HEPATITIS C VIRUS  EMPOWERMENT GROUPS IN  METHADONE MAINTENANCE TREATMENT PROGRAMS :   SUPPORT EDUCATION ADVOCACY   Alain ...
<ul><li>4 million people </li></ul><ul><li>in the United States are infected </li></ul><ul><li>with the hepatitis C virus ...
Sources of Infection for  Persons with Hepatitis C Sexual 15% Other* 5% Unknown 10% Injecting drug use 60% Transfusion 10%...
<ul><li>65%-84% of methadone- maintained patients are infected with HCV </li></ul>
Future HCV Disease Burden in the United States
Predictions for 2010-2019 <ul><li>193,000 HCV deaths </li></ul><ul><ul><li>1.83 million years of life lost </li></ul></ul>...
NIH Consensus Statement, 2002 <ul><li>Recent, albeit limited, experience has demonstrated the feasibility and effectivenes...
Integrating HCV care with MMT at AECOM/Montefiore <ul><li>Network of community-sited MMT programs in the Bronx, NY </li></...
On-site HCV Treatment  at AECOM/Montefiore MMTP MMTP Site: Article 28 facility Scant medical infrastructure  Staff: Intern...
Albert Einstein College of Medicine  Division of Substance Abuse  2003 Death Certificate Data (81 deaths) <ul><li>25% (20 ...
Hepatitis C  Start Support / Empowerment Groups
South Bronx Support Group “ We represent a coalition of patients, providers, family members and friends:  all affected by ...
Education <ul><li>Support groups specifically allow patients to educate each other about HCV infection, the steps involved...
Support
  Advocacy We the undersigned support the goals of the South Bronx Hepatitis C education, advocacy and support group in th...
From Florida to New York City… Becoming a hepatitis c  support group member
 
What the Support Group has meant to me Empowerment, education, motivation. A voice within my own community
<ul><li>Evolution of a </li></ul><ul><li>Support Group </li></ul>
HUB 1 Hepatitis Meeting 1:  COMMON QUESTIONS ABOUT HEPATITIS Irene Soloway Physician Assistant Hub 1 What is hepatitis? He...
HUB 1 Hepatitis Meeting 1:  COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Acute hepatit...
HUB 1 Hepatitis Meeting 1:  COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Which is the ...
HUB 1 Hepatitis Meeting 1:  COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Hepatitis C  ...
HUB 1 Hepatitis Meeting 1:  COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 If I have hep...
FIRST GROUP
Starting with  the Clinical Relationship Inform patients who are concerned about their hepatitis status  about the support...
Identify Core Leadership <ul><li>Every clinic has patients who have leadership ability.  </li></ul><ul><li>Some are alread...
Location / Food
HUB TRIPLEX   Hepatitis Group MEETING All Hub 1, Hub 2 and Hub 3 Clients Welco   WHEN:  February 3  12 pm-2 pm WHERE: PIZZ...
HUB TRIPLEX   HEPATITIS C  SUPPORT GROUP MEETING MONDAY JUNE 21  12 PM-1 PM HUB 1 BASEMENT   ALL ARE WELCOME TOPIC: METHAD...
HUB TRIPLEX HEPATITIS C MEETING MONDAY APRIL 19 12 -2 PM HUB 1 CONFERENCE ROOM TOPIC: ALCOHOL AND THE LIVER FIGHT BACK AGA...
Galvanizing Event
IMPORTANT MEETING   Monday May 20 at 11:30 !!!!  AMERICAN LIVER FOUNDATION WALKATHON  1) registration/sponsor $$$ 2) telep...
Group Identity Formed
Starting Hepatitis C Support Groups:  Useful Organizing Principles <ul><li>Become an expert on hepatitis C at your clinic ...
Starting Hepatitis C Support Groups:  Useful Organizing Principles <ul><li>Share responsibility with core leaders </li></u...
