Peer support positively impacts HCV treatment, outcomes

Peer support within marginalized groups at risk for hepatitis C virus increased treatment initiation and completion as well as improved outcomes, according to a presenter at the International Liver Congress.

“This has been the largest study on the impact of peers on hepatitis C and we have found that they have both an immediate and delayed impact,” Davina V. Jugnarain, of Queen Mary University of London, said during her presentation. “Their immediate impact may suggest that having peer support workers as part of a multidisciplinary team may motivate and engage staff to challenge their unconscious biases, encouraging them to think about injecting drug users as people deserving of treatment whereas the delayed effect suggests that community work by peers has a positive impact on referrals and treatment within drug services.”

Jugnarain explained that the National Health Service England deployed peers within their treatment networks to further their goals of eliminating HCV. They trained the peer support workers by The Hepatitis C Trust and then introduced to 17 of the 22 regional networks.

Due to funding and operational readiness, Jugnarain described the deployment as “pseudorandomized” stepwise implementation.

During the period studied, 30,729 patients underwent treatment. The first analysis of immediate impact included 6,718 patients who received peer support compared with 24,011 who did not; the second looking at impact after 2 months included 6,123 patients who received peer support and 24,606 who did not or did not meet the 2-month endpoint.

In the immediate cohort, Jugnarain reported an increase in patients engaging in treatment after peer support was implemented (RR = 1.12; 95% CI, 1.02-1.21) as well as an increase in treatment completion (OR = 2.45; 95% CI, 1.49-3.84). This group also showed an increase in completing an adequate treatment course (OR = 1.27; 95% CI, 0.998-1.5) as well as attendance of all sessions (OR = 1.14; 95% CI, 0.979-1.36).

“We found a significant increase in those initiating treatment after the implementation of peers; however, surprisingly, we did not observe a change in injecting drug users who began treatment. We also found that those in peer groups were more than twice as likely to complete treatment. There was also an observed increase in those completing an adequate treatment course and attending for follow up 12 weeks post treatment,” she said.

In looking at how patients fared 2 months after initiating peer support, Jugnarain reported similar results with the addition of increased drug service referrals (RR = 1.15; 95% CI, 0.99-1.33) and those treated in drug services (OR = 1.19; 95% CI, 1-1.44).

Jugnarain also reported that although rates of patients lost to follow-up were similar, treatment failures were 1.7% in the peer group and 2.8% in the non-peer group, “showing that peers were effective in engaging patients with treatment reflected by the lower rates of treatment failure in the peer group,” she said.

“We have found that the lived experience of peers has an immediate impact on improving the likelihood of patients to start and complete treatment. They may also reduce the rate of treatment failures. Although injecting drug users were not found to have an increased uptake of treatment, peers do seem to increase referrals and numbers treated in direct services, perhaps in outreach to other marginalized groups. Therefore, we believe that peers are effective in engaging at-risk groups and therefore they could help to accelerate the attainment of hepatitis C elimination targets,” Jugnarain said.