ORCID Profile
0000-0002-8230-0386
Current Organisation
UNSW Sydney
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Publisher: Informa UK Limited
Date: 16-11-2017
Publisher: Hindawi Limited
Date: 05-2013
DOI: 10.1111/HSC.12054
Abstract: Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non-Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined in idual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non-Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi-layered programme of work involving grass-roots community education, workers and Board members of Aboriginal community-controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community-based primary care and tertiary level cancer services.
Publisher: Public Library of Science (PLoS)
Date: 09-09-2016
Publisher: Wiley
Date: 25-11-2013
DOI: 10.1111/ADD.12392
Abstract: To explore identity transformation among service users attending opiate substitution therapy (OST) clinics following the introduction of hepatitis C (HCV) care and treatment. An interview-based substudy of the Australian ETHOS (Enhancing Treatment for Hepatitis C in Opiate Substitution Settings) project. Three OST clinics and one community health centre (operating a public OST) in New South Wales, Australia. Participants were interviewed at the recruitment sites. The s le consisted of 57 OST service users concurrently living with HCV, 16 staff, including specialist HCV clinicians, and three peer-support workers, employed on the ETHOS project. Semi-structured interviews. Service-user participants largely welcomed the introduction of HCV treatment as a practical, clinical intervention that also intimated a more comprehensive, holistic form of care. Negative stereotypes characteristic of OST settings-of limited, routinized clinical exchanges and minimal social-care interaction-were unsettled, opening up the possibility of new relations between staff and service users. The shift in the dynamic of the clinical encounter to address health in addition to dependence appeared to catalyse transformative possibilities not only for the therapeutic alliance but also for service-user understandings of self and identity. Trial introduction of HCV care and treatment in selected Australian opiate substitution therapy (OST) clinics may have facilitated alternative, 'non-addict' identities to emerge from a clinical setting where the stigmatizing figure of 'the drug user' has traditionally prevailed.
Publisher: Springer Science and Business Media LLC
Date: 16-07-2005
DOI: 10.1007/S00520-005-0808-5
Abstract: This study was conducted to assess the face, content and construct validity and the internal validity of the revised version of an instrument to measure the perceived needs of men diagnosed with prostate cancer [Prostate Cancer Needs Questionnaire version 2 (PCNQv2)]. The PCNQ was constructed in two parts with Part 1 measuring needs at diagnosis and initial treatment and Part 2 measuring current needs. A random s le of 650 men diagnosed with prostate cancer attending a Urologist of the Hunter Urology Group in Newcastle, New South Wales, Australia, were invited to participate in the study and sent by post the self-administered PCNQ. Information was provided on 145 men who were considered ineligible to participate. Completed questionnaires were received from 300 men. The principal components method of factor analysis with varimax orthogonal rotation identified eight factors with eigenvalues greater than 1, which together accounted for 68% of the variance in Part 1 of the PCNQ. Likewise, six factors were identified in Part 2 which accounted for 68% of the variance. Internal reliability coefficients (Cronbach's alpha) were adequate for identified factors with values ranging from 0.71 to 0.90 for Part 1, and from 0.80 to 0.92 for Part 2. These results support the validity and reliability of the PCNQv2 to assess the perceived needs experienced by men diagnosed with prostate cancer.
Publisher: Informa UK Limited
Date: 2007
Publisher: SAGE Publications
Date: 30-01-2017
Abstract: For over 20 years, drug policy experts have been calling for the wider availability of naloxone, to enable lay overdose witnesses to respond to opioid overdose events. However, the ‘evidence base’ for peer-administered naloxone has become a key point of contention. This contention opens up critical questions about how knowledge (‘evidence’) is constituted and validated in drug policy processes, which voices may be heard, and how knowledge producers secure privileged positions of influence. Taking the debate surrounding peer-administered naloxone as a case study, and drawing on qualitative interviews with in iduals (n = 19) involved in the development of naloxone policy in Australia, we examine how particular kinds of knowledge are rendered ‘useful’ in drug policy debates. Applying Bacchi’s poststructuralist approach to policy analysis, we argue that taken-for-granted ‘truths’ implicit within evidence-based policy discourse privilege particular kinds of ‘objective’ and ‘rational’ knowledge and, in so doing, legitimate the voices of researchers and clinicians to the exclusion of others. What appears to be a simple requirement for methodological rigour in the evidence-based policy paradigm actually rests on deeper assumptions which place limits around not only what can be said (in terms of what kind of knowledge is relevant for policy debate) but also who may legitimately speak. However, the accounts offered by participants reveal the ways in which a larger number of ways of knowing are already co-habiting within drug policy. Despite these opportunities for re-problematisation and resistance, the continued mobilisation of ‘evidence-based’ discourse obscures these contesting positions and continues to privilege particular speakers.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.DRUGALCDEP.2009.06.016
Abstract: Despite recognition of the benefits of involving consumers in their own treatment, there is little research on consumer participation in drug treatment. This paper focuses on clients who use illicit substances and the role of consumer participation in their self-reported satisfaction with their drug treatment and sense of goal achievement in that treatment. As part of a secondary analysis, the data from 492 participants who had previously or who were currently engaged in drug treatment were analysed to assess the importance of consumer participation in drug treatment. Participants who had a history of opiate or psychostimulant use were recruited at various treatment services and health care facilities for drug users located in five urban and rural/regional sites in Australia. They were asked to complete an interviewer-assisted questionnaire assessing a range of variables including five questions about consumer participation. Findings from this study illustrate that clients' opportunity to participate in drug treatment is independently associated with greater satisfaction with drug treatment and a greater sense of achievement of treatment goals. This research provides evidence to support the importance of consumer activity in drug treatment and should encourage drug treatment programs to afford clients appropriate levels of consumer participation.
Publisher: Informa UK Limited
Date: 02-2004
Publisher: Wiley
Date: 14-11-2019
DOI: 10.1111/JVH.13013
Abstract: Subsidized direct-acting antiviral (DAA) treatment recently became available to all adults living with chronic hepatitis C virus (HCV) in Australia. Based on rapid uptake (32 600 people initiated DAA in 2016), we estimated the impact on HCV epidemiology and mortality in Australia and determined if Australia can meet the WHO HCV elimination targets by 2030. Using a mathematical model, we simulated pessimistic, intermediate and optimistic DAA treatment scenarios in Australia over 2016-2030. We assumed treatment and testing rates were initially higher for advanced fibrosis and the same across HCV transmission risk level sub-populations. We also assumed constant testing rates after 2016. We compared the results to the 2015 level and a counterfactual (IFN-based) scenario. During 2016-2030, we estimated an intermediate DAA treatment scenario (2016, 32 600 treated 2017, 21 370 treated 2018 17 100 treated 2019 and beyond, 13 680 treated each year) would avert 40 420 new HCV infections, 13 260 liver-related deaths (15 320 in viraemic -2060 in cured) and 10 730 HCC cases, equating to a 53%, 63% and 75% reduction, respectively, compared to the IFN-based scenario. The model also estimated that Australia will meet the WHO targets of incidence and treatment by 2028. Time to a 65% reduction in liver-related mortality varied considerably between HCV viraemic only cases (2026) and all cases (2047). Based on a feasible DAA treatment scenario incorporating declining uptake, Australia should meet key WHO HCV elimination targets in 10 to15 years. The pre-DAA escalation in those with advanced liver disease makes the achievement of the liver-related mortality target difficult.
Publisher: Elsevier BV
Date: 09-2006
Publisher: Elsevier BV
Date: 2005
Publisher: Elsevier BV
Date: 04-2016
Abstract: Aboriginal Australians are disproportionately affected by hepatitis C (HCV). There are a range of barriers to HCV care, often beginning with poor diagnosis experiences. Little research exists on the experiences of Aboriginal Australians living with HCV. This study aimed to describe their patterns of HCV care and treatment with specific emphasis on the impact of their being informed of their diagnosis in a culturally sensitive manner. A total of 203 Aboriginal people living with HCV were recruited to complete a survey assessing experiences of HCV testing and care, HCV knowledge, lifestyle changes after diagnosis, perceived stigma and discrimination. Of the s le, 58% were male and 96% identified as Aboriginal, with a mean age of 28 years. Correlation analysis revealed that satisfaction with the cultural appropriateness of the diagnosis was associated with: being offered pre- and post-test counselling satisfaction with HCV care decreased feelings of HCV-related stigma lower scores on the medical mistrust scale and greater intentions to access HCV treatment. These findings confirm the importance of providing a HCV diagnosis in a culturally appropriate way for Aboriginal people. Satisfaction with HCV diagnosis appears essential in establishing patterns of greater engagement with HCV care and treatment for this group.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2018
Publisher: JMIR Publications Inc.
Date: 06-10-2021
DOI: 10.2196/25217
Abstract: Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention) baseline, 2-, and 8-week follow-up assessments conducted through telephone and qualitative telephone interviews with a convenience s le of study participants (20/72, 28%) and facilitators (n=8). Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97 95% CI –2.02 to 2.24) was reported. Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Australian New Zealand Clinical Trials Registry ACTRN12619000686101 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 RR2-10.2196/15113
Publisher: Informa UK Limited
Date: 04-2011
DOI: 10.1586/ERA.09.8
Abstract: The 6th Meeting of the European Society of Oncological Urology (chaired by Vincent Ravery, Paris, France) was held in Istanbul, Turkey, on 16-18 January 2009 and gathered more than 600 participants from 44 countries. Topics encompassed a number of uro-oncological issues, including prostatic carcinoma and bladder, renal and testicular cancers. The conference, in addition to its exciting scientific program and contribution from a highly prestigious international faculty, also included a series of debates and interactive voting dealing with the latest surgical and medical developments in the field of oncological urology.
Publisher: Informa UK Limited
Date: 2008
Publisher: Informa UK Limited
Date: 11-04-2011
Publisher: SAGE Publications
Date: 18-08-2009
Abstract: Hepatitis C virus infection is a stigmatized condition because of its close association with injecting drug use. There is a need to explore how people who inject drugs (IDUs) perceive hepatitis C, including in relation to treatment experience. We undertook a review, using a qualitative synthesis approach, of English-language qualitative research focusing on the lived experience of hepatitis C among IDUs. The review included 25 published articles representing 20 unique studies. A synthesis of this literature generated three interplaying themes: social stigma, biographical adaptation, and medical and treatment encounters. Interactions with health systems can reproduce stigma linked to drug injecting and hepatitis C, as well as trivialize the lived experience of diagnosis and illness. Hepatitis C can be biographically reinforcing of socially accommodated risk and spoiled identity, as well as disruptive to everyday life. We hypothesize hepatitis C as a liminal illness experience, oscillating between trivial and serious, normalized and stigmatized, public and personal. We conclude by emphasizing the disconnects between the lived experience of hepatitis C among IDUs and Western health care system responses.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.DRUGALCDEP.2016.09.010
Abstract: Despite injecting-equipment sharing between sexual partners leaving them at increased risk of hepatitis C (HCV), there is scant literature available to guide harm reduction workers in their encounters with couples who inject drugs. This article explored workers' understandings of such couples and their accounts of working with them in relation to HCV prevention. Semi-structured interviews were conducted with 22 staff of harm reduction services located in Sydney and Melbourne, Australia. Overall, staff represented couples as either absent from the service or as presenting with needs indiscernible from those of in idual clients. Responses to questions about HCV and couples were framed primarily in terms of risk. Staff participants questioned 'genuineness' of clients' intimate relationships, instead characterising them as inauthentic and drug-driven. Working with couples was seen to present a number of organisational and clinical challenges. The benefits of recognising and working with such partnerships received scant acknowledgement. Rather, staff tended to perceive couples as being 'impenetrable' to health promotion messaging. The framing and delivery of harm reduction in Australia remains an in idualising enterprise with little capacity to recognise the intimate partnerships, including addressing the HCV risks specific to them. More effective harm reduction strategies may be achieved by transitioning to a practice framework that addresses the social context of injecting, including the experience of couples. This would require direct involvement of couples who inject drugs.
Publisher: Wiley
Date: 04-2022
Abstract: Since the advent of direct-acting antiviral hepatitis C treatments, widespread enthusiasm about disease elimination has emerged. This article examines experiences of hepatitis C treatment and cure in this period. Mobilising Fraser and Seear's (Making disease, making citizens: The politics of hepatitis C, Ashgate, 2011) approach to hepatitis C as a 'gathering', we analyse cure not as a biomedical phenomenon but as a social and material event. To do so, we take a Science and Technology Studies-inspired approach to analyse three complementary cases drawn from an Australian project on experiences of hepatitis C, treatment and cure. First, we analyse the ways a friendship between two women combines with adjustments to treatment access to produce a gathering that makes cure possible. Second, we analyse the forces that gather and distribute responsibility when a cure does not occur in a context shaped by oversimplified treatment logics. Third, we analyse a gathering of relations in which hepatitis C lingers, thereby limiting the cure's possible transformative effects. We argue that, even in an era defined by highly effective medicines, the hepatitis C cure is not necessarily straightforward, but an unpredictable gathering constituted by a fragile coalescing of social and material forces.
Publisher: Informa UK Limited
Date: 10-04-2018
Publisher: Informa UK Limited
Date: 06-2010
Publisher: Informa UK Limited
Date: 08-2013
DOI: 10.1080/13557858.2012.754408
Abstract: Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. Our team--which includes both Aboriginal and non-Aboriginal researchers--conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of 'discursive framing' in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what 'cultural difference' means for the design and delivery of cancer care services to Aboriginal people. Despite geographical, organisational, disciplinary and cultural ersity, these interview participants consistently drew upon six discursive frames, which we have interpreted as either eliding a discussion of difference ('everyone is the same' and 'everyone is different') or facilitating that discussion ('different priorities,' 'different practices' and 'making difference safe'). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the 'taken for granted' assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer.
Publisher: Elsevier BV
Date: 10-2005
Publisher: Springer Science and Business Media LLC
Date: 05-2000
DOI: 10.1007/BF02820685
Publisher: Wiley
Date: 12-2000
Publisher: Wiley
Date: 22-09-2018
DOI: 10.1111/LIV.13949
Publisher: Mary Ann Liebert Inc
Date: 10-2018
Abstract: Social capital has been associated with improved health outcomes. Measures of social capital have been developed specifically for different population groups, cultures, and contexts however, there is no readily available measure for use among inmates in the prison setting. This study sought to translate a community concept into the prison setting through the development and piloting of the Inmate Social Capital Questionnaire (ISCQ). Thirty male inmates (living with hepatitis C) participated in the pilot phase of the ISCQ ( n = 23 sentenced and n = 7 held on remand). Dimensions of social capital were influenced by length of incarceration (time already served as well as time to release), connections with family, and duration at current prison.