Starting Hepatitis C Support Groups:  Useful Organizing Principles <ul><li>Create a galvanizing event </li></ul><ul><li>Ma...
Sustaining a Support Group Newsletters and the media can be important
PEER EDUCATION: A NATURAL OUTGROWTH OF SUPPORT GROUP
FORMAL TRAINING OF PEER EDUCATORS <ul><li>HCV Empowerment Groups are the foundation of formal peer education program </li>...
Role Playing <ul><li>2 Peer Educator students facilitate a 10-minute group session in front of peers and staff </li></ul><...
MEET HEPATITIS C PEER EDUCATORS FROM THE HUB’S  “ BRONX LIVERATORS ”  HEP C GROUP KNOWLEDGE IS POWER:  FIGHT BACK AGAINST ...
PEER EDUCATION: Group Members Come to Believe in their Expertise
IMPLEMENTATION OF PEER EDUCATION <ul><li>Stipends for educators </li></ul><ul><ul><li>-$20 per peer + transportation </li>...
IMPLEMENTATION OF PEER EDUCATION <ul><li>Peers go out in pairs </li></ul><ul><li>Props (plastic liver) and literature </li...
Peer Program  (2/2004-10/2004) <ul><li>35 sessions usually led by 2 peer educators </li></ul><ul><li>-22 at 8 DoSA sites <...
<ul><li>“ The peer educators are outspoken, knowledgeable and motivated to provide information to their peers.  They motiv...
Peer Educators Motivated to Care for Themselves   <ul><li>14 Peer Educators </li></ul><ul><li>13 HCV Ab+ (all HCV PCR+) </...
Peer Educators Motivated to Care for Themselves <ul><li>Renewed focus on recovery </li></ul><ul><li>Active users take step...
Peer Educators Motivate Others <ul><li>Patients learn about basic HCV knowledge and evaluation process </li></ul><ul><li>P...
Where do we go from here? <ul><li>Formally study outcomes of HCV empowerment groups and peer education programs  </li></ul...
Patient Literature <ul><li>http://www.ci.nyc.ny.us/html/doh/home.html </li></ul><ul><li>NYC DOH (brochures on website) </l...
Provider Information   <ul><li>www.natap.org  by Jules Levin </li></ul><ul><li>(Get on email list for updates on HCV and H...
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HEPATITIS C VIRUS EMPOWERMENT GROUPS IN METHADONE ...

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  • The impact of hepatitis C virus infection on methadone maintenance treatment. NovickmDM. The Mount Sinai Journal of Medicine 2000; 67(5/6): 437-443 Hepatitis C and HIV infections: implications for clinical care in injection drug users. Sullivan LE and Feillin DA. Am J Addict 2004;13:1-20.
  • The impact of hepatitis C virus infection on methadone maintenance treatment. NovickmDM. The Mount Sinai Journal of Medicine 2000; 67(5/6): 437-443 Hepatitis C and HIV infections: implications for clinical care in injection drug users. Sullivan LE and Feillin DA. Am J Addict 2004;13:1-20.
  • The impact of hepatitis C virus infection on methadone maintenance treatment. NovickmDM. The Mount Sinai Journal of Medicine 2000; 67(5/6): 437-443 Hepatitis C and HIV infections: implications for clinical care in injection drug users. Sullivan LE and Feillin DA. Am J Addict 2004;13:1-20.
  • Support Groups are vital in promoting the workup and treatment of hepatitis C in mmtp
  • : support groups specifically allow patients to educate each other about HCV infection, the steps involved in pre-treatment evaluation of HCV, and the management of side effects during HCV treatment.
  • The HCV support group empowers drug users to share information and support each other, and ensures that drug users have a voice within their own hepatitis C treatment programs and in the community. Support groups are also a powerful motivational tool as patients who are at earlier points in the evaluation process share in others’ successes as they pass through milestones in the evaluation and treatment process. Patients begin to believe that good outcomes are attainable.
