaging young people around their drug use. Young people complained about the lack of connection between existing information and their daily lives. The idea of utilising the medium of the Internet and developing a Website by and for ethnic Vietnamese drug users was warmly received by workers and young people alike. Young people were recruited in both Sydney (Cabramatta) and Melbourne (Footscray). The researchers collected stories from heroin users from South East Asian backgrounds to generate interest in the project and the concept of storytelling as a way of educating young people about drug use. Participants were introduced to the principals of harm reduction through a series of activities, including role-plays, discussions, agency visits, videos and guest facilitators. Young women in the Cabragirlz.com group were also asked to keep a journal and, during weekly sessions, participants were allowed to describe their experiences and relate their stories to each other. The two groups met weekly for about twelve months. During the course of the project the researchers noticed that participants dropped in and out of the weekly sessions, reflecting the often chaotic lifestyles many lead. The development and administration of the project was not predictable or smooth - but nor were the lives of the participants. Flexibility was crucial. The researchers learned to accept that people will come and go and that ‘our’ expectations are not always the same as participants' expectations. If we are to deliver the best possible outcomes for ethnic Vietnamese heroin users then these people need to feel that projects belong to them and that they have a say in the projects directions. 4. Hepatitis C prevention among gay men who inject drugs in Melbourne’s gay community Chief Investigator: Associate Professor Gary W. Dowsett, Australian Research Centre in Sex, Health and Society, LaTrobe University The design of the project required that the major celebration period in the gay community in Melbourne be the period in which the ethnographic fieldwork be undertaken. The fieldwork was designed to include large summer celebratory events such as the Midsumma Festival and its Red Raw dance party, the annual street festival and Gay Pride parade in Melbourne, culminating in the Gay and Lesbian Mardi Gras in Sydney in early March. The Mardi Gras is the focus of national gay community celebrations each year. These celebrations also include a high level of drug-taking.
  9. 9. The project was successful in terms of its design and process, and the partnership with the Victorian AIDS Council/Gay Men’s Health Centre was very productive. The research assistant position on the project was filled in sequence by two seconded educators from the community partner and from the Prostitutes Collective of Victoria. The project was thereby able to offer a training possibility for community Hepatitis C educators in research methods and feedback more awareness about social research, its processes and potential to community partners. This strengthened the research and the acceptability of the project and its findings as a resource for the Victorian AIDS Council/Gay Men’s Health Centre to develop evidence- led prevention strategies for Hepatitis C among injecting users in Australia. 5. Quality of life among people living with chronic Hepatitis C infection Chief Investigator: Dr Michael Dunne, Centre for Public Health Research, Queensland University of Technology The aim of this research was to explore the subjective experiences of people living with chronic Hepatitis C infection. Semi-structured interviews were conducted with 22 individuals and 12 focus groups (total N=70). Participants were recruited from Hepatology clinics, Hepatitis-related community agencies (including a blood disorders support group), a sexual health clinic, a prison, a drug dependence treatment agency, and through community chain-referral. The unifying theme emerging from the data was uncertainty. This permeated most aspects of life, including personal relationships, work, and subjective physical and mental health. Many participants reported a complex range of symptoms and social problems, and a sense that they had lost control over their lives. Some people reported severe illness episodes of unpredictable onset and duration. Labelled “hep C attacks”, they were described as bouts of severe fatigue, nausea, headaches and pain. Uncertainty regarding transmissibility to loved ones was a major concern, and was not assuaged by factual information about low risks. The researchers are working with the Queensland Hepatitis C Council to translate the findings into practical resources for dissemination to community groups and professionals. 6. Identifying the social, personal and health needs of women living with Hepatitis C Chief Investigators: Professor Sandra Gifford, School of Health Services, Deakin University The overall aim of this study was to collect baseline data on the specific social and health concerns of women affected with Hepatitis C virus (HCV) and to identify gender specific needs for medical and social support services. The specific objectives were: § To assess the social and personal impact of HCV on women, their partners and their families; § To identify the health, medical and social support needs of women living with HCV; § To identify the impact of HCV on parenting and families with specific reference to women and their adolescent children; § To identify specific needs in accessing appropriate treatment of HCV; § To identify the needs and concerns of women in relation to their reproductive health with specific reference to pregnancy and decisions concerning having children;