Publisher: Wiley
Date: 07-2010
DOI: 10.1111/J.1465-3362.2009.00154.X
Abstract: The comprehensive needle and syringe distribution system in New South Wales is partly based on the premise that different points of access to injecting equipment may attract different groups of injecting drug users. This paper examines patterns of equipment acquisition and risk for blood-borne virus transmission among injecting drug users who use pharmacies and needle and syringe programs (NSP) in south-east Sydney. Clients obtaining injecting equipment from four NSP (n = 147) and eight pharmacies (n = 227) in 2006 voluntarily completed a self-administered questionnaire. Respondents were grouped into three categories based on their needle and syringe acquisition patterns: exclusive use of NSP, exclusive use of pharmacies and use of both. Although it was common for respondents to report using both pharmacies and NSP to obtain needles and syringes (57%), a proportion reported exclusive use of pharmacies (17%) and NSP (14%). Exclusive pharmacy users were more likely to have never received treatment for their drug use and the least likely to have had a recent test for hepatitis C. Compared with respondents who exclusively used NSP, respondents who exclusively used pharmacies were more likely to report receptive sharing of injecting equipment (adjusted odds ratio 5.9, 95% confidence interval 2.02-17.14), as were respondents who reported using both sources (adjusted odds ratio 5.8, 95% confidence interval 2.35-14.40). The high prevalence of receptive equipment sharing among pharmacy clients indicates a need to improve access to needles and syringes and ancillary equipment, possibly by including ancillary equipment at no cost in existing pre-packaged pharmacy products.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.SOCSCIMED.2017.03.012
Abstract: Public health research treats intimate partnerships as sites of risk management, including in the management of HIV and hepatitis C transmission. This risk-infused biomedical approach tends to undermine appreciation of the emotional and socially situated meanings of care in intimate partnerships. In this article we explore qualitative interview accounts of the care enacted in partnerships between people who inject drugs, drawing on a 2014 study of 34 couples and 12 in iduals living in two locations of Australia. A thematic analysis highlights 'best friend relationships', 'doing everything together', 'co-dependency', and 'doing normalcy' as core to narratives of care. As we will argue, the accounts position the care undertaken by couples as at once shaped by day-to-day practices of drug use and by social situation, with the partnership enacting care as a form of social protection, including protection from stigma and other environmental hostilities. The intimacy of doing everything together offers insulation against stigma, yet also reproduces its isolating effects. While the care produced in drug-using partnerships is presented as double-edged, we note how interview accounts are used to deflect the charge that these relationships represent harmful co-dependency. Taken together, the interview accounts negotiate a 'counter-care' in relation to normalcy, presenting the intimate partnership between people who use drugs as a legitimate embodiment of care.
Publisher: Wiley
Date: 05-2007
DOI: 10.1080/09595230701247731
Abstract: This paper explores differences between women's and men's first experience of injecting in relation to socio-demographic context, drug use, and the role of others. We collected cross-sectional retrospective data from 334 recently initiated (<or=5 years) injecting drug users in New South Wales and Queensland, Australia using a structured questionnaire in face-to-face interviews. Logistic regression was used to estimate crude and adjusted odds ratios (OR). Findings from the adjusted analysis show that women had a shorter duration of illicit drug use prior to initiation (adjusted OR 0.84, 95%CI: 0.74 - 0.94), and were more likely to have their romantic-sexual partner facilitate the initiation by paying for the drugs (adjusted OR 4.64, 95%CI: 1.21 - 17.73). Women also reported a greater likelihood of being initiated in groups of other women (adjusted OR 2.87, 95%CI: 1.24 - 6.67), suggesting that some women play an active role in their initiation experience rather than relying on, or being lead by, a romantic-sexual partner. These findings demonstrate the crucial role that romantic-sexual partners play in women's initiation experience, but also provide evidence for the way that women can be active participants in their own initiation and in initiating other women.
Publisher: Wiley
Date: 21-03-2014
Publisher: Informa UK Limited
Date: 07-06-2017
DOI: 10.1080/13548506.2016.1189582
Abstract: Australian Aboriginal and Torres Strait Islanders are overrepresented in both the prevalence and incidence of the hepatitis C (HCV). HCV knowledge has been associated with a range of positive health behaviours. HCV knowledge has previously been investigated as a single construct however examining different knowledge domains (i.e. transmission, risk of complications, testing and treatment) separately may be beneficial. This study investigated whether having greater HCV knowledge in different domains is associated with self-reported positive health behaviours. 203 Aboriginal people living with HCV completed a survey assessing HCV knowledge, testing and care, lifestyle changes since diagnosis and treatment intent. Respondents' knowledge was relatively high. Greater knowledge of risk of health complications was associated with undertaking more positive lifestyle changes since diagnosis. Respondents testing and treatment knowledge was significantly associated with incarceration, lifestyle changes since diagnosis and future treatment intentions. This study illustrates the importance of ensuring that knowledge is high across different HCV domains to optimise a range of positive health behaviours of Aboriginal people living with HCV. Future health promotion c aigns targeted at Aboriginal people living with HCV could benefit from broadening their focus from prevention to other domains such as testing and treatment.
Publisher: JMIR Publications Inc.
Date: 19-06-2019
Abstract: espite the importance and popularity of mutual support groups, there have been no systematic attempts to implement and evaluate routine outcome monitoring (ROM) in these settings. Unlike other mutual support groups for addiction, trained facilitators lead all Self-Management and Recovery Training (SMART Recovery) groups, thereby providing an opportunity to implement ROM as a routine component of SMART Recovery groups. his study protocol aims to describe a stage 1 pilot study designed to explore the feasibility and acceptability of a novel, purpose-built mobile health (mHealth) ROM and feedback app (Smart Track) in SMART Recovery groups coordinated by SMART Recovery Australia (SRAU) The secondary objectives are to describe Smart Track usage patterns, explore psychometric properties of the ROM items (ie, internal reliability and convergent and ergent validity), and provide preliminary evidence for participant reported outcomes (such as alcohol and other drug use, self-reported recovery, and mental health). articipants (n=100) from the SMART Recovery groups across New South Wales, Australia, will be recruited to a nonrandomized, prospective, single-arm trial of the Smart Track app. There are 4 modes of data collection: (1) ROM data collected from group participants via the Smart Track app, (2) data analytics summarizing user interactions with Smart Track, (3) quantitative interview and survey data of group participants (baseline, 2-week follow-up, and 2-month follow-up), and (4) qualitative interviews with group participants (n=20) and facilitators (n=10). Feasibility and acceptability (primary objectives) will be analyzed using descriptive statistics, a cost analysis, and a qualitative evaluation. t the time of submission, 13 sites (25 groups per week) had agreed to be involved. Funding was awarded on August 14, 2017, and ethics approval was granted on April 26, 2018 (HREC/18/WGONG/34 2018/099). Enrollment is due to commence in July 2019. Data collection is due to be finalized in October 2019. o the best of our knowledge, this study is the first to use ROM and tailored feedback within a mutual support group setting for addictive behaviors. Our study design will provide an opportunity to identify the acceptability of a novel mHealth ROM and feedback app within this setting and provide detailed information on what factors promote or hinder ROM usage within this context. This project aims to offer a new tool, should Smart Track prove feasible and acceptable, that service providers, policy makers, and researchers could use in the future to understand the impact of SMART Recovery groups. ustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000686101 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336. RR1-10.2196/15113
Publisher: Wiley
Date: 03-01-2013
DOI: 10.1111/ADD.12051
Publisher: Oxford University Press (OUP)
Date: 15-08-2013
DOI: 10.1093/CID/CIT305
Abstract: 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. 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. 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 meth hetamine use (AOR, 2.26 95% CI, 1.12-4.57), and non-1 HCV genotype (AOR, 3.07 95% CI, 1.67-5.64). 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.
Publisher: Wiley
Date: 06-05-2018
DOI: 10.1111/ADD.14226
Publisher: Elsevier BV
Date: 11-2013
Publisher: Wiley
Date: 03-12-2013
DOI: 10.1111/JVH.12183
Abstract: Provision of hepatitis C virus (HCV) assessment and treatment via opioid substitution treatment (OST) clinics has been posed as an effective means of engaging populations with high HCV prevalence. This study explores OST client and health professional reports concerning barriers and facilitators affecting the delivery and uptake of HCV care and treatment within OST settings. In-depth interviews were conducted with 57 clients, 16 staff from four NSW clinics participating in the Australian ETHOS study and three peer workers. Client participants included those who had not had HCV assessment those who had HCV assessment only and those who were awaiting or undertaking HCV treatment. A clear difference in decisions about HCV treatment emerged between participant groups. For those who have not been assessed, barriers to engaging with HCV care included the perception that they were physically well, were not experiencing HCV symptoms, had other life priorities and were concerned about the side effects and tolerability of treatment. Those who had engaged with care expressed motivations stemming from seeing friends becoming unwell, wanting to live longer and hearing positive stories of treatment. For those interested in HCV treatment, issues related to both provider and setting were important, such as presence of an engaged clinician, an accessible treatment pathway and availability of support. In this integrated care model, some barriers to HCV care and treatment (particularly those relating to health provider and the system) are minimized. In this setting, HCV treatment remained an unattractive option for a significant number of clients. Providing ways for those without HCV symptoms to be assessed for liver damage may be important to open up alternative conversations about HCV care. Further, the importance of a changing discourse of treatment is apparent from these data and could be enhanced by peer communication that provides information about successful treatment experiences.
Publisher: SAGE Publications
Date: 07-2015
Abstract: This research assessed whether greater attachment to an Aboriginal community buffers against the negative effects of stigma and promotes positive health outcomes. Aboriginal Australians ( n = 203) living with hepatitis C completed a survey assessing community attachment, stigma, resilience, quality of life, treatment intent, hepatitis C knowledge and positive lifestyle changes. A stronger sense of community attachment was associated with greater resilience, increased quality of life, less hepatitis C–related stigma and with increased lifestyle changes after diagnosis. Hence, community attachment can buffer against the negative health effects of stigma and may promote the resources to engage in positive behaviour changes, ultimately increasing long-term health outcomes.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.DRUGPO.2015.06.001
Abstract: The objective was to assess social functioning and its association with treatment intent, specialist assessment and treatment uptake for hepatitis C virus (HCV) infection among people with a history of injecting drug use. ETHOS is a prospective observational cohort evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from nine community health centres and opioid substitution treatment clinics (NSW, Australia). Social functioning was assessed using a short form of the Opioid Treatment Index social functioning scale. Those classified in the highest quartile (score >6) were considered having lower social functioning. Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 24% were considered having lower social functioning, 70% had early HCV treatment intent (intention to be treated in the next 12 months), 53% were assessed by a specialist and 27% initiated treatment. Lower social functioning was independently associated with unemployment, unstable housing, recent injecting drug use and moderate to extremely severe symptoms of depression, anxiety and stress. Lower social functioning was independently associated with reduced early HCV treatment intent (aOR 0.51, 95% CI 0.30-0.84) and lower specialist assessment (aOR 0.48, 95% CI 0.29-0.79), but not HCV treatment uptake (aOR 0.76, 95% CI 0.40-1.43). Living with someone was independently associated with HCV treatment uptake (with someone and children: aOR 2.28, 95% CI 1.01-5.14 with someone and no children: aOR 2.36, 95% CI 1.30-4.31), but not early HCV treatment intent or specialist assessment. This study highlights the need for the development and implementation of strategies targeting people who inject drugs with lower social functioning to enhance HCV treatment intent and specialist assessment. Further, strategies to enhance social support may play a role in increasing HCV treatment uptake.
Publisher: Elsevier
Date: 2013
Publisher: Informa UK Limited
Date: 23-07-2018
Publisher: SAGE Publications
Date: 25-08-2012
Abstract: Hepatitis C virus (HCV) infection is a significant global public health problem. In developed countries, 90% of new infections occur among people who inject drugs (PWID), with seroprevalence increasing rapidly among new injectors. Staying Safe is an international, qualitative, social research project, the aim of which is to draw on the experiences of long-term PWID to inform a new generation of HCV prevention strategies. The Sydney project team employed life history interviews and computer-generated timelines to elicit detailed data about unexposed participants’ ( n =13) injecting practices, circumstances, and social networks over time. The motivations and strategies that enabled participants to avoid risk situations, and which might have helped them to “stay safe,” appeared not to be directly related to harm-reduction messages or HCV avoidance. These included the ability and inclination to maintain social and structural resources, to mainly inject alone, to manage withdrawal, and to avoid injecting-related scars. These findings point to the multiple priorities that facilitate viral avoidance among PWID and the potential efficacy of nonspecific HCV harm-reduction interventions for HCV prevention.
Publisher: Informa UK Limited
Date: 11-01-2011
DOI: 10.3109/10826084.2010.540289
Abstract: This project evaluated consumer participation projects in five drug user treatment services in metropolitan and regional areas in three Australian states. Qualitative interviews were conducted with staff and consumers at two time points between 2008 from 2010 (n = 108). At baseline staff and some consumers focused on the stability of consumers to undertake representative roles. At postimplementation, the focus was on the stability of the organization, as frequent staffing changes and lack of adequate handover affected the progress of the projects. These issues combined with the perceived "noncore" status of consumer participation resulted in none of the projects achieving all of their agreed goals.
Publisher: Wiley
Date: 05-09-2008
DOI: 10.1111/J.1360-0443.2008.02306.X
Abstract: Intervention impact on reductions in hepatitis C virus (HCV) incidence among injecting drug users (IDUs) are modest. There is a need to explore how drug injectors' interpret HCV risk. To review English-language qualitative empirical studies of HCV risk among IDUs. Qualitative synthesis using a meta-ethnographic approach. Searching of eight electronic databases and reference lists identified manually papers in peer-reviewed journals since 2000. Only studies investigating IDU perspectives on HCV risk were included. Themes across studies were identified systematically and compared, leading to a synthesis of second- and third-order constructs. We included 31 papers, representing 24 studies among over 1000 IDUs. Seven themes were generated: risk ubiquity relative viral risk knowledge uncertainty hygiene and the body trust and intimacy risk environment and the in idualization of risk responsibility. Evidence supports a perception of HCV as a risk accepted rather than avoided. HCV was perceived largely as socially accommodated and expected, and in relative terms to human immunodeficiency virus (HIV) as the 'master status' of viral dangers. Symbolic knowledge systems, rather than biomedical risk calculus, and especially narratives of hygiene and trust, played a primary role in shaping interpretations of HCV risk. Critical factors in the risk environment included policing, homelessness and gendered risk. Appealing to risk calculus alone is insufficient. Interventions should build upon the salience of hygiene and trust narratives in HCV risk rationality, and foster community changes towards the perceived preventability of HCV. Structural interventions in harm reduction should target policing, homelessness and gendered risk.
Publisher: Wiley
Date: 10-2003
Publisher: Wiley
Date: 24-10-2016
DOI: 10.1111/JVH.12627
Abstract: Prisoner populations are characterized by high rates of hepatitis C (HCV), up to thirty times that of the general population in Australia. Within Australian prisons, less than 1% of eligible inmates access treatment. Public health strategies informed by social capital could be important in addressing this inequality in access to HCV treatment. Twenty-eight male inmates participated in qualitative interviews across three correctional centres in New South Wales, Australia. All participants had recently tested as HCV RNA positive or were receiving HCV treatment. Analysis was conducted with participants including men with experiences of HCV treatment (n=10) (including those currently accessing treatment and those with a history of treatment) and those who were treatment naïve (n=18). Social capital was a resourceful commodity for inmates considering and undergoing treatment while in custody. Inmates were a valuable resource for information regarding HCV treatment, including personal accounts and reassurance (bonding social capital), while nurses a resource for the provision of information and care (linking social capital). Although linking social capital between inmates and nurses appeared influential in HCV treatment access, there remained opportunities for increasing linking social capital within the prison setting (such as nurse-led engagement within the prisons). Bonding and linking social capital can be valuable resources in promoting HCV treatment awareness, uptake and adherence. Peer-based programmes are likely to be influential in promoting HCV outcomes in the prison setting. Engagement in prisons, outside of the clinics, would enhance opportunities for linking social capital to influence HCV treatment outcomes.
Publisher: Informa UK Limited
Date: 2006
Publisher: Wiley
Date: 19-09-2018
DOI: 10.1111/JVH.12987
Abstract: Hepatitis C virus (HCV) infection is a major public health concern. Globally, 15% of those incarcerated are HCV-antibody positive (anti-HCV). Even where HCV treatment is available within prisons, treatment uptake has remained low. This qualitative study was conducted to understand the barriers and facilitators for the delivery of HCV treatment in prisons from the perspectives of prisoners. This is important to inform health messaging for HCV treatment within correctional institutions. Thirty-two prisoners (including eight women) with a history of injecting drug use participated in this qualitative study. Participants were equally recruited across four correctional centres (n = 8 per site). Overall, 16 participants (50%) had chronic HCV at their most recent test, and two participants were awaiting test results at time of interview. Structural (eg proximity of health clinic) and patient-level (routine and motivation) factors were viewed as facilitators of HCV treatment within the prison setting. Structural (eg risk of reinfection) and social (eg lack of confidentiality and lack of social support) factors were perceived as barriers to prison-based HCV care and treatment. In conclusion, to increase HCV treatment uptake, prison-based programmes should implement (or advocate for) patient-centred treatment approaches that protect privacy, provide social support, and promote access to clean needles and substitution therapy to protect prisoners from reinfection.