  • Every clinic has patients who have leadership ability. Some are already recognized as leaders (e.g. pac committee leaders). Others will emerge in the course of meetings. Opportunities to identify leaders include asking members to help with recruiting and orienting new members, setting up and cleaning up the meeting space, speaking at and facilitating meetings. We also encourage patient leaders who accompany other patients to procedures and make hospital visits. These leaders should be acknowledged for their work, thus motivating others to step forward in leadership roles. A culture of self help and education is developed.
  • Every clinic has patients who have leadership ability. Some are already recognized as leaders (e.g. pac committee leaders). Others will emerge in the course of meetings. Opportunities to identify leaders include asking members to help with recruiting and orienting new members, setting up and cleaning up the meeting space, speaking at and facilitating meetings. We also encourage patient leaders who accompany other patients to procedures and make hospital visits. These leaders should be acknowledged for their work, thus motivating others to step forward in leadership roles. A culture of self help and education is developed.
  • Franks personal story : History of his discovery he had hepatitis C, rejection by GI doctor, his work up in Hub 1, liver biopsy findings of cirrhosis Motivation for becoming a leader in our support group : to get the word out
  • The HCV support group empowers drug users to share information and support each other, and ensures that drug users have a voice within their own hepatitis C treatment programs and in the community. Support groups are also a powerful motivational tool as patients who are at earlier points in the evaluation process share in others’ successes as they pass through milestones in the evaluation and treatment process. Patients begin to believe that good outcomes are attainable.
  • Starting and sustaining an hcv support group in a mtp clinic
  • First Meeting: Based on our experience with patients one on one in the course of medical visits, we believed that people were hungry for information and thought that by putting up flyers and provided basic information about hepatitis C, people would naturally flock to the meeting
  • First Meeting: Based on our experience with patients one on one in the course of medical visits, we believed that people were hungry for information and thought that by putting up flyers and provided basic information about hepatitis C, people would naturally flock to the meeting
  • First Meeting: Based on our experience with patients one on one in the course of medical visits, we believed that people were hungry for information and thought that by putting up flyers and provided basic information about hepatitis C, people would naturally flock to the meeting
  • First Meeting: Based on our experience with patients one on one in the course of medical visits, we believed that people were hungry for information and thought that by putting up flyers and provided basic information about hepatitis C, people would naturally flock to the meeting
  • First Meeting: Based on our experience with patients one on one in the course of medical visits, we believed that people were hungry for information and thought that by putting up flyers and provided basic information about hepatitis C, people would naturally flock to the meeting
  • So how do we really start a hep C empowerment group: the clinical relationship is key:We inform patients who are concerned about their hepatitis status about the support group as soon as the first medical visit. For patients who are afraid to take any steps in their treatment (blood test, biopsy), going to a group is a treatment step in itself. For patients who have been through tests, procedures and treatment, we stress the important role they can play in helping others make treatment decisions.
  • Every clinic has patients who have leadership ability. Some are already recognized as leaders (e.g pac committee leaders). Others will emerge in the course of meetings. Opportunities to identify leaders include asking members to help with recruiting and orienting new members, setting up and cleaning up the meeting space, speaking at and facilitating meetings. We also encourage patient leaders who accompany other patients to procedures and make hospital visits. These leaders should be acknowledged for their work, thus motivating others to step forward in leadership roles. A culture of self help and education is developed.
  • In the first year of our group, meeting space was not reliably available. Rather than put off meetings, we negotiated with a local restaurant that had a private meeting room. Having food available after the meeting was helpful in providing a congenial atmosphere and lent itself to informal socializing and group bonding after the meetings. As this can be expensive, we accepted donations towards food from regional pharmaceutical representatives. No reps at meetings, and no company endorsements.