  10. 10. § To examine the self-reported incidence and risk factors and health impacts for Hep A and Hep B; and § To identify particular issues of stigma relating to HCV diagnosis that impact on women, with a specific reference to access to health care, parenting and paid employment. Most of the women in this study experienced social or economic disadvantage and this makes it more difficult for them to meet the cost of treatment and care for their HCV. The majority of women did not receive adequate, if any, pre (71%) and post (49%) counselling at the time of diagnosis. Almost half (46%) of the women in our study described their health as fair to poor. A little more than half (54%) of the women surveyed were satisfied with their current level of medical care in relation to their Hepatitis C. Thirty-two percent of women were living in households with dependent children and the majority of these women had concerns about the risk of HCV transmission to their children. About a third of women reported ever experiencing less favourable treatment from doctors, dentists, pharmacists or nurses because of their HCV. Of these women, those who were current injecting drug users (IDUs) were at least twice as likely to be treated worse than women who had never injected drugs or who were past IDUs, when it came to nurses, pharmacists and dentists. 7. National survey of general practitioners about needs, outcomes and patterns of care Chief Investigator: Dr Leena Gupta, Central Sydney Area Health Service This project is a national survey of general practitioners to determine their quality of care, education needs and suggestions for support and research to improve outcomes for patients with Hepatitis C. As this project is still underway, an interim report will be made at the workshop. 8. Risks for Hepatitis C: transition and initiation to injecting drug use among youth in a range of drug user networks Chief Investigator: Professor Susan Kippax, National Centre in HIV Social Research, University of New South Wales This study focused on the history of initiation and transition to injecting drug use amongst a range of current injectors aged 25 years and under. It aimed to document risk practices and influences associated with the initial injecting episode, including age of initiation, role of the initiator; reasons for injecting; context of first injection and sources of information. It also aimed to explore the influence of a range of variables on initial and current risk practice. As such, the study focused on contextualising risk practice, examining the importance of different histories of transition and initiation and assessing the relationship between initial risk and current risk practice. It also looked at knowledge of HCV and HIV transmission and the relationship between these and current risk practices. The study combined qualitative and quantitative measures in order to provide contextual and in-depth information on initiation to injecting and injecting cultures among young people. A closed structured questionnaire was designed addressing the following topics - drug use history prior to injecting; first injecting experience, nature of the network prior to and including initiation to injecting, factors associated with initial injecting; sharing, re-use and passing on of fits and injecting equipment; sexual history; health issues related to injecting;
  11. 11. knowledge of HCV and HIV/AIDS transmission; current patterns of drug use and injecting practice. The researchers examined the relationship between variables such as age of initiation; gender; location; HCV status; level of dependency; frequency of use; and current risk practices. 9. Exploring testing injecting drug users for Hepatitis and HIV/AIDS Chief Investigator: Dr Wendy Loxley, National Drug Research Centre, University of Western Australia Australian injecting drug users are commonly tested for Hepatitis C, Hepatitis B and HIV/AIDS. While a considerable literature exists in relation to human factors involved in testing for HIV/AIDS, there appears to be little or no literature related to human factors in testing for Hepatitis C and B, or vaccinating against Hepatitis B. Some studies suggest that being tested is not necessarily a valuable or useful experience for individuals and/or that failure to take account of the complex human factors involved in testing can either deter individuals from presenting for testing, or render testing ineffectual for both the those tested and her/his community. This study examined clinical and practical difficulties with the NHMRC Guidelines. It aimed to deepen knowledge about the process of testing injectors for Hepatitis C and other blood borne viral infections, and to develop recommendations for changes to the testing process. The project was informed at every stage by consultants drawn from a range of relevant organisations. The data collection methodology was primarily qualitative, using a number of different techniques (interviews, focus groups, and consultations) to develop a total data set upon which conclusions and recommendations were based. The findings have led the researchers to the conclusion that a test event is a not only a medical but also a psychosocial intervention to prevent risk behaviour. Both injectors and TSPs need to have the expectation that a test event is an opportunity for them to discuss why the injector could be infected and how further risk to the individual and the community could be avoided. 10. National survey of Hepatitis C risk practices among injecting drug users Chief Investigator: Dr Craig Fry, Turning Point Alcohol and Drug Centre Despite the magnitude of the public health problem associated with the continuing spread of the Hepatitis C virus (HCV) among people who inject drugs in Australia, we currently have little knowledge of the extent to which these individuals are participating in practices that contribute to the spread of Hepatitis C. The Australian Blood borne virus and Injecting Drug Use Study (ABRIDUS) was a national study conducted to explore Hepatitis C risk practices among people who inject drugs. The aims of the study were: 1. To improve the current understanding of the extent to which individuals who inject drugs engage in a range of specific practices that may lead to the transmission of the Hepatitis C virus (HCV). 2. To explore the social and environmental context of identified HCV risk practices.