Publisher: Wiley
Date: 09-2004
DOI: 10.1111/J.1445-5994.2004.00639.X
Abstract: Abstract Background: There is a paucity of academic literature that describes patients’ experiences of receiving a hepatitis C‐positive diagnosis, doctors’ explanations of the infection and referral to support services. Aim: The aim of the present study was to report findings on receiving a positive diagnosis from a study of people with hepatitis C infection. Method: A cross‐sectional study of people with hepatitis C infection living in New South Wales, Australia, was carried out ( n = 504). Results: Of participants diagnosed with hepatitis C infection from 1989 to 2001 ( n = 417), just under one‐third (29.5%, n = 123) reported that they had received ‘no explanation’ about their infection from their doctor at diagnosis. Women and those diagnosed from 1989 to 1996 were significantly more likely to report receiving no explanation than men and those diagnosed later (35.4 vs 23.7% and 37.5 vs 23.0%, respectively). Similarly, current injecting drug users and those diagnosed from 1989 to 1996 were significantly more likely to report receiving no post‐test counselling than those who were not currently injecting and those diagnosed later (42.9 vs 30.2% and 37.6 vs 25.9%, respectively). Participants diagnosed from 1997 to 2001 were significantly more likely to report receiving p hlets about hepatitis C infection (39.2 vs 23.7%), information about treatments (24.5 vs 16.2%) and advice regarding natural therapies (9.1 vs 3.8%) than those diagnosed earlier. Conclusions: These data provide evidence of an increase in the dissemination of hepatitis C information by doctors at diagnosis during the late 1990s. Continued effort is needed to improve doctors’ provision of information and referral to specialists and support agencies for people newly diagnosed with hepatitis C. (Intern Med J 2004 34: 526−531)
Publisher: Wiley
Date: 26-06-2019
DOI: 10.1111/ADD.14698
Publisher: Elsevier BV
Date: 03-2010
Publisher: SAGE Publications
Date: 03-08-2016
Abstract: Despite the majority of needle–syringe sharing occurring between sexual partners, the intimate partnerships of people who inject drugs have been largely overlooked as key sites of both hepatitis C virus prevention and transmission, and risk management more generally. Drawing on interviews with 34 couples living in inner-city Australia, this article focuses on participants’ accounts of ‘sharing’. While health promotion discourses and conventional epidemiology have tended to interpret the practice of sharing (like the absence of condom use) in terms of ‘noncompliance’, we are interested in participants’ socially and relationally situated ‘rationalities’. Focussing on participants’ lived experiences of partnership, we endeavour to make sense of risk and safety as the participants themselves do.How did these couples engage with biomedical knowledge around hepatitis C virus and incorporate it into their everyday lives and practices? Revisiting and refashioning the concept of ‘negotiated safety’ from its origins in gay men’s HIV prevention practice, we explore participants’ risk and safety practices in relation to multiple and alternative framings, including those which resist or challenge mainstream epidemiological or health promotion positions. Participant accounts revealed the extent to which negotiating safety was a complex and at times contradictory process, involving the balancing or prioritising of multifarious, often competing, risks. We argue that our positioning of participants’ partnerships as the primary unit of analysis represents a novel and instructive way of thinking about not only hepatitis C virus transmission and prevention, but the complexities and contradictions of risk production and its negotiation more broadly.
Publisher: Hindawi Limited
Date: 06-04-2021
DOI: 10.1111/HSC.13368
Publisher: Oxford University Press (OUP)
Date: 15-04-2005
DOI: 10.1086/427446
Abstract: Despite recent improvements in outcomes of treatment for infection with hepatitis C virus (HCV), very few current injection drug users (IDUs) have access to treatment programs. We examined the natural history of and treatment knowledge about HCV infection and barriers and willingness to seek treatment for HCV infection. A convenience s le of current IDUs (n=100) with self-reported HCV-positive status drawn from a primary health facility and methadone clinic in inner Sydney completed an interviewer-administered questionnaire. Participants had a reasonable knowledge of the natural history of HCV infection but poorer knowledge of treatment for HCV infection. Most believed that being a current IDU was an exclusion criterion for treatment. Despite this, 70%-80% of IDUs reported that they would consider treatment under current scenarios in Australia: requirement for liver biopsy, subcutaneous injections, common adverse effects, and 40% efficacy. Study participants at the methadone clinic had higher levels of consideration of treatment. These findings support the development of specific education programs regarding treatment for HCV infection for current IDUs.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2016
Publisher: Elsevier BV
Date: 11-2013
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13134
Abstract: Objectives People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. Methods Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. Results Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. Conclusions Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV. What is known about this topic? The limited research available suggests that there are gaps in HCV knowledge among mental-health-service providers, although such research has generally targeted physicians. What does this paper add? This paper is the first to assess HCV knowledge, attitudes towards PWID and HCV among mental-health support workers. The findings suggest that although HCV knowledge is moderate, significant gaps exist, which are related to negative attitudes towards PWID. What are the implications for practitioners? Supportive and non-judgemental care is essential for people with mental illness and HCV, due to the potential for a double stigma arising from negative attitudes towards both mental illness and injecting drug use. This paper highlights the importance of targeted education for workers in the mental-health sector, to increase HCV knowledge and promote positive attitudes towards people with co-occurring mental-health, substance use problems and HCV.
Publisher: SAGE Publications
Date: 2005
Abstract: Risk of blood borne virus among injecting drug users is high and is a significant challenge for public health efforts. Mindlessness/mindfulness theory provides an alternative lens through which to understand social phenomena. Interview transcripts of 32 current and former injectors were explored for evidence of mindless injecting (or automatic behaviour). Mindlessness in injecting practices can be important as opportunities to reduce injecting risk can emerge from understanding ‘expert’ approaches to injecting. Further work is required to generate fuller understandings of this construct on injecting drug use and to incorporate carefully and sensitively this tool into health promotion efforts.
Publisher: Springer Science and Business Media LLC
Date: 10-2018
DOI: 10.1007/S40271-018-0332-6
Abstract: Growing international interest in mechanisms to capture and measure experiences and outcomes of health interventions from the patient perspective has led to the development of patient-reported measures (PRMs) across many areas of medicine. Although PRMs are now well utilised in some settings, the rapidly expanding area of direct-acting antiviral (DAA) treatments for hepatitis C has received remarkably little attention. In addition, questions are also being raised about the extent to which patients have been involved in the development of PRMs, which are primarily designed to reflect the patient perspective. In this context, the aim of this paper was to explore the possibility of developing a new PRM for use in hepatitis C DAA therapy that would also be acceptable to the patient group, in this case people who inject drugs (PWID). The study was based on a participatory design that included a peer researcher and foundational qualitative research including semi-structured interviews with 24 PWID with hepatitis C to inform the development of the PRMs. Stage 2 included four focus groups of six PWID with hepatitis C, who were asked to complete the draft measures and provide feedback. Participants responded positively to the draft PRMs. The results indicate that participants' concerns during DAA treatment are often not sufficiently attended to in clinical settings. In the light of this finding, participants reported that PRMs have a positive role to play in the negotiation of patients' care during DAA treatment. The findings show that utilising a participatory approach to the development of PRMs for DAA HCV treatment with PWID not only provides a way to measure experiences and outcomes of treatment from the patient perspective, but also provides a means for highly marginalised patient groups to have a say in and negotiate their care in ways that might not otherwise be possible.
Publisher: JMIR Publications Inc.
Date: 22-11-2020
Abstract: utual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. he aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app ( i SMART Track /i ) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. lt i SMART Track /i was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the i SMART Track /i app. Four modes of data collection were used: ROM data directly entered by participants into the app app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention) baseline, 2-, and 8-week follow-up assessments conducted through telephone and qualitative telephone interviews with a convenience s le of study participants (20/72, 28%) and facilitators (n=8). f the 72 study participants, 68 (94%) created a i SMART Track /i account, 64 (88%) used i SMART Track /i at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data ( i Urges /i screen and i Overall Progress /i screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of i SMART Track /i and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97 95% CI –2.02 to 2.24) was reported. indings support the feasibility, acceptability, and utility of i SMART Track /i . Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. i SMART Track /i offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. ustralian New Zealand Clinical Trials Registry ACTRN12619000686101 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 R2-10.2196/15113
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/HEX.12449
Publisher: Springer Science and Business Media LLC
Date: 30-08-2019
Publisher: Informa UK Limited
Date: 10-2004
Publisher: Springer Science and Business Media LLC
Date: 03-08-2018
Publisher: Hindawi Limited
Date: 12-2013
DOI: 10.1111/HSC.12009
Publisher: Informa UK Limited
Date: 06-05-2015
Publisher: Informa UK Limited
Date: 09-04-2013
Publisher: Hindawi Limited
Date: 07-03-2013
DOI: 10.1111/HSC.12026
Abstract: Although the levels of injecting drug use among lesbian, gay, bisexual and transgender (LGBT) populations are high, we know little about their experiences of injecting drugs or living with hepatitis C virus (HCV) infection. The loss of traditional family and cultural ties means connection to community is important to the well-being of LGBT populations. Although some kinds of drug use are normalised within many LGBT communities, injecting drug use continues to be stigmatised. This exploratory qualitative study of people with newly acquired HCV used semi-structured interviews to explore participants' understandings and awareness of HCV, seroconversion, testing, diagnosis and treatment. We present a secondary thematic analysis of eight LGBT participants of the experience of injecting drugs, living with HCV and having a marginalised sexual or gender identity. Community was central to the participants' accounts. Drug use facilitated connection to a chosen community by suppressing sexual or gender desires allows them to fit in to the mainstream enacting LGBT community norms of behaviour and connection through shared drug use. Participants also described feeling afraid to come out about their drug use to LGBT peers because of the associated stigma of HCV. They described a similar stigma associated with HIV within the people who inject drugs (PWID) community. Thus, the combination of being LGBT/living with HIV (a gay disease) and injecting drugs/living with HCV (a junkie's disease) left them in a kind of no-man's-land. Health professionals working in drug and HCV care services need to develop capacity in providing culturally appropriate health-care for LGBT PWID.
Publisher: Informa UK Limited
Date: 2006
Publisher: Wiley
Date: 21-06-2007
DOI: 10.1111/J.1365-2648.2007.04305.X
Abstract: This paper is a report of a study to explore how healthcare professionals prepare patients for hepatitis C treatment and the management strategy used during this treatment. A high proportion of patients receiving hepatitis C treatment has dose reductions or discontinues treatment because of adverse events arising from the therapeutic drugs. An exploratory study was carried out in Australia in 2004 and 2005 using semi-structured interviews with a s le of six healthcare professionals with experience in managing hepatitis C treatment regimens. Participants reported that pretreatment preparation focused on information provision regarding the adverse events and the medical strategies that could ameliorate their impact. Patients' vulnerabilities and supports were assessed prior to treatment and healthcare professionals sought to address patients' problems as they arose during treatment. Participants discussed patients' resilient coping style and the beneficial impact this had on treatment management. Among our s le, a deficits-based approach was taken to hepatitis C treatment management. While some attempts were made to assess patients' strengths, these were limited to identifying those in family, work and social networks who could lend support to patients when problems occurred. Exploring patients' past experiences of adversity and making a detailed evaluation of a range of patients' strengths might assist clinicians in managing hepatitis C treatment regimens.
Publisher: Hindawi Limited
Date: 04-12-2014
DOI: 10.1111/HSC.12145
Abstract: While numerous studies have examined characteristics of young people who have recently initiated injecting, little attention has focused on young people who may be at high risk of transitioning to injecting. This study sought to examine the extent that socially disadvantaged young people were exposed to injecting, determine their level of hepatitis C (HCV) knowledge and identify correlates of higher injecting exposure. A cross-sectional survey was administered to 210 young people in 2010-2011 who were exposed to injecting drug use, but had not transitioned to injecting. Respondents were primarily recruited from youth services in metropolitan Sydney. Exposure to injecting in the previous 12 months was assessed with four items that examined whether close friends, romantic/sexual partners or family members/acquaintances injected drugs, and whether they were offered an injection. Most respondents had at least a few close friends who injected drugs (65%) and almost half had been offered drugs to inject in the previous 12 months (48%). It was less common for respondents to report having a partner who injects (11%). Correlates of higher injecting exposure were examined with multivariate ordinal regression. In the multivariate model, higher exposure to injecting was independently associated with the experience of abuse or violent crime [adjusted odds ratio (AOR) = 1.80] and reporting more favourable attitudes towards injecting (AOR = 0.86). Higher exposure to injecting was not independently associated with patterns or history of drug use. HCV knowledge was low to moderate and was not associated with higher exposure to injecting. That drug use was not independently associated with higher injecting exposure may suggest that exposure is shaped more by social disadvantage than by drug use patterns. Additional research is required to investigate this, using an improved measure of exposure to injecting.
Publisher: Informa UK Limited
Date: 28-04-2016
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/AH090100
Abstract: To assess whether HCV-positive clients perceive that alcohol and other drug (AOD) staff discriminate against them, this study compared the treatment experiences of 120 HCV-positive clients with those of 120 HCV-negative clients attending the same AOD treatment facility. Despite the overall findings of favourable attitudes of HCV-positive clients toward their health care workers, these attitudes were less positive than those of their HCV-negative counterparts. Clients with HCV also rated their interpersonal treatment by their health care workers less favourably. These findings suggest that HCV-positive clients? attitudes towards their health care workers and their experiences of differential treatment by these health care workers might be a barrier to HCV treatment uptake in AOD treatment facilities.
Publisher: SAGE Publications
Date: 2017
Abstract: People who inject drugs are highly stigmatised. Discriminatory experiences are commonly reported, particularly in health care settings. This article evaluates an online stigma reduction training module targeting health providers working with people who inject drugs. A total of 139 participants completed a pre- and post-survey including attitude items and items depicting hypothetical scenarios and concerns around client behaviours. Participants’ attitudes towards people who inject drugs were more positive and they showed less concerns about client behaviours after completing the online training module. Findings highlight the benefits of online training in reducing discriminatory attitudes towards people who inject drugs and improving confidence in working with this client group.
Publisher: Wiley
Date: 18-06-2015
DOI: 10.1111/DAR.12281
Abstract: People who are new to injecting are at the highest risk of acquiring blood-borne viruses, and certain other characteristics, such as sexual identity, have been known to further heighten this risk. We investigate whether disadvantaged drug-using young people who are gay, lesbian, bisexual or who identify as other sexual identity (GLBO) are more likely to have ever injected drugs compared with their heterosexual peers. Convenience s ling was employed across 15 youth services in metropolitan Sydney. Respondents were required to be 16-24 years of age, to have used an illicit drug, to have been exposed to injecting through social networks and been socially disadvantaged in the past 12 months. Participants self-completed a survey using touch screen laptops. In a s le of 250 young people, GLBO participants more commonly reported ever injecting drugs [37.1%, confidence interval (CI) 21.5-55.1% vs. 12.3%, CI 8.1-17.4%] or injecting drugs in the past 12 months [31.4%, CI 16.9-49.3% vs. 5.7%, CI 2.9-9.6%] compared with participants who identified as heterosexual. The higher rates of injecting among GLBO young people found in this s le advocates for the development of targeted prevention strategies for this group. Utilising existing networks in GLBO communities could be one strategy to limit the transition to injecting drug use and reduce the risk of drug-related harms among this group.