  • Flyers are important,: MTP programs tend to be papered with flyers and often ignored. We tried to make ours attention-grabbing, out with bold graphics and clear slogans. We also try to change the image monthly to alert people of each new meeting. t is fairly simple to create graphically interesting flyers on the computer.Trye Google Image Search for graphics, and just cut and paste into your word program to create flyers. However, flyers are only props: we use our core group leaders to distrubute flyers
  • example
  • example
  • In the beginning, there were few patients in the support group who were receiving hcv treatment. We discussed hcv issues in the context of hcv as a disease which disproportionately affects drug users and people in drug treatment. Our group decided to fight back against the epidemic by walking as a team in the American Liver Foundation’s annual Liver Walk fundraiser. We spent several months discussing our goals, soliciting sponsors and organizing logistics.
  • As you can see in this slide, preparing for the event generates activities that provide training and education
  • Preparing for the Liver Walk gave us an opportunity to developed a more high profile group identity: The group came up with a name, graphics, t shirts and a banner. We reached out to friends and family as well as clinic staff and program administrators. Awareness of the importance of our mission grew
  • Newsletters and the media can be important
  • Peer Education naturally evolves out of support group: as group members are called on to answer questions, they develop skills as educators. The group facilitator can provide support and corrections.
  • We have found that having the challenge of
  • At the graduation event, certificates are formally presented. The peer educators have an opportunity to introduce themselves and demonstrate their skills and knowledge. At this event, we invited patients, staff, and special guests (the Bronx Dept of Health Commissioner, heads of local harm reduction programs).
  • HEPATITIS C VIRUS EMPOWERMENT GROUPS IN METHADONE ...

    1. 1. HEPATITIS C VIRUS EMPOWERMENT GROUPS IN METHADONE MAINTENANCE TREATMENT PROGRAMS : SUPPORT EDUCATION ADVOCACY   Alain Litwin, MD, MPH Irene Soloway, RPA Frank Medina, Peer Educator October 19, 2004
    2. 2. <ul><li>4 million people </li></ul><ul><li>in the United States are infected </li></ul><ul><li>with the hepatitis C virus </li></ul><ul><li>(HCV) </li></ul>
    3. 3. Sources of Infection for Persons with Hepatitis C Sexual 15% Other* 5% Unknown 10% Injecting drug use 60% Transfusion 10% (before screening) *In a medical setting; healthcare work; perinatal Source: Centers for Disease Control and Prevention
    4. 4. <ul><li>65%-84% of methadone- maintained patients are infected with HCV </li></ul>
    5. 5. Future HCV Disease Burden in the United States
    6. 6. Predictions for 2010-2019 <ul><li>193,000 HCV deaths </li></ul><ul><ul><li>1.83 million years of life lost </li></ul></ul><ul><li>$11 billion in direct medical care costs </li></ul><ul><li>$21.3 and $54 billion societal costs from premature disability and mortality </li></ul>