  12. 12. 3. To disseminate and apply the findings of this research extensively to inform national prevention and education initiatives currently underway in Australia. A key contextual determinant of risk practices emerging from the survey was injecting in public where access to necessary facilities was limited and where the injection itself occurred in hurried conditions. Other determinants were buying and using drugs in a group, being helped to inject by other people and being in a relationship where injection equipment was often shared as an expression of trust. Despite the broadening of blood borne virus (BBV) prevention messages to cover sharing of all injection paraphernalia as well as blood awareness, this study has shown evidence of persistent levels of BBV risk practices among people who inject drugs. This was consistent across the three states. The study also identified key social and environmental contextual determinants of these risk practices. HCV prevention initiatives need to incorporate an understanding of these contextual determinants if they are to be effective in reducing the prevalence of practices that may result in the transmission of blood-borne viruses among people who inject drugs. 11. Reducing transmission of Hepatitis C virus in high-risk young people – a peer education strategy Chief Investigator: Dr S Sawyer, Centre for Adolescent Health, Murdoch Children’s Research Institute Our experience with young injecting drug users is that much of the information available about blood awareness is inappropriate for this group. The aim of this project was to design and pilot a peer education strategy about HCV for young injecting drug users aged 15 to 22 years, using a dynamic approach to recruitment. Sixty-five young people (mean age 19.8 years) were recruited from a local needle exchange over a 12 week period (primary recruitment). A brief questionnaire identified demographics, risk taking behaviour, HCV status and HCV knowledge - focussing on infection, transmission and harm minimisation (pre-intervention testing). One-to-one education was then provided that focused on misconceptions and areas of poor knowledge, using interactive approaches based on real life situations. Participants were asked to return for a follow-up appointment (post-education testing). At the end of the session, participants were asked if they would be interested in recruiting and educating their peers (secondary recruitment). Interested young people were given three ‘Teach Sheets’ and were briefed on how to use these as an aid to educating their peers about HCV. Twenty-seven participants returned for follow-up appointments, 13 of whom had been secondarily recruited. Only one did not try to recruit anyone to the project. All but one young person reported they had learnt something new and changed some aspect of their behaviour. Being a peer educator had a significantly greater effect on knowledge than being educated by a peer. This pilot project is of particular interest in its innovative approach to recruitment (which promotes access to hidden groups), method of education, costs and sustainability.
  13. 13. 12. A feasibility study of non-injecting routes of administration among intravenous drug users Chief Investigator Dr Alex Wodak, St Vincent’s Hospital, Sydney The Non-Injecting Routes of Administration (NIROA) intervention was feasible and beneficial. When asked 'How much do you feel your injecting behaviour has changed?', 12 of 21 subjects stated 'somewhat' to 'very much'. At six months, the number of subjects abstaining from drugs had increased from nil at baseline to three; the number of subjects using drugs more than once a week by NIROA increased from one to five and the number who had never tried NIROA decreased from nine to one. Fifteen out of 30 subjects beginning treatment completed four or more sessions. NIROA was adopted by subjects and introduced to other injecting drug users. Interventions were generally well received by the subjects of this study. The research design underestimated the potential benefits for injecting drug users. Modification of the intervention will be necessary if widespread implementation is to occur. Recruitment was slow. No negative unintended consequences were detected. There is a need for further education of IDUs regarding the benefits of NIROA.

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