Publisher: Wiley
Date: 21-05-2012
DOI: 10.1111/J.1465-3362.2012.00468.X
Abstract: Uptake of treatment for hepatitis C virus (HCV) infection among people who inject drugs is low. Further understanding is required of the relationship between HCV knowledge and treatment willingness, assessment and treatment in this population. A cross-sectional self-administered survey was conducted with clients of four opioid substitution therapy (OST) clinics and the Medically Supervised Injecting Centre in Sydney, Australia. Of 132 participants, 85 (64%) self-reported having HCV infection. HCV knowledge was mixed (mean 6.5, range 0-12) and was relatively lower on items measuring knowledge of factors impacting HCV-related disease progression. The likelihood of being in a higher knowledge category was associated with being female [adjusted odds ratio (AOR) = 3.78, 95% confidence interval (CI) (1.79, 7.98)], higher formal education [AOR = 3.28, 95% CI (1.57, 6.88)], being on a current OST program [AOR = 2.61, 95% CI (1.10, 6.19)] and being older [AOR = 1.04, 95% CI (1.01, 1.09)]. Participants receiving OST were more likely to report higher willingness to have HCV treatment [OR = 4.45, 95% CI (2.23, 8.17)]. Having been assessed for HCV treatment was associated with younger age [AOR = 0.93 CI 95% (0.88, 1.00)] and higher formal education [AOR = 7.81 95% CI (1.62, 37.71)]. Overall, knowledge scores were mid-range. Knowledge of modifiable factors influencing HCV-related liver disease progression was particularly low indicating the need for ongoing education. Education should also be targeted at older people and those not on OST, and be inclusive of those with lower literacy levels.
Publisher: Elsevier BV
Date: 10-2005
DOI: 10.1016/J.JCLINEPI.2005.02.025
Abstract: Measurement of multimorbidity and comorbidity is important in epidemiologic and health services research. The aim of this research was to derive a generic multimorbidity index based on patient self-report, incorporating severity, for predicting a range of outcomes. The dataset was obtained from a trial including 1,541 Veterans and war widows aged 70 years and over. The survey included sociodemographics, hospital admissions, SF-36, and information on deaths was obtained. The methods of Charlson were used to derive Multimorbidity Indices. All indices predicted quality of life, with decreasing quality of life for each increase in multimorbidity category. Multimorbidity scores incorporating severity significantly contributed to the prediction of mortality, hospital admission, and follow-up quality of life, regardless of adjustment for baseline quality of life. Our results indicate that a single index cannot predict a variety of relevant outcomes. Consequently, research undertaken to assess the impact of intervention or illness on health outcomes should use an index that is valid for predicting the specific outcome of interest.
Publisher: Wiley
Date: 12-02-2023
DOI: 10.1111/ADD.16137
Abstract: Hepatitis C virus (HCV) is highly prevalent within the prison setting. Although HCV testing and treatment are available within prisons, system barriers can impede progress along the HCV care cascade for those who are incarcerated. The PIVOT intervention used a ‘one‐stop‐shop‘ model (i.e. point‐of‐care HCV RNA testing, Fibroscan‐based liver disease assessment and treatment) at a reception prison in New South Wales, Australia. This analysis sought to understand the role of point‐of‐care HCV RNA testing at intake in reducing barriers to the HCV care cascade within the male prison setting. Qualitative analysis using semi‐structured interviews in a reception prison in Australia. Twenty‐four men enrolled in the PIVOT study all participants had undergone HCV point‐of‐care testing in the intervention arm. Høj's Integrated Framework informed this analysis. Participants widely expressed the view that point‐of‐care HCV RNA testing on entry was beneficial for care engagement. Point‐of‐care testing was perceived as timely (compared with standard pathology) and reduced opportunities for adjudication by correctional officers due to fewer clinic visits for testing and results. Adoption of routine opt‐out testing at prison intake was regarded as an important strategy for normalising HCV testing (and likely to increase pathways to treatment uptake) and fostered patient candidacy (i.e. self‐perceived eligibility to access care). Twenty‐four men in prison in New South Wales, Australia, who underwent opt‐out point‐of‐care HCV RNA testing on entry into prison, widely supported the programme as a means of overcoming barriers to HCV testing and treatment in the prison setting, as well as providing public health benefits through early detection of HCV infection among people entering into custody.
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.DRUGALCDEP.2010.11.018
Abstract: Assessment and uptake of treatment for hepatitis C among people who inject drugs (PWID) is low and strategies to enhance hepatitis C care in this group are needed. Knowledge of hepatitis C and its treatment is one precursor to decisions about treatment. We conducted a cross-section study designed to evaluate treatment considerations in participants with self-reported hepatitis C infection in New South Wales, Australia. Participants were recruited from needle and syringe programs, opiate substitution clinics, pharmacies that dispensed opiate substitution treatment and from the mailing list of a community-based hepatitis C organisation and completed a self-administered survey. Knowledge of hepatitis C was assessed by a 48-item scale addressing the natural history and treatment of hepatitis C. Factors associated with knowledge were assessed by ordinal regression. Among the 997 participants recruited, 407 self-reported acquiring hepatitis C through injecting drug use and had never received hepatitis C treatment. Knowledge about hepatitis C was overall poor and the effects of the long term consequences of hepatitis C were over-estimated. Higher knowledge scores were associated with recruitment site, higher education levels and recent contact with a general practitioner. One-third of participants indicated that they did not intend to have treatment and one-fifth did not answer this question. Knowledge is a precursor to informed decisions about hepatitis C treatment. These results indicate that efforts to support those less engaged with hepatitis C care (and specifically those on opiate substitution treatment) and those with lower literacy are required.
Publisher: Informa UK Limited
Date: 12-06-2014
Publisher: Springer Science and Business Media LLC
Date: 02-2018
Publisher: JMIR Publications Inc.
Date: 26-07-2019
DOI: 10.2196/14084
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.SOCSCIMED.2011.10.003
Abstract: The hepatitis C virus (HCV) epidemic is a significant public health challenge in Australia. Current initiatives to expand access to HCV treatment focus on opiate substitution therapy (OST) settings where the prevalence of hepatitis C among clients is high. In Australia, the provision of OST for many clients is via large clinics, with an estimated median of 150 clients per service. Conceptually informed by the work of Michel Foucault, our analysis of the proposed integrated treatment model focuses on the critical but overlooked question of organisational culture and power operating within OST. We argue that the specific context of OST not merely reflects but actively participates in the political economy of social exclusion via which the socio-spatial segregation and stigmatisation of the service user as 'drug user' is enacted. This paper analyses data collected from two s les during 2008/9: OST clients living in New South Wales, Australia and a range of OST health professionals working in Australian settings. In total, 27 interviews were conducted with current OST clients 19 by phone and 8 face-to-face. One focus group and 16 telephone interviews were conducted with OST health professionals. Our analysis of key themes emerging from the interview data suggests that the successful introduction of HCV treatment within the OST clinic is not a given. We are concerned that particular areas of tension, if not explicit contradiction, have been overlooked in current research and debates informing the proposed combination treatment model. We question the appropriateness of co-locating a notoriously arduous, exacting treatment (HCV) within the highly surveillant and regulatory environment of OST. While applauding the intention to improve access to HCV care and treatment for people who inject drugs we caution against a treatment model that risks further entrenching (socio-spatial) stigmatisation amongst those already experiencing significant marginalisation.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.DRUGPO.2014.05.002
Abstract: While there is growing recognition of the benefits of user involvement within drug treatment there is scant literature documenting the actual implementation of such initiatives. Nonetheless, the extant research is remarkably consistent in identifying poor relationships between service users and staff as a principal barrier to the successful implementation of consumer participation. Focussing on participants' accounts of change within the 'therapeutic alliance', this paper investigates a consumer participation initiative introduced within three Australian drug treatment services. In 2012, the New South Wales Users and AIDS Association (NUAA), a state-based drug user organisation, introduced a consumer participation initiative within three treatment facilities across the state. This paper draws on 57 semi-structured interviews with staff and service-user project participants. Approximately ten participants from each site were recruited and interviewed at baseline and six months later at evaluation. The enhanced opportunities for interaction enabled by the consumer participation initiative fostered a sense of service users and staff coming to know one another beyond the usual constraints and limitations of their relationship. Both sets of participants described a diminution of adversarial relations: an unsettling of the 'them and us' treatment ide. The routine separation of users and staff was challenged by the emergence of a more collaborative ethos of 'working together'. Participants noted 'seeing' one another--the other--differently as people rather than simply an identity category. For service users, the opportunity to have 'a voice' began to disrupt the routine objectification or dehumanisation that consistently, if unintentionally, characterises the treatment experience. Having a voice, it seemed, was synonymous with being human, with having ones' 'humanness' recognised. We contend that not only did the introduction of consumer participation appear to empower service users and enhance the therapeutic alliance, it may have also improved service quality and health outcomes.
Publisher: Informa UK Limited
Date: 08-2005
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.DRUGPO.2006.12.018
Abstract: Exploration of patients' illicit drug use during treatment for hepatitis C virus (HCV) infection is largely absent from the clinical literature. This paper explores injecting and other illicit drug use among people receiving interferon-based treatment for HCV infection, from the perspective of one group of health professionals. Data are presented from a qualitative study of six health professionals responsible for managing HCV treatment regimens at three major metropolitan hospitals across Sydney, Australia. During semi-structured in-depth interviews, participants discussed patients' use of injected and non-injected illicit drugs while coping with a demanding therapeutic regimen. Health professionals highlighted the socially conservative environment of healthcare and its negative perceptions of illicit drug users. Also discussed are the management of people who inject during treatment and the efficacy of cannabis to reduce side effects. The findings of this study indicate that while the health professionals adopted a harm reduction approach to patients' illicit drug use during HCV treatment, information regarding the risks and benefits of illicit drug use is silenced in this context. While ever prohibition remains Australia's illicit drug policy this situation appears unlikely to change. Research which investigates the extent of illicit drug use during HCV treatment, the risks and benefits associated with their use in this context, and the harms of perpetuating a duplicitous healthcare system is required.
Publisher: Wiley
Date: 07-2009
DOI: 10.1111/J.1465-3362.2009.00031.X
Abstract: In an effort to increase the number of people undergoing hepatitis C treatment, a range of initiatives are planned or underway to provide treatment in non-specialist services, such as opioid pharmacotherapy treatment (OPT) clinics. This commentary considers the implications of this new approach to treatment delivery, taking account of in idual-level issues generally discussed in the literature, such as knowledge of treatment and concerns about side effects. In addition, because less visible organisational and structural factors would equally influence the successful implementation of hepatitis C treatment in OPT services, these are also explored. Provision of hepatitis C treatment in OPT services raises a broad range of pressing questions, from in idual knowledge and concern about treatment, to workforce issues, such as discrimination, and tensions between the need for supportive care during hepatitis C treatment and the surveillant, regulatory nature of OPT clinic operations. A thorough critical examination of the structure and delivery of all services involved is necessary. Social research can play a unique role in this assessment because of its ability to generate detailed insights into lived experience and make use of social theories that allow previously invisible operations of power to become visible. The success of hepatitis C treatment in new sectors, such as OPT clinics, is not a given. Close attention needs to be paid to the context and culture in which OPT is delivered. In turn, this needs to be considered alongside the context and culture necessary for successful hepatitis C treatment delivery.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.DRUGPO.2017.06.001
Abstract: An open cohort study (LiveRLife) evaluating an intervention integrating non-invasive liver disease assessment via transient elastography (TE) among people who inject drugs (PWID) was conducted in New South Wales, Australia. Participant follow-up occurred 2-16 weeks post-enrolment. It is imperative that PWID understand liver assessment results in order to make informed decisions about their health. The aim of this study was to evaluate the decisions and experiences of participants who received a liver disease assessment, including interpretation of TE score and subsequent health behaviours, using a health literacy framework. Participants who had participated in LiveRLife were recruited from two opioid substitution treatment clinics and one medically supervised injecting centre between November 2015 and February 2016. The four recruitment categories were: (a) high TE score (≥9.5kPa)/attended follow-up, n=12 (b) high score/did not attend follow-up, n=2 (c) low score (<9.5kPa)/attended follow-up, n=11 and (d) low score/did not attend follow-up, n=8. Participants were not reminded of their category during recruitment. Inclusion criteria were: participants who received a TE score and informed consent. Of 33 semi-structured interviews, reasons for receiving a TE assessment were varied. Most participants interpreted level of liver disease correctly based on their TE score. Participants with higher TE scores frequently described feeling surprised by their result and also, often incorrectly identified drug use as a cause of advanced liver disease. In contrast, persons with lower TE scores felt encouraged by their result and spoke more to maintenance of healthy behaviours. When applicable, participants spoke of HCV therapy. Findings highlight some positive health changes made by PWID following liver disease assessment as well as ongoing misunderstandings of chronic liver disease in relation to illicit drug use. Results will inform strategies for targeted liver health education and 'linkage to care' for PWID with, and at-risk of, advanced liver disease.
Publisher: Public Library of Science (PLoS)
Date: 27-04-2020
Publisher: Wiley
Date: 02-05-2019
DOI: 10.1111/JVH.13112
Abstract: People who are homeless have increased hepatitis C virus (HCV) infection risk, and are less likely to access primary healthcare. We aimed to evaluate HCV RNA prevalence, liver disease burden, linkage to care and treatment uptake and outcomes among people attending a homelessness service in Sydney. Participants were enrolled in an observational cohort study with recruitment at a homelessness service over eight liver health c aign days. Finger-stick whole-blood s les for Xpert® HCV Viral Load and venepuncture blood s les were collected. Participants completed a self-administered survey and received transient elastography and clinical assessment by a general practitioner or nurse. Clinical follow-up was recommended 2-12 weeks after enrolment. For participants initiating direct-acting antiviral (DAA) therapy, medical records were audited retrospectively and treatment outcome data were collected. Among 202 participants (mean age, 48 years), 82% were male (n = 165), 39% (n = 78) reported ever injecting drugs, of whom 63% (n = 49) injected in the previous month. Overall, 23% (n = 47) had detectable HCV RNA and 6% (n=12) had cirrhosis. HCV RNA prevalence among participants with either injecting or incarceration history was 35% (37/105), compared to 4% (3/73) among participants without these risk factors. Among those with detectable HCV RNA, 23 (49%) commenced therapy, of whom 65% (n = 15) achieved sustained virological response, while the remainder had no available treatment outcome. No participant had documented virological failure. HCV DAA treatment uptake among people attending a homelessness service was encouraging, but innovative models of HCV care are required to improve linkage to care and treatment uptake among this highly marginalized population.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.DRUGPO.2018.08.011
Abstract: Uptake of hepatitis C virus (HCV) testing remains inadequate globally. Simplified point-of-care tests should enhance HCV diagnosis and elimination. We aimed to assess the acceptability of finger-stick and venepuncture HCV RNA testing among people who inject drugs (PWID). Participants were enrolled in an observational cohort study with recruitment at 13 sites between June 2016 and February 2018. Capillary whole-blood collected by finger-stick and plasma collected by venepuncture were performed for Xpert Among 565 participants (mean age, 44 years 69% male), 64% reported injecting drugs in the last month, and 63% were receiving opioid substitution treatment. Eighty three percent reported that finger-stick testing was very acceptable. Overall, 65% of participants preferred finger-stick over venepuncture testing, with 61% of these preferring to receive results in 60 min. The most common reason for preferring finger-stick over venepuncture testing was it was quick (62%) followed by venous access difficulties (21%). The main reasons for preferring venepuncture over finger-stick testing were that it was quick (61%) and accurate (29%). Females were more likely to prefer finger-stick testing than males (adjusted OR 1.96 95% CI 1.30, 2.99 p = 0.002). Among people with recent (previous month) injecting drug use, Aboriginal and/or Torres Strait Islander people were less likely than non-Aboriginal people to prefer finger-stick testing (adjusted OR 0.57 95% CI 0.34, 0.9 p = 0.033). Finger-stick whole-blood collection is acceptable to people who inject drugs, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.