    7. 7. NIH Consensus Statement, 2002 <ul><li>Recent, albeit limited, experience has demonstrated the feasibility and effectiveness of treating chronic hepatitis C in people who use illicit injection drugs, known as injection drug users (IDUs). </li></ul><ul><li>Management of HCV-infected IDUs is enhanced by linking these patients to drug treatment programs. </li></ul><ul><li>Methadone treatment has been shown to reduce risky behaviors that can spread HCV infection, and it is not a contraindication to HCV treatment. </li></ul><ul><li>Efforts should be made to promote collaboration between experts in HCV and healthcare providers specializing in substance-abuse treatment. </li></ul><ul><li>HCV therapy has been successful even when the patients have not abstained from continued drug or alcohol use or are on daily methadone. </li></ul><ul><li>However, few data are available on HCV treatment in active IDUs who are not in drug treatment programs. Thus, it is recommended that treatment of active injection drug use be considered on a case-by-case basis, and that active injection drug use in and of itself not be used to exclude such patients from antiviral therapy. </li></ul>
    8. 8. Integrating HCV care with MMT at AECOM/Montefiore <ul><li>Network of community-sited MMT programs in the Bronx, NY </li></ul><ul><li>Comprehensive on-site primary care </li></ul><ul><li>4300 patients </li></ul><ul><ul><li>59% Latino/a, 23% African-American, 18% Caucasian </li></ul></ul><ul><ul><li>Mean methadone dose: 90 mg </li></ul></ul><ul><ul><li>65-75% (2800) HCV Antibody positive </li></ul></ul><ul><ul><li>56% chronic HCV infection (detectable HCV-PCR) </li></ul></ul>
    9. 9. On-site HCV Treatment at AECOM/Montefiore MMTP MMTP Site: Article 28 facility Scant medical infrastructure Staff: Internist or FP, PA Part-time psychiatrist Counselors, HIV Coordinators, nursing, SW Services: Opioid agonist therapy Comprehensive on-site 1 º care General, HIV, HCV, Gyn Psych evaluation and tx Support group Laboratory testing, EKG Urine toxicology testing Hospital Hepatologist Interventional radiologist Pathologist EST, optho, etc. Lab
    10. 10. Albert Einstein College of Medicine Division of Substance Abuse 2003 Death Certificate Data (81 deaths) <ul><li>25% (20 patients) died from HCV with end-stage liver disease </li></ul><ul><li>21% (17 patients) died from unknown causes </li></ul><ul><li>6% (5 patients) died from HIV/AIDS related complications </li></ul>
    11. 11. Hepatitis C Start Support / Empowerment Groups
    12. 12. South Bronx Support Group “ We represent a coalition of patients, providers, family members and friends: all affected by the hepatitis C epidemic in our South Bronx Community.” “ People in methadone maintenance must have access to hepatitis C resources. We work to ensure that current and former drug users have access to treatment for both substance abuse and hepatitis C. ”
    13. 13. Education <ul><li>Support groups specifically allow patients to educate each other about HCV infection, the steps involved in pre-treatment evaluation of HCV, and the management of side effects during HCV treatment. </li></ul>
    14. 14. Support
    15. 15. Advocacy We the undersigned support the goals of the South Bronx Hepatitis C education, advocacy and support group in their advocacy for Medicaid reimbursement for hepatitis C PCR and genotype testing. Name Address Phone Contact
    16. 16. From Florida to New York City… Becoming a hepatitis c support group member
    17. 18. What the Support Group has meant to me Empowerment, education, motivation. A voice within my own community
    18. 19. <ul><li>Evolution of a </li></ul><ul><li>Support Group </li></ul>
    19. 20. HUB 1 Hepatitis Meeting 1: COMMON QUESTIONS ABOUT HEPATITIS Irene Soloway Physician Assistant Hub 1 What is hepatitis? Hepatitis is an inflammatory condition of the liver. It can be caused by bacterial or viral infection, fat buildup in the liver, drugs, alcohol, toxins, and other causes. Most hepatitis is caused by viruses that invade the liver cells. They take over the liver cells and can cause damage that impairs liver function.
