1. 1 Integrated HCV Treatment for Active Drug Users Jenny Kelsall VIVAIDS Combined APSAD & Cutting Edge Addiction Conference Auckland, NZ November 5-8 2007

2. 2 In this presentation The Model A brief overview of the Healthy Liver Clinic (HLC) model Innovative aspects of the model What aspects of the model resonate most with the clients? The C lients A snapshot of the HLC clients What informs and influences clients decisions re treatment? What are the most important issues and considerations for clients when deciding on treatment? Conclusions What changes will make current models and modes of delivery better able to accommodate the complexity of our clients lives?

3. 3 The Healthy Liver Clinic (HLC) The Model Distinguishing features of the HLC model: HLC was established in an existing drug treatment agency - attended by drug users for pharmacotherapy programs HLC constitutes a one-stop shop – with access to a range of services under the same roof Treatment is provided at no cost – all meds including meds to treat side effects dispensed at no cost from onsite pharmacy HLCs vision includes a strong commitment to health promotion

4. 4 The Healthy Liver Clinic (HLC) The Model The Healthy Liver Clinic Team @ Turning Point A & D Centre Advanced Clinician/Manager (Physician Assistant) A GP/S100 prescriber Shared care with ID specialists from St Vs/Royal Melbourne Hepatology Nurse VIVAIDS Peer counsellor/support worker (Part of Liver Clinic Team) Drug & Alcohol and Related Services @ Turning Point A & D Centre GPs/Pharmacotherapy prescribers (2 x S100 Prescribers) Drug and alcohol counsellors/case managers Onsite pharmacy Psychiatrists/psychologists Needle Syringe Program Forensic services

5. 5 The Healthy Liver Clinic (HLC) The Model Unique features of the HLC model include: The involvement of VIVAIDS, the State drug user organisation for Victoria, as a key partner A VIVAIDS peer support worker in a shared position with Turning Point as a member of the clinical team A strong emphasis on consumer perspectives and peer input Close monitoring and evaluation of the impact of peer input and involvement

6. 6 The Healthy Liver Clinic (HLC) The Model The role of the VIVAIDS peer support worker is: To address barriers to the uptake of treatment To devise ways to respond to clients needs during screening, assessment and treatment To provide ongoing advocacy and support for clients at all stages of screening and treatment To provide peer based information and education in response to clients requests and concerns

7. 7 The Healthy Liver Clinic (HLC) The Model Advantages of the peer support role: Pivotal, go-between role Alternative, non-clinical perspective Consumer-focussed approach Insights into clients perspectives & priorities Clients regard peer support as an integral part of the screening and treatment process

8. 8 The Healthy Liver Clinic (HLC) The Clients (1) 72 clients have completed screening and assessment 34 clients have commenced treatment 16 clients are currently on treatment 12 clients have completed treatment 4 have SVR 8 have ETR - <6 months after end of treatment 2 were non-responders (stopped at 12 wks) 3 dropped out prematurely due to adverse events 1 lost to follow up

9. 9 The Healthy Liver Clinic (HLC) The Clients (2) 4 main groups: 1.Clients undergoing screening and assessment who are considering treatment 2.Clients who have completed screening/assessment and have started treatment 3.Clients who have completed screening/assessment and have deferred treatment OR are not sufficiently stable to start treatment OR have decided not to proceed with treatment 4.Clients who have completed treatment and have ETR – <6 months after end of treatment have achieved SVR

10. 10 The Healthy Liver Clinic (HLC) The Clients (3) What do clients need in order to start treatment? Easy access – I just walked in off the street one day and next thing I was sitting in Ks office talking about when I wanted to start treatment. Immediate access – I had to wait for months for my first appointment when I rang the hospital liver clinic and then I forgot to go! you loose your momentum when its like that and nothings going to happen for a ages. I just forgot about it Staff I could relate to and who didnt judge me – I got on with all the staff straight away. I felt sort of safe. I thought these people wont look down on me; these people will look after me Confidence from treatment staff – Their whole attitude was you can do this! All my doubts and misgivings just fell away. The doctors I had discussed treatment with in the past had all fixated on all the problems and all the reasons I wasnt a suitable case for treatment. They made it all too hard; one doctor made me think I didnt even deserve the chance to get rid of it.

11. 11 The Healthy Liver Clinic (HLC) The Clients (4) What do clients need in order to start treatment? My first meeting with K was a transformative experience – I walked out of his office a different person. It was like an epiphany – even the name of the place Turning Point was significant. I walked out of there knowing that it was going to happen and that I was finally going to get treated for my hep C. Male client (36yrs)

12. 12 The Healthy Liver Clinic (HLC) The Clients (4) What do clients need in order to start treatment? I didnt know they had people like J in these sorts of places. She knows where you are coming from. She can walk in your shoes and she can lay it all out for you so that you can get your head around it. If it wasnt for J I wouldnt be here – its as simple as that. The others at the HLC are great too – but it would be different without J. I know I can trust her and that she will be straight with me all the way Male client (32yrs)

13. 13 The Healthy Liver Clinic (HLC) The Clients (3) What do clients need to get through treatment? Easy access – I just walked in off the street one day and next thing I was sitting in Ks office talking about when I wanted to start treatment. Immediate access – I had to wait for months for my first appointment when I rang the hospital liver clinic and then I forgot to go! you loose your momentum when its like that and nothings going to happen for a ages. I just forgot about it Staff I could relate to and who didnt judge me – I got on with all the staff straight away. I felt sort of safe. I thought these people will look after me Confidence from treatment staff Clients illicit drug use