Publisher: AMPCo
Date: 10-2012
DOI: 10.5694/MJA12.10228
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.SOCSCIMED.2016.08.040
Abstract: Social capital is a valuable resource that has received little attention in the prison context. Differences in the construct and accessibility of bonding, bridging, and linking social capital exist for Aboriginal Australians in mainstream society, but were previously unexplored in prison. This study seeks to understand contextual differences of social capital for Australian Aboriginal and non-Aboriginal men in prison. Thirty male inmates participated in qualitative interviews across three New South Wales (NSW) correctional centres. Interviews were completed between November 2014 and March 2015. Experiences of bonding and linking social capital varied among Aboriginal and non-Aboriginal participants. Opportunities for bridging social capital were limited for all participants. There is greater scope for building bonding social capital among male inmates than either bridging or linking social capital. Bonding social capital, particularly among Aboriginal men in prison, should be utilised to promote health and other programs to inmates.
Publisher: Elsevier BV
Date: 10-2010
Publisher: Queensland University of Technology
Date: 28-06-2021
DOI: 10.5204/IJCJSD.1894
Abstract: Discourse on sex work is replete with narratives of risk and danger, predominantly focused on violence and disease. However, the risks instigated by police, maintained by the criminal justice system and sanctioned by the state—criminal laws, licensing laws and targeted policing—receive far less attention. This paper responds to this gap in three ways. First, we examine how stigma manifests in sex workers’ experiences of Australian policing, which act to disincentivise sex workers from accessing criminal legal mechanisms. Second, we illustrate how sex workers are denied victim status as they are seen by law as ‘irresponsible citizens’ and blamed for their experiences of crime. Third, we argue that these factors create conditions in which sex workers must constantly assess risks to access safety and legal redress while structural sex work stigma persists unabated. We conclude that ‘whore stigma’ is entrenched in the criminal legal system and requires a systematic response that necessitates but goes beyond the decriminalisation of sex work.
Publisher: Wiley
Date: 03-02-2003
DOI: 10.1002/CNCR.11156
Abstract: This study was conducted to evaluate a self-administered questionnaire developed to measure the needs experienced by men diagnosed with prostate carcinoma (the Prostate Cancer Needs Questionnaire [PCNQv1.1]). The PCNQv1.1 was constructed in two parts. Part 1 measures the needs at diagnosis and initial treatment and Part 2 measures current needs. A random s le of 650 men diagnosed with prostate carcinoma who were being treated by a urologist of the Hunter Urology Group in Newcastle, New South Wales, Australia, were invited to participate in the study. They were sent by post the self-administered PCNQv1.1. Completed questionnaires were received from 385 men. Information provided on 100 additional men was considered ineligible. The principal components method of factor analysis with varimax orthogonal rotation identified eight factors with eigenvalues greater than 1, which accounted for 61.7% of the variance in Part 1 of the PCNQv1.1. Likewise, six factors were identified in Part 2, which accounted for 63.5% of the variance. Internal reliability coefficients (Cronbach alpha) were adequate for identified factors with values ranging from 0.70 to 0.88 for Part 1 and from 0.71 to 0.87 for Part 2. Test-retest reliability was acceptable with intraclass correlation coefficients ranging from 0.61 to 0.78 for Part 1 and from 0.60 to 0.82 for Part 2. These results suggest that the PCNQv1.1 is a valid and reliable instrument to assess the needs experienced by men diagnosed with prostate carcinoma.
Publisher: Elsevier BV
Date: 10-2004
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.07.002
Abstract: 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 c aign. The LiveRLife c aign involved three phases: (1) c aign resource development (2) c aign resource testing and (3) c aign 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. 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 s le. 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). 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.
Publisher: Wiley
Date: 07-2000
DOI: 10.1046/J.1365-2923.2000.00567.X
Abstract: The factors determining intern attendance at 'resident rounds' training programmes are not known. This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital. These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts. Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention. The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40-47%) from logbook attendance, and 63% (95% CI 61-65%) by self-report. Cronbach's alpha for the subscales ranged from 0.62 to 0.91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0.26, P<0.0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0.19, P < 0.0001). The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme.
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.07.006
Abstract: 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. 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. 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%). 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.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.DRUGPO.2014.01.011
Abstract: Given the increasing burden of hepatitis C (HCV) related liver disease, innovative health care models are required to extend the reach of HCV care and treatment. Opioid substitution treatment (OST) clinics are places of high HCV prevalence. The OST clinic is a complex environment, quite distinct to other health care settings, with punitive regulations and practices, and a client population likely to be mistrustful of systems of authority. Nonetheless, trust is widely documented as essential to effective therapeutic encounters. This paper examines what is required to develop a trustworthy service in a place, the OST clinic, described by some critics as a site of "social control". In-depth interviews were conducted with 57 clients and 19 staff from four NSW pilot clinics participating in the Australian ETHOS study. Interview data were examined using Hall's framework of trust, involving five principle domains: fidelity, competence, honest, confidentiality and global trust. 'Honesty' was found to be key to participants' establishing trust in the co-located service and its staff. However, the clinic site was also found to be a place of rationed trust, in which the themes of OST as "ruling peoples' lives" and the fear of repercussions resulting from perceived transgressions against clinic rules, threatened to over-ride or undermine the development of trust in HCV services. Client participants described trusting health workers "to a point". They expressed concerns about the fidelity of co-located HCV and OST services and described fears of "institutionalised lies" and breaches of confidentiality. Anxieties around the latter revealed a sense of "us and them" held by some clients, one in which health workers were perceived to "stick together" by putting their own interests before those of the clients. Although the co-location of HCV and opioid treatments makes intuitive policy sense, HCV health workers in the OST space may be seen as representatives of a deeply mistrusted system. For the effective development of a trustworthy HCV care service, policy and practice activities are required to engender trust through clearly articulated explanations of service boundaries and the promotion of "success stories" through trusted peer networks.
Publisher: Wiley
Date: 22-05-2007
DOI: 10.1111/J.1360-0443.2007.01842.X
Abstract: This study investigated equity of access to treatment and barriers to treatment for illicit drug use, using Andersen's behavioural model of health service utilization. The study involved 492 drug users who had received treatment and 193 who had not. Participants were interviewed to gather data relating to 19 predisposing, need and enabling variables. Never-treated participants exhibited less need for treatment than those who had received treatment. They experienced less negative emotion, used their main drug less often, had fewer drug-related health problems and fewer drug-using friends, were less likely to have blood-borne virus infections and were more likely to be using drugs for 'fun'. They also had more negative attitudes towards drug treatment staff, were less likely to believe that appropriate treatment was available and less likely to believe that professional help was necessary to get off drugs. Prevalence of physical and mental health problems was high in both groups. The study documented significant unmet treatment need and identified several sources of inequity and barriers to treatment that would be amenable to policy and service development. Drug user organizations and peer educators and motivational interventions in primary care settings should be utilized to market the nature and benefits of treatment effectively, and to address the causes of drug users' negative attitudes towards treatment.
Publisher: Oxford University Press (OUP)
Date: 10-10-2011
DOI: 10.1093/HER/CYR094
Abstract: Despite advances in understanding the structural contexts in which drug use occurs and shifts beyond the in idual-level focus of adult education theory, peer education models remain wedded to questions of in idual behaviour. Our analysis examines the structural context of peer education and its implications for peer training. People who inject drugs (PWID) were invited to participate in a series of three focus group discussions in order to develop peer education messages and strategies. These were then trialled by participants within their networks and their experiences discussed in subsequent focus groups. The influence of structural factors (such as the policing of public space) on participants' peer education attempts were identified and discussed. We propose that despite the damaging impact of structural factors on the lives of PWID, they can in turn be used by peer educators to develop innovative interventions designed to increase resilience and reduce internalized stigma. Peer education programmes need sufficient flexibility and resources to allow for the negotiation of participants' immediate needs and for collaborative learning between PWID and peer educators. This would require an informed and responsive funder-a challenge to the current orthodoxy wherein peer education is increasingly delivered in formats predetermined by the funder.
Publisher: Wiley
Date: 10-04-2017
DOI: 10.1111/JVH.12701
Abstract: Hepatitis C virus (HCV) transmission is high in prisons. This study investigated trends in HCV incidence and associated factors among a cohort of prisoners with a history of injecting drug use in New South Wales, Australia. Data were available from the Hepatitis C Incidence and Transmission Study-prisons (HITS-p) from 2005 to 2014. Temporal trends in HCV incidence were evaluated. Factors associated with time to HCV seroconversion among people with ongoing injecting was assessed using Cox proportional hazards. Among 320 antibody-negative participants with a history of injecting drug use (mean age 26 72% male), 62% (n=197) reported injecting drug use during follow-up. Overall, 93 infections were observed. HCV incidence was 11.4/100 person-years in the overall population and 6.3/100 person-years among the continually imprisoned population. A stable trend in HCV incidence was observed. Among the overall population with ongoing injecting during follow-up, ≥weekly injecting drug use frequency was independently associated with time to HCV seroconversion. Among continuously imprisoned injectors with ongoing injecting during follow-up, needle/syringe sharing was independently associated with time to HCV seroconversion. This study demonstrates that prison is a high-risk environment for acquisition of HCV infection. Needle and syringe sharing was associated with HCV infection among continually imprisoned participants, irrespective of frequency of injecting or the type of drug injected. These findings highlight the need for the evaluation of improved HCV prevention strategies in prison, including needle/syringe programmes and HCV treatment.
Publisher: Elsevier BV
Date: 11-2015
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.DRUGPO.2017.12.010
Abstract: Much research concerning drug use in the context of sexual activity among gay and bisexual men derives from public health scholarship. In this paper, we critically examine how the relationship between meth hetamine use and sexual risk practice is treated and understood in this body of research. While public health has made important contributions to establishing the link between meth hetamine use and sexual risk-taking, the precise nature of the relationship is not well defined. This creates space for ungrounded assumptions about meth hetamine use to take hold. We outline what appear to be two dominant interpretations of the meth hetamine/sexual practice relationship: the first proposes that meth hetamine has specific pharmacological properties which lead to sexual disinhibition, risky behaviour and poor health outcomes the second proposes that meth hetamine attracts men who are already inclined toward highly sexualised interactions and risky practice, and that such men are likely to engage in these practices with or without drugs. We suggest that both interpretations are problematic in that they in idualise and cast drug and sex practices as inherently risky and biopsychologically determined. We outline a more historically, socially and politically engaged way to understand meth hetamine use in the context of sexual activity by drawing on the concept of sex-based sociality and the ways in which gay and bisexual men may use meth hetamine and sex as social resources around which to build identities, establish relationships, participate in gay communities, and maximise pleasure while protecting themselves and others from harm.
Publisher: Informa UK Limited
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 2015
Publisher: AMPCo
Date: 10-2015
DOI: 10.5694/MJA15.00523
Publisher: Informa UK Limited
Date: 07-2004
DOI: 10.1080/13576280410001711012
Abstract: Previous investigation has shown that the health sector is a main source of discrimination against people with hepatitis C. This paper examines the perceptions and experiences of people with hepatitis C of their interactions with healthcare workers, particularly examining the implementation of infection control precautions. We contend that rather than applying infection control precautions universally, health care workers make judgements about in idual patients and the likelihood that they are infected with hepatitis C. Thus, infection control practices can be used as a tool to discriminate against people with hepatitis C. Social identity theory is used to illustrate these insights and to propose recommendations for education of health care workers. Semi-structured interviews with 19 people who had hepatitis C were conducted. The analysis examines issues of diagnosis, discrimination and disclosure in relation to healthcare workers' use of infection control procedures during clinical interactions. Participants described non-compliance with infection control guidelines by healthcare workers in a range of settings. In some instances, participants expressed disapproval of non-compliance, at other times participants felt vulnerable and discriminated against. Participants felt obliged to disclose their infections, but some decided against future disclosure because of negative reactions from healthcare workers. Infection control procedures were used as a tool to discriminate against some participants. Non-compliance with infection control guidelines persists among healthcare workers and can be identified by patients. A minority of workers use infection control as a discriminatory tool against those with hepatitis C. Further intervention is required to ensure infection control guidelines are enacted in the manner intended.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.DRUGPO.2016.04.005
Abstract: In Australia, sterile needles and syringes are distributed to people who inject drugs (PWID) through formal services for the purposes of preventing blood borne viruses (BBV). Peer distribution involves people acquiring needles from formal services and redistributing them to others. This paper investigates the dynamics of the distribution of sterile injecting equipment among networks of people who inject drugs in four sites in New South Wales (NSW), Australia. Qualitative data exploring the practice of peer distribution were collected through in-depth, semi-structured interviews and participatory social network mapping. These interviews explored injecting equipment demand, access to services, relationship pathways through which peer distribution occurred, an estimate of the size of the different peer distribution roles and participants' understanding of the illegality of peer distribution in NSW. Data were collected from 32 participants, and 31 (98%) reported participating in peer distribution in the months prior to interview. Of those 31 participants, five reported large-scale formal distribution, with an estimated volume of 34,970 needles and syringes annually. Twenty-two participated in reciprocal exchange, where equipment was distributed and received on an informal basis that appeared dependent on context and circumstance and four participants reported recipient peer distribution as their only access to sterile injecting equipment. Most (n=27) were unaware that it was illegal to distribute injecting equipment to their peers. Peer distribution was almost ubiquitous amongst the PWID participating in the study, and although five participants reported taking part in the highly organised, large-scale distribution of injecting equipment for altruistic reasons, peer distribution was more commonly reported to take place in small networks of friends and/or partners for reasons of convenience. The law regarding the illegality of peer distribution needs to change so that NSPs can capitalise on peer distribution to increase the options available to PWID and to acknowledge PWID as essential harm reduction agents in the prevention of BBVs.
Publisher: Wiley
Date: 09-2006
DOI: 10.1080/09595230600891282
Abstract: The aim of this study was to compare demographic and drug use profiles of non-needle and syringe programmes (NSP) attendees with NSP attendees from the same geographic area. Two data sources were used. One was from an annual national survey of injecting drug users (IDU) at NSP and analysis was restricted to survey sites in Kings Cross and Kogarah in 2003 (NSP survey). The other was from a survey of IDU who do not use NSP as their primary source of injecting equipment within the same broad geographical region (Access survey). Of the total 264 survey participants, 102 had never attended a NSP (non-NSP attendees) and 162 had previous experience of NSP (NSP attendees). Compared with NSP attendees, non-NSP attendees were less likely to report severe drug problems and more likely to report lower prevalence of HIV, hepatitis B and hepatitis C infection. Nevertheless, about 20% of non-NSP attendees reported re-use of needles and syringes after someone else in the previous month. Compared to NSP attendees, a lower rate of usage of health services was reported by non-NSP attendees. Strategies to promote access to NSP and harm reduction services, including testing for blood-borne viruses, information provision and consideration of referral to treatment among non-NSP attendees are recommended.
Publisher: Informa UK Limited
Date: 09-2012
Publisher: Informa UK Limited
Date: 04-09-2015
Publisher: Informa UK Limited
Date: 2006
Publisher: Wiley
Date: 07-2010
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.DRUGPO.2015.01.005
Abstract: Peer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few ex les 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. 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. 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. 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.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2007
DOI: 10.1007/S10461-007-9347-Z
Abstract: Research about initiation to injecting drugs emphasises the role that relationships with others plays in the experience, suggesting investigations of initiation should include an examination of both initiates and initiators. This paper uses cross-sectional data collected from 324 young, early-career injecting drug users (IDU) to describe the socio-demographic characteristics, drug and injecting practices, and harm reduction knowledge and practices of people who report initiating others to injecting. Fifty-five participants (17%) reported giving someone else their first injection. They reported initiating a total of 128 other people within the first 5 years of their own injecting. Compared to non-initiators, initiators were more likely to pass on harm reduction information [odds ratios (OR): 2.36, 95% confidence intervals (CI): 1.26-4.40]. However, the quality of this information was unknown and initiators did not have more accurate knowledge of blood borne viruses (BBV) than non-initiators, and commonly obtained needles and syringes from sources where the sterility of the equipment could not be guaranteed.