    20. 21. HUB 1 Hepatitis Meeting 1: COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Acute hepatitis : an infection that lasts less than 6 months and that your body can get rid of Chronic hepatitis : an infection that stays in your body and needs medical treatment to eliminate it Fibrosis: scarring that occurs as the liver attempts to repair itself Cirrhosis: when all the scar tissue formed from the constant repairing process is connected together, making the liver smaller and harder. Blood is not able to freely flow through the liver, and eventually the liver cannot function normally COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1
    21. 22. HUB 1 Hepatitis Meeting 1: COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Which is the worst hepatitis? There are 6 different hepatitis viruses: A, B, C, D, E and G. Hepatitis A and B are most likely to cause symptoms, and chronic hepatitis B and C are the most likely to cause long term health problems. D, E, and G are quite rare Hepatitis B is more common and contagious than HIV. It is spread through contact with infected blood, and through sexual contact. However, most people who get infected will fight off the infection. There is a vaccine to protect your from getting hepatitis B if you have not already been exposed. COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1
    22. 23. HUB 1 Hepatitis Meeting 1: COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 Hepatitis C is the most common. Almost 5 million Americans have been exposed to hepatitis C. over 80% of people who have used IV drugs have chronic hepatitis C. Hepatitis C is spread by blood to blood contact, including blood transfusions before 1992, body piercing, knife fights, tattooing, and IV drug use. Even sharing straws while sniffing cocaine or heroin can be a risk factor. The risk of getting hepatitis C from sex is very low, unless you have multiple sexual partners and STDs. There is no vaccine at this time to protect you from it. COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1
    23. 24. HUB 1 Hepatitis Meeting 1: COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1 If I have hepatitis C, am I going to die? Hepatitis C is a slow acting virus, and it usually takes 20-30 years to progress to cirrhosis and liver failure. Symptoms do not show up for years. Many people who have hepatitis C will live out their life spans without ever getting sick from it. However, at least 2 out of 10 people will get cirrhosis and have greater risk of complications or death. People who have a history of heavy drinking or HIV usually have a faster disease progression. COMMON QUESTIONS ABOUT HEPATITIS (cont.) Irene Soloway Physician Assistant Hub 1
    24. 25. FIRST GROUP
    25. 26. Starting with the Clinical Relationship Inform patients who are concerned about their hepatitis status about the support group as soon as the first medical visit.
    26. 27. Identify Core Leadership <ul><li>Every clinic has patients who have leadership ability. </li></ul><ul><li>Some are already recognized as leaders (e.g pac committee leaders). </li></ul><ul><li>Others will emerge in the course of meetings. </li></ul><ul><li>These leaders should be acknowledged for their work, thus motivating others to step forward in leadership roles. A culture of self help and education is developed. </li></ul>
    27. 28. Location / Food
    28. 29. HUB TRIPLEX Hepatitis Group MEETING All Hub 1, Hub 2 and Hub 3 Clients Welco WHEN: February 3 12 pm-2 pm WHERE: PIZZA RESTAURANT 448 E. 149 TH ST (WALK TOWARDS ST ANN’S, RESTAURANT IS BETWEEN BERGEN AND BROOK, ACROSS FROM PARKING LOT) TOPIC: HEPATITIS C TRANSMISSION A COMMUNITY DISCUSSION Create interesting flyers to promote meetings.
    29. 30. HUB TRIPLEX HEPATITIS C SUPPORT GROUP MEETING MONDAY JUNE 21 12 PM-1 PM HUB 1 BASEMENT ALL ARE WELCOME TOPIC: METHADONE AND HEPATITIS: MYTHS AND REALITIES:
    30. 31. HUB TRIPLEX HEPATITIS C MEETING MONDAY APRIL 19 12 -2 PM HUB 1 CONFERENCE ROOM TOPIC: ALCOHOL AND THE LIVER FIGHT BACK AGAINST THE HCV EPIDEMIC ALL ARE WELCOME
    31. 32. Galvanizing Event
    32. 33. IMPORTANT MEETING Monday May 20 at 11:30 !!!! AMERICAN LIVER FOUNDATION WALKATHON 1) registration/sponsor $$$ 2) telephone tree 3) the banner 4) the walk 5) the movie 6) the party
    33. 34. Group Identity Formed
    34. 35. Starting Hepatitis C Support Groups: Useful Organizing Principles <ul><li>Become an expert on hepatitis C at your clinic (even if you aren’t one) </li></ul><ul><li>Raise awareness of hepatitis C issues clinic wide </li></ul><ul><li>- annuals/clinic visits/treatment plans </li></ul><ul><li>- pamphlets (literature rack) </li></ul><ul><li>- staff meetings </li></ul><ul><li>- articles </li></ul><ul><li>- grand rounds </li></ul>
    35. 36. Starting Hepatitis C Support Groups: Useful Organizing Principles <ul><li>Share responsibility with core leaders </li></ul><ul><li>Link individual success to group goals </li></ul><ul><li>Link group goals to administrative goals </li></ul><ul><li>Consider all administrative issues </li></ul>
    36. 37. Starting Hepatitis C Support Groups: Useful Organizing Principles <ul><li>Create a galvanizing event </li></ul><ul><li>Make sure every meeting is an event </li></ul><ul><li>Invite special guests </li></ul><ul><ul><li>Medical students / residents </li></ul></ul><ul><ul><li>Medical experts </li></ul></ul><ul><ul><li>Harm reduction workers </li></ul></ul><ul><ul><li>Local health department </li></ul></ul><ul><li>Document everything </li></ul>
    37. 38. Sustaining a Support Group Newsletters and the media can be important
    38. 39. PEER EDUCATION: A NATURAL OUTGROWTH OF SUPPORT GROUP
    39. 40. FORMAL TRAINING OF PEER EDUCATORS <ul><li>HCV Empowerment Groups are the foundation of formal peer education program </li></ul><ul><li>3 classroom sessions (2 hours each) </li></ul><ul><li>-1 st 2 sessions included informal written pre and post-test (P/PEGS) </li></ul><ul><li>-final session included role playing with feedback, and a written final exam </li></ul>
    40. 41. Role Playing <ul><li>2 Peer Educator students facilitate a 10-minute group session in front of peers and staff </li></ul><ul><li>-Practice Introductions </li></ul><ul><li>-Deliver basic HCV knowledge </li></ul><ul><li>-Practice responding to difficult questions </li></ul><ul><li>Formal Feedback </li></ul><ul><ul><li>-Peers identify own strengths/weaknesses </li></ul></ul><ul><ul><li>-Staff/peers identify strengths/weaknesses </li></ul></ul><ul><li>Practice ongoing facilitation and knowledge skills in our own monthly HCV Empowerment Group </li></ul>
    41. 42. MEET HEPATITIS C PEER EDUCATORS FROM THE HUB’S “ BRONX LIVERATORS ” HEP C GROUP KNOWLEDGE IS POWER: FIGHT BACK AGAINST THE HCV EPIDEMIC WHERE: CD SOUTH CONFERENCE ROOM WHEN: TODAY!!!!!! THURSDAY MARCH 11 2:00 PM PEER EDUCATION GRADUATION 2:30 PM HEP C QUESTIONS AND ANSWERS REFRESHMENTS WILL BE SERVED
    42. 43. PEER EDUCATION: Group Members Come to Believe in their Expertise
    43. 44. IMPLEMENTATION OF PEER EDUCATION <ul><li>Stipends for educators </li></ul><ul><ul><li>-$20 per peer + transportation </li></ul></ul><ul><li>Documentation: attendance records </li></ul><ul><li>Feedback from peer educators and host </li></ul>
    44. 45. IMPLEMENTATION OF PEER EDUCATION <ul><li>Peers go out in pairs </li></ul><ul><li>Props (plastic liver) and literature </li></ul><ul><li>Peers educate both staff and patients </li></ul>
    45. 46. Peer Program (2/2004-10/2004) <ul><li>35 sessions usually led by 2 peer educators </li></ul><ul><li>-22 at 8 DoSA sites </li></ul><ul><li>-11 at SEP outreach site </li></ul><ul><li>-2 at outside sites </li></ul><ul><li>Approximately 250 patients and 30 staff members reached </li></ul><ul><li>14 peer educators graduated (10 have </li></ul><ul><li>led sessions to this date) </li></ul>