Publisher: Informa UK Limited
Date: 16-03-2015
Publisher: Informa UK Limited
Date: 08-03-2011
Publisher: Informa UK Limited
Date: 12-2012
DOI: 10.1080/13548506.2012.656660
Abstract: Attitudes toward people who inject drugs (PWID) and attitudes toward peer workers among a cross-section of 101 Australian hepatitis C health workers were assessed. A survey consisting of Likert-type questions and one open-ended question regarding training was used. Bivariate and regression analyses demonstrated that health workers' attitudes toward peer workers were associated with their attitudes toward PWID, independent of type of organization or time in the hepatitis C sector. Qualitative analysis revealed four training areas suggested by health workers for peer workers. Implications of these findings for staff and peer training are discussed and future research directions suggested.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.SOCSCIMED.2017.01.031
Abstract: For over twenty years there have been calls for greater 'consumer' participation in health decision-making. While it is recognised by governments and other stakeholders that 'consumer' participation is desirable, barriers to meaningful involvement nonetheless remain. It has been suggested that the reifying of 'evidence-based policy' may be limiting opportunities for participation, through the way this discourse legitimates particular voices to the exclusion of others. Others have suggested that assumptions underpinning the very notion of the 'affected community' or 'consumers' as fixed and bounded 'policy publics' need to be problematised. In this paper, drawing on interviews (n = 41) with in iduals closely involved in Australian drug policy discussions, we critically interrogate the productive techniques and constitutive effects of 'evidence-based policy' and 'consumer participation' discourses in the context of drug policy processes. To inform our analysis, we draw on and combine a number of critical perspectives including Foucault's concept of subjugated knowledges, the work of feminist theorists, as well as recent work regarding conceptualisations of emergent policy publics. First, we explore how the subject position of 'consumer' might be seen as enacted in the material-discursive practices of 'evidence-based policy' and 'consumer participation' in drug policy processes. Secondly, we consider the centralising power-effects of the dominant 'evidence-based policy' paradigm, and how resistance may be thought about in this context. We suggest that such interrogation has potential to recast the call for 'consumer' participation in health policy decision-making and drug policy processes.
Publisher: Wiley
Date: 25-11-2015
DOI: 10.1111/ADD.13197
Abstract: 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. 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). 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. 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). Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24 weeks post-treatment). 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. 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.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Informa UK Limited
Date: 2005
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080570
Abstract: This study explores the perception of and readiness for hepatitis C treatment within a s le of 77 clients already participating in drug treatment, with a view to identifying likely barriers and incentives to hepatitis C treatment within a drug treatment population. Participants with hepatitis C did not demonstrate a consistent, indepth knowledge of the infection, lacked confidence in symptom recognition, and had little awareness of treatment options. Those without obvious symptoms or liver deterioration did not have a pressing interest in treatment, and many had heard concerning stories about the side effects of hepatitis C treatment. For those coping with anxiety or depression, the increased risk of a depressive episode under interferon treatment was a major barrier to treatment.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.DRUGALCDEP.2016.12.020
Abstract: While the health-related benefits of intimate partnership are well documented, little attention has been paid to couples exposed to high levels of social stigma and exclusion. In this project we investigated an important site of stigma for partnerships by collecting accounts of changing hepatitis C (HCV) status ("sero-change") among couples that inject drugs. We explored what these accounts reveal about the meaning of HCV for these couples, and how this understanding contributes to our collective efforts at prevention and care. Drawing from a large dataset of qualitative interviews with couples, we focussed on those containing reports of sero-change. By adopting a methodology that positioned partnerships rather than in iduals as the primary unit of analysis, we addressed the commonplace tendency to either overlook or discount as dysfunctional, the sexual relationships of people who inject drugs. While some couples sought greater biomedical understanding as a means of coming to terms with sero-change, others drew on alternative logics or "rationalities" that sat firmly outside conventional biomedical discourse (privileging notions of kinship, for ex le). Regardless of which explanatory framework they drew on, participants ultimately prioritised the security of their relationship over the dangers of viral infection. Effectively engaging couples in HCV prevention and care requires acknowledging and working with the competing priorities and complex realities of such partnerships beyond simply the identification of viral risk. The "new era" of direct acting antiviral treatments will provide ongoing opportunities to learn to integrate biomedical information within more socially sophisticated, relationally aware approaches.
Publisher: Equinox Publishing
Date: 05-2006
DOI: 10.1515/CAM.2006.003
Publisher: Informa UK Limited
Date: 19-11-2018
DOI: 10.1080/13548506.2018.1546018
Abstract: Complex lifestyle issues associated with injecting drug use may make it difficult to provide care to people who inject drugs (PWID). Negative attitudes towards PWID can undermine the provision of good quality care, hence, it is important to explore the impact of health workers' attitudes in the delivery of care to PWID. An online survey was administered to 336 health workers assessing contact with and attitudes towards PWID, concerns about these clients as well as whether health workers feel stigmatised by working with PWID. Health workers were also asked whether they supported the discriminatory behaviour of a colleague in a series of hypothetical scenarios about working with PWID. In correlational analyses, negative attitudes towards PWID, greater concerns about the behaviour of PWID, not feeling stigmatised by colleagues and seeing fewer clients who inject were associated with greater support for discriminatory actions in the hypothetical scenarios. Multiple regression analysis results showed that only attitudes towards PWID and concerns about the behaviour of injecting clients remain independent predictors of participant support for the hypothetical scenarios. This research highlights the role of attitudes toward PWID in understanding health workers' decisions, practices and potential behaviour.
Publisher: Informa UK Limited
Date: 31-01-2017
Publisher: Informa UK Limited
Date: 06-2006
Publisher: Informa UK Limited
Date: 23-06-2015
Publisher: Wiley
Date: 25-08-2015
DOI: 10.1111/JVH.12451
Abstract: Efforts to increase the number of people having hepatitis C virus (HCV) treatment require understanding how to best deliver services to meet consumers' needs. The general health literature has examined the role that partners can play in supporting health outcomes. This study examines the experiences of couples who inject drugs in relation to knowledge of, decisions about and management of HCV treatment. This is a qualitative interview study of people who inject drugs in couples. Participants were recruited from harm reduction services in two major Australian cities. Couples were interviewed separately. Data were examined using the couple as the unit of analysis and to identify patterns of experience related to the HCV serostatus of couples. Knowledge of HCV and HCV treatment was low and variable but showed some relationship to serostatus. Decisions about HCV treatment were deeply informed by concerns regarding treatment side effects. Positive concordant couples considered 'staging' treatment to ensure that each partner could (in turn) care for the other. People with HCV in serodiscordant relationships may need specific support regarding HCV treatment information. Within positive concordant partnerships, our data indicated the need to support the HCV-positive 'carer' during their partner's treatment. Changing treatment regimens, and their anticipated lower side effect profiles, will need to be actively promoted to ensure that couples understand how these changes affect their treatment options.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2015
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1365-3148.2005.00544.X
Abstract: Before planned surgery, patients may choose autologous donation in order to avoid the small, but potential, risks of receiving an allogeneic blood transfusion. This study examined the perceived risks of allogeneic blood transfusions, preferences and willingness to pay for autologous donation and the desired role in the decision-making process in three populations: post-surgical patients, special interest group members and the general public. Quantitative and qualitative data were collected from 206 respondents with the help of computer-assisted semi-structured telephone interviews. Thirty-three per cent of the s le voiced concerns about receiving allogeneic blood transfusions. The risks of hepatitis C virus, human immunodeficiency virus, variant Creutzfeldt-Jakob disease and a haemolytic reaction were perceived as being low, but were rated as numerically higher than those of other life events that have equal probability. Autologous donation was perceived as removing all the risks associated with transfusion, and respondents were willing to pay a median $976 AUD ($664 US) to use this technique. Over 80% of respondents preferred to be involved in making the decision about whether to use autologous donation. Even though autologous donation is not 'risk-free' and the blood supply is very safe, people overestimate the associated risks and have a preference for their own blood. Decision aids presenting balanced information on the advantages and disadvantages of both allogeneic and autologous blood may be required.
Publisher: SAGE Publications
Date: 03-2007
Abstract: This study explores the experiences of people with hepatitis C within two models of chronic illness—illness trajectory and shifting perspectives—and examines the effects of clinical markers of disease in relation to perceived health. The findings show some support for both models and suggest how they can be seen as complementary and inter-related. The social consequences of living with hepatitis C, such as potential social limitations and isolation, were more significant and had greater impact than clinical markers of disease progress and should be emphasized in understandings of transformation experiences in chronic illness.
Publisher: Wiley
Date: 14-02-2006
DOI: 10.1111/J.1360-0443.2006.01379.X
Abstract: This paper examines differences between early- and late-onset injection drug users (12-16 years versus 17-24 years) in terms of the antecedents and circumstances of first injection. Cross-sectional retrospective design, using logistic regression. Setting Australia: Sydney, Brisbane, rural New South Wales. A total of 336 injection drug users aged 16-25 years at the time of interview. Independent variables included family injection drug use, homelessness and other demographic variables, drugs used prior to the first injection, length of pre-injection drug career, behaviours at time of first injection (e.g. drug injected, reasons/motives for the first injection, risk behaviours). Early-onset injection was associated independently with: having a family who injected drugs, having left school early, an unreliable source of income, a short pre-injection drug career, planning of the first injection, reliance on others for administration of the first injection and denial that experimentation was the motive for the first injection. In bivariate analysis, early-onset injection was associated further with: homelessness, being an Indigenous Australian, omission of use of certain pre-injection drugs, group presence at first injection, reliance on others for acquisition of the first needle and syringe and having injected the first time because an injection was offered. The research shows that early-onset, compared with late-onset injectors, are more likely to have an immediate family who inject drugs and other problematic beginnings in early life. They have an accelerated transition to injection, and differences in autonomy and motivation at first injection. These characteristics may make them more vulnerable to risk taking.
Publisher: SAGE Publications
Date: 03-2014
DOI: 10.1177/009145091404100103
Abstract: The aim of this study was to calculate the cost of a range of needle and syringe program (NSP) models to contribute to planning for effective NSP delivery. Existing health service data was used to estimate the cost per needle distributed across four modes of service delivery (Primary NSP, including one model of Primary NSP providing primary health care Secondary NSP Vending Machine and Outreach) over three years. Costs were primarily affected by the ratio of the volume of equipment distributed to staff costs. The average cost per unit for Primary, Secondary and Outreach modes was approximately $1.00. The cost for Vending Machine provision (accounting for income from service users) was the cheapest option at $0.30–0.40 per unit. When income from services users are not included in calculations, other considerations may be more important than cost when making decisions about providing access to NSP services to a marginalized client group with erse needs.
Publisher: SAGE Publications
Date: 2008
Abstract: Social marginalization is associated with poor health outcomes for affected people. However, in a psychosocial study of treatment for hepatitis C infection conducted in Sydney, Australia, participants living in socially disadvantaged circumstances applied adaptive approaches learned from past experiences of drug dependence, living with symptoms of chronic illness, coping with depression and childhood sexual abuse to enable them to cope with severe treatment-related side-effects. This finding has implications for the clinical management of hepatitis C treatment the factors and processes that facilitate adaptive coping to adversity associated with social marginalization can be assessed for their clinical contribution to coping with an arduous regimen.
Publisher: American Society for Microbiology
Date: 15-11-6349
DOI: 10.1128/JVI.03717-14
Abstract: The interaction between hepatitis C virus (HCV) and cellular immune responses during very early infection is critical for disease outcome. To date, the impact of antigen-specific cellular immune responses on the evolution of the viral population establishing infection and on potential escape has not been studied. Understanding these early host-virus dynamics is important for the development of a preventative vaccine. Three subjects who were followed longitudinally from the detection of viremia preseroconversion until disease outcome were analyzed. The evolution of transmitted/founder (T/F) viruses was undertaken using deep sequencing. CD8 + T cell responses were measured via enzyme-linked immunosorbent spot (ELISpot) assay using HLA class I-restricted T/F epitopes. T/F viruses were rapidly extinguished in all subjects associated with either viral clearance ( n = 1) or replacement with viral variants leading to establishment of chronic infection ( n = 2). CD8 + T cell responses against 11 T/F epitopes were detectable by 33 to 44 days postinfection, and 5 of these epitopes had not previously been reported. These responses declined rapidly in those who became chronically infected and were maintained in the subject who cleared infection. Higher-magnitude CD8 + T cell responses were associated with rapid development of immune escape variants at a rate of up to 0.1 per day. Rapid escape from CD8 + T cell responses has been quantified for the first time in the early phase of primary HCV infection. These rapid escape dynamics were associated with higher-magnitude CD8 + T cell responses. These findings raise questions regarding optimal selection of immunogens for HCV vaccine development and suggest that detailed analysis of in idual epitopes may be required. IMPORTANCE A major limitation in our detailed understanding of the role of immune response in HCV clearance has been the lack of data on very early primary infection when the transmitted viral variants successfully establish the acute infection. This study was made possible through the availability of specimens from a unique cohort of asymptomatic primary infection cases in whom the first available viremic s les were collected approximately 3 weeks postinfection and at regular intervals thereafter. The study included detailed examination of both the evolution of the viral population and the host cellular immune responses against the T/F viruses. The findings here provide the first evidence of host cellular responses targeting T/F variants and imposing a strong selective force toward viral escape. The results of this study provide useful insight on how virus escapes the host response and consequently on future analysis of vaccine-induced immunity.
Publisher: Elsevier BV
Date: 11-2014
Publisher: Wiley
Date: 18-10-2020
DOI: 10.1111/ADD.15277
Publisher: SAGE Publications
Date: 10-11-2017
Abstract: Associated with social and in idual harm, loss of control and destructive behaviour, addiction is widely considered to be a major social problem. Most models of addiction, including the influential disease model, rely on the volition/compulsion binary, conceptualising addiction as a disorder of compulsion. In order to interrogate this prevailing view, this article draws on qualitative data from interviews with people who describe themselves as having an alcohol or other drug ‘addiction’, ‘dependence’ or ‘habit’. Applying the concept of ‘diffraction’ elaborated by science studies scholar Karen Barad, we examine the process of ‘addicting’, or the various ways in which addiction is constituted, in accounts of daily life with regular alcohol and other drug use. Our analysis suggests not only that personal accounts of addiction exceed the absolute opposition of volition/compulsion but also that the polarising assumptions of existing addicting discourses produce many of the negative effects typically attributed to the ‘disease of addiction’.