    46. 47. <ul><li>“ The peer educators are outspoken, knowledgeable and motivated to provide information to their peers. They motivated the group with self-disclosures, encouraged follow-up with primary care provider and offered support. The group had many questions about transmission, symptoms, treatment process and effects of medications. The peer educators are very well informed and are able to relate their message clearly and simply to patients and staff. Personally, I am amazed by their presentations and I believe that this is extremely important to the community” </li></ul><ul><li>Substance Abuse Counselor / Relapse Prevention Group Facilitator </li></ul>
    47. 48. Peer Educators Motivated to Care for Themselves <ul><li>14 Peer Educators </li></ul><ul><li>13 HCV Ab+ (all HCV PCR+) </li></ul><ul><li>9 underwent liver biopsy </li></ul><ul><li>(1 not treated due to mild liver disease; 7 treated due moderate/advanced liver disease; 1 NASH) </li></ul><ul><li>5 with cirrhosis (including 2 decompensated) </li></ul><ul><li>10 initiated HCV antiviral treatment </li></ul><ul><li>Overall, good responses to treatment </li></ul><ul><ul><li>5 sustained viral responses (SVR) including 2 HIV/HCV </li></ul></ul><ul><ul><li>2 end of treatment responses (ETR): awaiting SVR </li></ul></ul><ul><ul><li>1 6-month EVR </li></ul></ul><ul><ul><li>1 recently initiated treatment </li></ul></ul><ul><ul><li>Only 1 did not tolerate antiviral treatment (HIV/HCV) </li></ul></ul>
    48. 49. Peer Educators Motivated to Care for Themselves <ul><li>Renewed focus on recovery </li></ul><ul><li>Active users take steps towards abstinence and sustained recovery </li></ul><ul><li>Renewed focus on relapse prevention </li></ul>
    49. 50. Peer Educators Motivate Others <ul><li>Patients learn about basic HCV knowledge and evaluation process </li></ul><ul><li>Patients motivated to focus on addiction treatment and recovery </li></ul><ul><li>Patients motivated to undergo various steps of HCV evaluation and treatment process </li></ul><ul><ul><li>Establish diagnosis </li></ul></ul><ul><ul><li>Liver Biopsy </li></ul></ul><ul><ul><li>Initiate HCV Treatment </li></ul></ul>
    50. 51. Where do we go from here? <ul><li>Formally study outcomes of HCV empowerment groups and peer education programs </li></ul><ul><li>Expand HCV support / empowerment groups and peer education programs </li></ul><ul><li>Continue to build bridges to hepatitis C treatment through advocacy </li></ul><ul><li>Continue to educate providers to break down barriers </li></ul>
    51. 52. Patient Literature <ul><li>http://www.ci.nyc.ny.us/html/doh/home.html </li></ul><ul><li>NYC DOH (brochures on website) </li></ul><ul><li>www.cdc.gov (also www.cdc.gov/idu ) </li></ul><ul><li>www.natap.org </li></ul><ul><li>www. harmreduction .org </li></ul><ul><li>(Harm Reduction Coalition) </li></ul><ul><li>http://www. lola -national.org </li></ul><ul><li>(Latino Organization for Liver Awareness) </li></ul><ul><li>www. hcvadvocate .org </li></ul><ul><li>http://www.liverfoundation.org/order_form.pdf </li></ul><ul><li>(American Liver Foundation charges 0.75 for single copies and $20 for 100 copies) </li></ul>
    52. 53. Provider Information <ul><li>www.natap.org by Jules Levin </li></ul><ul><li>(Get on email list for updates on HCV and HIV) </li></ul><ul><li>www.projectsinknowledge.com </li></ul><ul><li>(Care and Counsel Handbook and other HCV CME) </li></ul><ul><li>IN-Viro advancing the study of liver disease 1-800-227-7448 </li></ul><ul><li>http://www.uchsc.edu/mpaetc/home.html </li></ul><ul><li>http://www.uchsc.edu/mpaetc/HIV_HCV%20pocket%20guide.pdf </li></ul><ul><li>[Clinician’s Guide to HIV/HCV Co-infection and lots of other useful links] </li></ul>
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