Publisher: SAGE Publications
Date: 09-2003
Abstract: Although multicenter studies proliferate in quantitative health and medical studies, few ex les of similar multidisciplinary cross-national qualitative studies exist. In this article, the authors present a commentary on this type of study based on their involvement with two international projects. Issues include maintaining coinvestigators' participation in an international qualitative project with limited funding difficulties in promoting collaboration in protocol development factors inhibiting interest and enthusiasm ethical concerns issues of data recording, language, coding, and analysis and implications for write-up and publication. Despite the difficulties and challenges posed at each stage of the process, the authors remain convinced of the value of these projects and provide recommendations for facilitating future multidisciplinary cross-national qualitative health projects.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.DRUGPO.2015.08.018
Abstract: Interest in health-care related trust is growing with the recognition that trust is essential for effective therapeutic encounters. While most trust-related research has been conducted with general patient groups, the experiences of people who inject drugs cannot be understood without acknowledging the critical role social stigma plays in shaping (mis)trust, both generally and in regards to health services specifically. This study examined the experiences of trust among clients and staff of Needle and Syringe Programs (NSPs) in one area of Sydney, Australia. In-depth interviews with 12 NSP staff and 31 NSP clients were conducted. Analysis was informed by a five component model of trust, with particular emphasis on the notion of "global trust" as encompassing experiences of stigma and other negative social processes related to injecting drug use. Participant experiences of trust in NSPs were compared with those within other drug-related health services. Particular attention was paid to understanding the relationship between 'identity' (as a drug user) and 'legitimacy' (as a service user) and the centrality of this relationship to the experience of global trust for PWID. Notions of identity and legitimacy were inextricably bound up with the stigmatisation of drug use, shaping participants' experiences and accounts of trust in NSPs and drug treatment services. Client participants reported high levels of trust in NSPs, especially when compared with drug treatment services, describing being treated like "any other person" even when negotiating 'sensitive' issues. NSP staff participants described the establishment of trust as not only underpinning their work with clients but as something that required ongoing renewal and demonstration. "Global trust" assists us to better understand the complex experiences shaping PWID decisions to engage with and trust health services. The high levels of trust reported between client and NSP need to be recognised as a valuable resource for the delivery of effective health care for people who inject drugs, including encouraging behaviours to support the prevention of blood-borne viruses.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.DRUGALCDEP.2017.10.030
Abstract: Hepatitis C (HCV) is a blood-borne virus that is most commonly transmitted through shared injecting equipment. Due to the criminalisation of injecting drug use, HCV is highly prevalent among those incarcerated. Using a risk environment framework, this qualitative study sought to understand the role of HCV risk within injecting networks in the prison setting. Thirty-two adult prisoners (n=24 men n=8 women) with a history of injecting drug use participated in this qualitative sub-study. Participants were recruited across four correctional centres. Social, economic, and environmental risk factors contributed to injecting practices within prison. Commonly, the person supplying the drugs injected first, with the person who owns the injecting equipment going next. HCV did not regularly factor into determining order of injection within networks (i.e., first, second, third), although it was reported that some prisoners claimed not to have HCV in efforts to "jump the queue". Social, economic, and environmental risk factors contribute to negotiation of injecting order among people who inject drugs in prison. Risk of HCV exposure rarely influenced the injecting order. Harm reduction strategies should consider the social factors influencing injecting drug use in the prison setting especially to optimise the population benefits of the roll-out of highly effective HCV treatments.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Wiley
Date: 09-2000
DOI: 10.1046/J.1365-2923.2000.00625.X
Abstract: Research on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally erse backgrounds, undertaking problem-based learning courses. This study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants' experiences. Six focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained. Participants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants' experiences demonstrated a relationship between sense of 'belongingness' to the medical school community, participation in learning opportunities and progress through the course. The results suggest that interventions aimed at reducing barriers to progress need to promote students' confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from erse backgrounds.
Publisher: Informa UK Limited
Date: 10-02-2016
DOI: 10.1080/13557858.2015.1004870
Abstract: Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments. In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales. Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison. The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet in iduals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people.
Publisher: Elsevier BV
Date: 12-1999
DOI: 10.1016/S1353-8292(99)00018-0
Abstract: Associations between obesity and cardiovascular disease have been documented in the Developed World and have been linked with levels of 'development' in Developing World countries. This study aimed to explore the sociocultural influences on attitudes towards obesity, physical activity and dietary change using a four level conceptual framework (from personal to societal influences). Focus group discussions were conducted in: India, Indonesia, Cameroon, Egypt and Australia. The results of these discussions were analysed to reveal emergent themes. The interpretation of the qualitative data emphasised the need to incorporate influences beyond the in idual in efforts to reverse or prevent obesity related disease.
Publisher: Elsevier BV
Date: 05-2010
Publisher: Elsevier BV
Date: 2009
Publisher: Public Library of Science (PLoS)
Date: 30-11-2018
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.DRUGPO.2022.103788
Abstract: Stigma has corrosive effects on all aspects of care and can undermine in idual and population health outcomes. Addiction-related stigma has implications for opiate agonist treatment (OAT) and the people who receive, provide and fund it. It is important to understand how stigma is made in OAT and the political purposes that it serves, in order to change the relations of stigma and avoid the reproduction of stigma in the delivery of new treatment formulations, such as extended release buprenorphine (BUP-XR). Semi-structured qualitative interviews were conducted at two time points with participants in a prospective single-arm, multicentre, open-label trial of monthly BUP-XR. Thirty-six participants (25 men, 11 women) were interviewed, and of these 32 participated in a second interview to explore their experience of transition from other treatment to BUP-XR. Participants were highly aware of the of the social and material effects of stigma through the negative stereotypes attached to OAT and those who receive it. Participants narrated ex les of how stigma governed as a biopower in the relations and practices of OAT provision at numerous levels: structural (such as in public discourse about OAT and the people who receive it, in media, in perceptions about the decisions of investment in medical technologies) organisational (policies about legitimate access to OAT) interpersonal (with health workers) and in idual (self-identities). BUP-XR allowed greater freedom and normalcy for clients. The experience of BUP-XR drew attention to the stigmatising potential of time, place and things associated with other OAT requiring daily (or frequent) dosing, accentuating how stigma comes to be materialised as a relational effect of everyday practices. Receiving BUP-XR allowed participants to avoid some of the everyday biopolitical powers of other forms of OAT and to reshape self-identities. The altering of relations between time, place and things associated with other forms of OAT allowed participants to feel as though they "pass as normal" . However, the negative public discourse and stigma of OAT is a potential threat to BUP-XR to realise its potential for in idual and population benefits.
Publisher: Springer Science and Business Media LLC
Date: 31-05-2016
Publisher: Oxford University Press (OUP)
Date: 15-08-2013
DOI: 10.1093/CID/CIT263
Abstract: A large body of literature emphasizes the relationship between stigma and adverse health outcomes and health access measures. For people living with hepatitis C virus (HCV), stigma is a defining feature given the association of HCV with the socially demonized practice of injection drug use. However, there is little literature that specifically examines stigma as a barrier to HCV care and treatment. This review argues that the relationship between the person living with HCV and their health worker can work to ameliorate the effects of stigma. We draw on an emerging literature that examines the positive association between a patient's "trust" in their health worker and outcomes such as increased healthcare utilization and reduced risk behaviors. We investigate a growing body of health services research that acknowledges the importance of stigma and demonstrates ways to build positive, enabling relationships between patient, health worker, and health setting.
Publisher: Informa UK Limited
Date: 29-04-2015
Publisher: Elsevier BV
Date: 10-2005
Publisher: Wiley
Date: 24-01-2018
DOI: 10.1111/ADD.14131
Publisher: Wiley
Date: 09-2010
DOI: 10.1111/J.1465-3362.2010.00173.X
Abstract: Staff interactions with their clients are an important factor in the quality of care that is provided to people in drug treatment. Yet there is very little research that addresses staff attitudes or clients' perceptions of discrimination and prejudice by staff with regard to treatment outcomes. This research aimed to assess whether perceptions of discrimination by staff predict drug treatment completion. The study used a mixed methods approach. Ninety-two clients in residential rehabilitation facilities in Sydney were administered a series of quantitative measures assessing drug history, severity of drug use, treatment history, perceptions of staff discrimination and treatment motivation. Clients were followed up regularly until an outcome (dropout or completion) was obtained for the full s le. Perceptions of discrimination were a significant predictor of treatment completion, with greater perceived discrimination associated with increased dropout. Qualitative interviews with 13 clients and eight health-care workers from these treatment services were then conducted to gain insight into how perceived discrimination may impact on treatment experiences. Clients and staff discussed how they would address the issue of perceived discrimination during the current treatment experience. Adopting a mixed methods approach facilitated exploration of the impact of perceived discrimination on treatment from both clients' and health-care workers' perspectives. This methodology may also enhance interpretation and utilisation of these findings in drug treatment.
Publisher: Elsevier BV
Date: 10-2007
Publisher: SAGE Publications
Date: 23-07-2010
Abstract: In this paper the authors quantify hepatitis C disclosure outcomes across social contexts and identify the factors associated with widespread disclosure of infection. In a cross-sectional survey of people with hepatitis C ( N = 504) more than half reported receiving a bad reaction from someone following disclosure. Unauthorized disclosure occurred, and many participants had been pressured into disclosing their infection. The factors associated with widespread disclosure were: education level knowing other people with hepatitis C feeling fatigued receiving disclosure advice and experiencing unauthorized disclosure. Bad reactions following disclosure are common and may impede health-seeking behaviour including uptake of hepatitis C treatment.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.DRUGALCDEP.2013.07.023
Abstract: Internationally, there are ongoing efforts to increase access to hepatitis C (HCV) assessment and treatment to counter a generally low uptake of treatment among people with a history of injecting drug use. The aim of this qualitative study was to examine client and staff attitudes towards and experience of co-location of HCV and opioid substitution treatment (OST) services. In-depth interviews were conducted with 57 clients and 19 staff from four NSW clinics participating in the Australian ETHOS study. Client and staff participants typically welcomed integrated treatment, citing issues of convenience, reduced travel time and costs, persistent cues to engagement and immediacy of access to care. Positive attitudes towards the initiative were expressed even by clients who had not engaged with HCV care. Providing co-located care largely avoided the negative, stigmatising or discriminatory experiences that participants reported encountering in settings less familiar with people who use drugs. A minority of client participants expressed concerns about the lack of privacy and/or confidentiality available in the co-located model, preferring to seek HCV care elsewhere. The co-location of HCV care in OST clinics was welcomed by the large majority of participants in this study. Besides issues of convenience, the appeal of the co-located service centred on the familiarity of existing relationships between clients and staff in the OST setting. While some clients remained distrustful of OST and chose not to take up HCV care in this setting, the co-located treatment model was overwhelmingly successful amongst both client and staff participants.
Publisher: Informa UK Limited
Date: 02-2008
Publisher: Wiley
Date: 10-05-2017
DOI: 10.1111/DAR.12562
Abstract: Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2008
Publisher: Informa UK Limited
Date: 12-2004
Publisher: Wiley
Date: 17-09-2021
DOI: 10.1111/JVH.13612
Abstract: Whilst the testing and treatment of people who inject drugs (PWID) in Australia is a priority for local hepatitis C (HCV) elimination efforts, perceived stigma related to injecting drug use (IDU) has been identified as a major barrier for PWID engaging in health services. We used data from the EC Experience cohort study to explore associations between IDU-related perceived stigma and the number of different health services accessed by PWID in Melbourne, Australia. Data from the baseline questionnaire were used. Primary outcome was self-reported experience of stigma due to IDU (never, rarely, sometimes, often, always) in the previous 12 months. An ordinal logistic regression model assessed the association between stigma experienced and the number of different health services used (1-2, 3-4, 5-6, 7-10 different services) adjusted for recent IDU and key socio-demographics. Between September 2018 and February 2020, 281 participants were recruited from four health services. Sixty-nine per cent were male, median age was 42, 83% reported past-month IDU, 34% had never tested/tested >12 months, 8% tested negative <12 months, 43% were HCV-positive but not treated and 16% had been treated. Those accessing 5-6 services had 2.2 times greater odds of experiencing stigma (95% CI 0.86-6.65) compared with those using <5 services and those reporting 7-10 services had 2.43 times greater odds of experiencing stigma (95% CI 0.85-6.92) compared with those accessing <7 services. In conclusion, experiences of stigma may not necessarily be a barrier for PWID to access health services, but high rates of health service use may further expose, exacerbate or exaggerate stigma amongst PWID. Further examination of how stigma may be in/directly impact on hepatitis C treatment uptake is important and place-based interventions aimed at reducing stigma experienced by PWID may be needed.
Publisher: Elsevier BV
Date: 10-2008
Publisher: Informa UK Limited
Date: 05-2008
DOI: 10.1080/13548500701477532
Abstract: Hepatitis C treatment is known to produce significant physical and psychiatric side-effects. Healthcare workers in hepatitis C treatment clinics focus on preparing people to cope with these side-effects. Unrealistic optimism, or judging oneself to be at low risk of negative events, has been implicated in contributing to practices that place health at risk and to delays in seeking help or facilitating coping with negative events. In the context of hepatitis C treatment, patients with overly optimistic expectations of their ability to cope with treatment-related side-effects are less prepared for their impact and therefore may be more likely to discontinue treatment. In this exploratory qualitative study, data from semi-structured interviews with 20 people undergoing hepatitis C treatment and six healthcare workers at three hepatitis C treatment clinics in Sydney, Australia were explored for the presence of unrealistic optimism and also the impact that this had on patients' processing of information pre-treatment and management of side-effects during treatment. The concept of unrealistic optimism was evident in both patients' and healthcare workers' interview transcripts. Patients' descriptions of their preparation for hepatitis C treatment included references to delays in seeking help for depressive symptoms attributable to unrealistic optimism. Healthcare workers also discussed their observations of the effects of unrealistic optimism on patients' coping strategies. Data from this study contribute to an understanding of unrealistic optimism and its impact on the experience of hepatitis C treatment side-effects, patients' coping styles and potential for delays in seeking help. Unrealistic optimism should be explored as part of pre-treatment assessments for hepatitis C treatment and considered throughout treatment to avoid delays in help seeking.
Publisher: Wiley
Date: 17-08-2022
DOI: 10.1111/JVH.13736
Abstract: Despite the importance of trust in healthcare settings, there remains a paucity of evidence on the role it plays in patient–provider relationships and healthcare outcomes among people living with hepatitis B virus (HBV). International evidence suggests that Chinese immigrants living with HBV experience inequitable access, outcomes and treatment quality in chronic hepatitis B (CHB) health care. This study explores in idual trust in healthcare providers and its impact on health‐seeking behaviours and health outcomes among Chinese people living with HBV in Australia. A total of 16 participants were recruited from the Chinese community in Sydney and Melbourne and participated in semi‐structured interviews. The data were analysed within a conceptual model of trust that contains five dimensions: fidelity, competence, honesty, confidentiality and global trust. The data shows how trust in physicians was formed and influenced by factors including patient–provider interactions, historically relevant experiences, health and illness beliefs and systemic barriers. While the research confirms prior findings on the impact of trust and mistrust, showing an association between low trust and treatment nonadherence, it also generates fresh insights by examining what leads to mistrust and the role of trust in shaping participants' healthcare outcomes. Findings suggest that by treating patients with respect and dignity, improving interpersonal skills and cultural competency, having open discussion on complementary and alternative medicine (CAM) treatment and protecting private information, physicians can increase patients' trust. The findings will contribute to efforts to address HBV as a health priority and increase patients' trust in healthcare providers among Chinese immigrants living with HBV.
Publisher: Elsevier BV
Date: 02-2004
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.VACCINE.2010.05.064
Abstract: Several candidate vaccines for hepatitis C are currently in preclinical development or the early stages of clinical trials. Implementing trials of these vaccines among people who inject drugs will be challenging. Previous research, particularly willingness to participate studies in relation to HIV vaccines in marginalized groups, has focused on the modifiable characteristics of in idual participants. This qualitative research with people who inject drugs, health staff and clinicians focuses on social, organisational and structural elements of vaccine trial designs which may exclude or reduce the participation of people who inject drugs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1097/ADM.0000000000000261
Abstract: The aims of this study were to assess symptoms of depression, anxiety, and stress and associated sociodemographic factors among people living with chronic hepatitis C virus (HCV) infection with a history of injecting drug use and to assess the association between symptoms of depression, anxiety, or stress and HCV treatment intent, specialist assessment, or treatment uptake. The Enhancing Treatment for Hepatitis C in Opioid Substitution Settings was an observational cohort study evaluating the provision of HCV assessment and treatment among people with chronic HCV and a history of injecting drug use, recruited from 9 community health centers and opioid substitution therapy (OST) clinics (New South Wales, Australia). Symptoms were assessed using the Depression Anxiety Stress Scales (DASS-21). Analyses were performed using logistic regression. Among 415 participants (mean age 41 years, 71% male), 47%, 52%, and 36% demonstrated moderate to extremely severe symptoms of depression, anxiety, and stress, respectively. In adjusted analyses, depression symptoms were associated with recent injecting drug use [adjusted odds ratio (aOR) 1.63, 95% confidence interval (CI) 1.07–2.49), whereas stress symptoms were associated with unemployment (aOR 2.99, 95% CI 1.09–8.15) and not living with a spouse or other relatives/friends (aOR 1.55, 95% CI 1.01–2.39). Symptoms of depression, anxiety, or stress or having a history of treated mental illness were not independently associated with HCV treatment intent, specialist assessment, or treatment uptake. Findings suggest a need for improved interventions and care regarding mental health among people living with chronic HCV with a history of injecting drug use, but suggest that symptoms of depression, anxiety, and stress should not be immediate contraindications to HCV assessment and treatment.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 05-2015
Publisher: Wiley
Date: 07-2007
DOI: 10.1080/09595230701373867
Abstract: Despite evidence for their effectiveness, harm reduction services such as needle and syringe programmes (NSPs) are highly vulnerable to perceptions of community disapproval. This paper reviews Australian research on community attitudes to harm reduction services and its impact on research, policy and practice. The literature on community attitudes to NSPs in Australia comprises a small number of representative national s les and surveys of local communities affected by specific services. Despite these extremely limited data, negative community attitudes are often cited by policy-makers and health professionals as a primary constraint on policy-making. The main finding of this literature review is that community perceptions of NSPs are largely positive. Also, support for NSPs was not synonymous with condoning drug use. The failure of policy-makers and politicians to recognise positive community attitudes to NSPs has led in some instances to hasty political responses to adverse media reports, including the closure of services. This literature review showing positive community attitudes to harm reduction services should embolden researchers, practitioners and policy-makers to challenge such reactionary responses. Further, this evidence should be used in countering negative publicity surrounding these services.
Publisher: SAGE Publications
Date: 05-2005
Abstract: Clinical trials of interferon-based treatments for hepatitis C infection show decrements in patients’ health-related quality of life due to side effects of therapy. The impact of side effects on patients’ overall quality of life still remains unclear. To explore this issue, the authors interviewed people living in New South Wales, Australia, who had undergone treatment for hepatitis C. Their aim in this article is to report participants’ experiences of treatment side effects. In Australia, this information is important, because a new interferon-based regimen has been adopted as the mainstay of hepatitis C treatment, and it is predicted that many more people will seek treatment. The authors argue for further qualitative research to enhance knowledge of the impact of this therapy.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2013
DOI: 10.1007/S00038-013-0466-1
Abstract: Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.DRUGPO.2007.01.005
Abstract: Blood awareness messages have been used for some years in hepatitis C prevention efforts. However, hepatitis C prevention education has achieved only limited success. Innovative means of reaching people who inject drugs (PWIDs) are required. This study involved video recording injecting episodes of 13 clients of the Sydney Medically Supervised Injecting Centre in Kings Cross. Participants were interviewed the following day and asked to review their video and comment on their injecting practice. Also, feedback was provided to the participants on injecting technique and hepatitis C prevention. A peer researcher was present and engaged the participant in discussion around safer practice and explored the participants' explanations of their practice. This analysis provides information about the common aspects of "safer" and "unsafer" injecting technique observed in the video recordings. Unsafer in this context was defined as any practice which could cause harm including blood borne virus transmission risks, vein damage and introduction of other pathogens to the blood stream. Analysis of the video data show that common "unsafer" practices which have implications for blood borne virus transmission include: not washing hands before injecting using fingers to stop bleeding wiping injection site with swab (instead of applying pressure) to stop bleeding after injecting and using the same swab to wipe another site. Analysis of interview data provided participants' explanations of their practices. Analysis of the discussions between the interview team and the participant provides insight into the types of messages and communication strategies which had credibility with the participants. These data show that broadening of hepatitis C education discussions to include other aspects of "safer" injecting can be useful in engaging experienced PWIDs in prevention. Embedding blood borne virus prevention messages in discussions about vein care may provide innovative ways to reinvigorate hepatitis C prevention efforts and impart these messages in a context which acknowledges the skills and knowledge of experienced PWIDs.
Publisher: Informa UK Limited
Date: 02-01-2016
Publisher: Informa UK Limited
Date: 22-01-2021
Publisher: Informa UK Limited
Date: 03-06-2014
DOI: 10.1080/13548506.2014.923103
Abstract: Hepatitis C virus (HCV) infection is a major public health burden. Despite recent advances in HCV treatment, uptake remains low, particularly amongst people who inject drugs. HCV-related stigma and discrimination are common, especially within the health care sector. This research examines a more nuanced approach for how HCV-related stigma and discrimination impacts treatment access and uptake. Based on a social identity framework, we explore whether perceived HCV-related discrimination is associated with attempts to remove the stigma of being HCV-positive via HCV treatment intentions. Based on the results of prior research it was also hypothesised that the source of discrimination (health care workers versus others), and whether the discrimination is perceived to be directed to oneself or to the HCV-positive group, will differentially impact treatment intentions. The s le consisted of 416 people living with HCV in New South Wales, Australia, who acquired HCV from injecting drugs. Participants were asked about their experiences of perceived discrimination directed towards themselves versus their HCV-positive group and perceived discrimination within the health care sector. Findings indicate that discrimination towards the self is a more powerful indicator of treatment intentions than discrimination aimed at the HCV-positive group. This finding is consistent with social identity theory suggesting that people from low status groups are motivated to change their stigmatised status when it is possible to do so. The source of the perceived discrimination also matters, however, as participants who report experiencing discrimination from health workers have lowered intentions to engage with HCV treatment in the future. In combination, the results indicate that while perceived discrimination is commonly understood to act as a barrier to treatment uptake, the relationship is actually more complex than previously conceptualised.
Publisher: Wiley
Date: 21-05-2015
DOI: 10.1111/JVH.12415
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.
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1365-2923.2009.03519.X
Abstract: The Australian Medical Council requires all accredited Australian medical schools to have specific admission and recruitment policies for Indigenous Australian students. However, there is no clear evidence about how these students can be retained through to graduation. This study aimed to explore the training experiences of Indigenous undergraduate medical students and their perceptions of the factors influencing their progression through training. Methods We used a qualitative methodology involving focus groups. All participants had successfully completed at least 1 year of the Bachelor of Medicine programme at the University of Newcastle, New South Wales, Australia. Sixteen of 18 eligible students participated in the study. The factors that influence an Indigenous student's progress through medical training are multi-faceted and inter-related and are associated with student support, course content and styles of learning, personal qualities (such as confidence and coping skills), discrimination and distinctive cultural issues pertinent to Indigenous students. Both academic and non-academic factors affect the progression through training of Indigenous medical students. A number of in idual and systemic interventions which actively encourage a range of support networks, increase confidence and coping skills, and reduce cultural clash by assertively addressing discrimination and stereotyping need to be introduced. The outcomes of this work may provide some guidance to medical schools engaged in implementing strategies to enroll and support Indigenous students.
Publisher: Wiley
Date: 10-11-2010
DOI: 10.1111/J.1365-2893.2009.01250.X
Abstract: Uptake of treatment for hepatitis C virus (HCV) infection is very low particularly among people who have injected drugs. Opiate substitution treatment (OST) programs, with a high prevalence of people living with HCV, have been a site of growing interest in the delivery of hepatitis C treatment. There has been no exploration of OST clients' and health professionals' perceptions of the barriers and facilitators to uptake and delivery of HCV treatment in OST clinics from personal and organizational perspectives. This qualitative study involved interviews with 27 OST clients in New South Wales and a focus group and interviews with 22 Australian OST health professionals. Clients and health professionals viewed hepatitis C treatment in OST as a 'one-stop-shop' model which could increase access to and uptake of treatment and build on existing relationships of trust between OST client and health professional. Elements of the organizational culture were also noted as barriers to HCV treatment delivery including concerns about confidentiality, lack of discussion of HCV treatment and that HCV treatment was not perceived by clinicians as a legitimate activity of OST clinics. OST client participants also reported a number of personal barriers to engaging with HCV treatment including family responsibilities (and concerns about treatment side effects), unstable housing, comorbidities and perceptions of the unsatisfactory level of treatment efficacy. These findings emphasize the need for future research and delivery of services which addresses the complexity of care and treatment for people in marginalized social circumstances.
Publisher: Wiley
Date: 24-03-2021
DOI: 10.1111/ADD.15477
Abstract: Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment‐as‐prevention strategies in custodial settings, yet limited empirical data exists. The Australian ‘Surveillance and Treatment of Prisoners with Hepatitis C’ study is the world's first trial of hepatitis C virus (HCV) treatment‐as‐prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment‐as‐prevention in prison using interview data from the SToP‐C qualitative substudy. Qualitative analysis using semi‐structured interviews in Australia. Nineteen key HCV experts. Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude ethicality opportunity costs and perceived effectiveness. Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention‐as‐prevention, including the improvement and expansion of existing harm reduction measures. Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment‐as‐prevention in Australian prisons found no opposition to the universal rollout of direct‐acting anti‐virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons.
Publisher: Informa UK Limited
Date: 03-2008
Publisher: Wiley
Date: 14-09-2010
DOI: 10.1111/J.1365-2893.2010.01370.X
Abstract: Assessment and treatment for hepatitis C virus (HCV) in the community remains low. We evaluated factors associated with HCV specialist assessment and treatment in a cross-sectional study to evaluate treatment considerations in a s le of 634 participants with self-reported HCV infection in New South Wales, Australia. Participants having received HCV specialist assessment (n = 294, 46%) were more likely to be have been older (vs <35 years 35-44 OR 1.64, P = 0.117 45-54 OR 2.00, P = 0.024 ≥55 OR 5.43, P = 0.002), have greater social support (vs low medium OR 3.07, P = 0.004 high OR 4.31, P < 0.001), HCV-related/attributed symptoms (vs none 1-10 OR 3.89, P = 0.032 10-21 OR 5.01, P = 0.010), a diagnosis of cirrhosis (OR 2.40, P = 0.030), have asked for treatment information (OR 1.91, P = 0.020), have greater HCV knowledge (OR 2.49, P = 0.001), have been told by a doctor to go onto treatment (OR 3.00, P < 0.001), and less likely to be receiving opiate substitution therapy (OR 0.10, P < 0.001) and never to have seen a general practitioner (OR 0.24, P < 0.001). Participants having received HCV treatment (n = 154, 24%) were more likely to have greater fibrosis (vs no biopsy none/minimal OR 3.45, P = 0.001 moderate OR 11.47, P < 0.001 severe, OR 19.51, P < 0.001), greater HCV knowledge (OR 2.57 P = 0.004), know someone who has died from HCV (OR 2.57, P = 0.004), been told by a doctor to go onto treatment (OR 3.49, P < 0.001), were less likely to have been female (OR 0.39, P = 0.002), have recently injected (OR 0.42, P = 0.002) and be receiving opiate substitution therapy (OR 0.22, P < 0.001). These data identify modifiable patient-, provider- and systems-level barriers associated with HCV assessment and treatment in the community that could be addressed by targeted interventions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.DRUGPO.2015.05.014
Abstract: The law is a key site for the production of meanings around the 'problem' of drugs in public discourse. In this article, we critically consider the material-discursive 'effects' of laws prohibiting peer distribution of needles and syringes in Australia. Taking the laws and regulations governing possession and distribution of injecting equipment in one jurisdiction (New South Wales, Australia) as a case study, we use Carol Bacchi's poststructuralist approach to policy analysis to critically consider the assumptions and presuppositions underpinning this legislative and regulatory framework, with a particular focus on examining the discursive, subjectification and lived effects of these laws. We argue that legislative prohibitions on the distribution of injecting equipment except by 'authorised persons' within 'approved programs' constitute people who inject drugs as irresponsible, irrational, and untrustworthy and re-inscribe a familiar stereotype of the drug 'addict'. These constructions of people who inject drugs fundamentally constrain how the provision of injecting equipment may be thought about in policy and practice. We suggest that prohibitions on the distribution of injecting equipment among peers may also have other, material, effects and may be counterproductive to various public health aims and objectives. However, the actions undertaken by some people who inject drugs to distribute equipment to their peers may disrupt and challenge these constructions, through a counter-discourse in which people who inject drugs are constituted as active agents with a vital role to play in blood-borne virus prevention in the community. Such activity continues to bring with it the risk of criminal prosecution, and so it remains a vexed issue. These insights have implications of relevance beyond Australia, particularly for other countries around the world that prohibit peer distribution, but also for other legislative practices with material-discursive effects in association with injecting drug use.
Publisher: Wiley
Date: 20-05-2001
DOI: 10.1046/J.1445-5994.2001.00047.X
Abstract: Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost-effectiveness is generally inconclusive and provides a suboptimal basis for policy development. To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders. Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript. A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a s le of clinicians drawn from hospitals with variable use of blood-saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that 'enthusiasts' were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices rocedures. Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an 'enthusiast'. Critical review of the evidence for effectiveness or cost-effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence-based medicine principles to play a greater role in policy decisions in this area.
Publisher: Informa UK Limited
Date: 24-01-2013
Publisher: Informa UK Limited
Date: 2010
Publisher: Informa UK Limited
Date: 26-03-2010
Publisher: Elsevier BV
Date: 09-2017
Publisher: JMIR Publications Inc.
Date: 09-07-2020
DOI: 10.2196/15113
Abstract: Despite the importance and popularity of mutual support groups, there have been no systematic attempts to implement and evaluate routine outcome monitoring (ROM) in these settings. Unlike other mutual support groups for addiction, trained facilitators lead all Self-Management and Recovery Training (SMART Recovery) groups, thereby providing an opportunity to implement ROM as a routine component of SMART Recovery groups. This study protocol aims to describe a stage 1 pilot study designed to explore the feasibility and acceptability of a novel, purpose-built mobile health (mHealth) ROM and feedback app (Smart Track) in SMART Recovery groups coordinated by SMART Recovery Australia (SRAU) The secondary objectives are to describe Smart Track usage patterns, explore psychometric properties of the ROM items (ie, internal reliability and convergent and ergent validity), and provide preliminary evidence for participant reported outcomes (such as alcohol and other drug use, self-reported recovery, and mental health). Participants (n=100) from the SMART Recovery groups across New South Wales, Australia, will be recruited to a nonrandomized, prospective, single-arm trial of the Smart Track app. There are 4 modes of data collection: (1) ROM data collected from group participants via the Smart Track app, (2) data analytics summarizing user interactions with Smart Track, (3) quantitative interview and survey data of group participants (baseline, 2-week follow-up, and 2-month follow-up), and (4) qualitative interviews with group participants (n=20) and facilitators (n=10). Feasibility and acceptability (primary objectives) will be analyzed using descriptive statistics, a cost analysis, and a qualitative evaluation. At the time of submission, 13 sites (25 groups per week) had agreed to be involved. Funding was awarded on August 14, 2017, and ethics approval was granted on April 26, 2018 (HREC/18/WGONG/34 2018/099). Enrollment is due to commence in July 2019. Data collection is due to be finalized in October 2019. To the best of our knowledge, this study is the first to use ROM and tailored feedback within a mutual support group setting for addictive behaviors. Our study design will provide an opportunity to identify the acceptability of a novel mHealth ROM and feedback app within this setting and provide detailed information on what factors promote or hinder ROM usage within this context. This project aims to offer a new tool, should Smart Track prove feasible and acceptable, that service providers, policy makers, and researchers could use in the future to understand the impact of SMART Recovery groups. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000686101 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336. PRR1-10.2196/15113
No related grants have been discovered for Carla Treloar.