By Tamar Sapir, Ph.D.; Laura Simone, Ph.D.; Jeffrey Carter, Ph.D.; Laurence Greene, Ph.D.; Kathleen Moreo, RN-BC, BSN, BHSA, CCM, Cm, CDMS, PRIME Education LLC
Over the last few years, the FDA approvals of new direct acting antiviral therapies for hepatitis C virus (HCV) infection have created a truly remarkable opportunity: the potential to cure the disease and eradicate the virus in our lifetime. However, gaps in HCV care widely exist in marginalized and vulnerable groups, including people with a history of substance abuse and addiction, especially those who inject illicit drugs. Among the latter group, 30 percent of young adults and 70-90 percent of older adults are reported to have HCV.1,2 Due to their risky behaviors, these groups are also vulnerable to HCV reinfection after successful treatment. Many people with substance abuse, and the healthcare professionals in clinics where they seek help, are unaware of the risk of HCV or where to send patients for screening and treatment. Moreover, formidable barriers, including stigma, limit participation of people with substance abuse in health promotion activities that support national efforts to cure HCV and eradicate the virus.3
To address the HCV education needs of healthcare professionals and patients in substance abuse/addiction centers, PRIME developed an innovative program based on principles of co-production and models of collaborative learning.4,5 The program’s main component was a series of HIPAA-compliant, IRB-approved and multi-accredited patient-provider learning sessions. Held in 10 large substance abuse/addiction centers across the U.S., the sessions were led by each center’s director and clinical team, guided by PRIME’s sustainable and published Train-the-Trainer instructional format.6 The sessions were attended by the clinics’ patients and clients who had a history of substance abuse and were at risk for HCV. The program was supported through an educational grant from Gilead Sciences Inc.
Innovation in Program Design and Execution
The PRIME Train-the-Trainer educational format emphasizes “learning by doing.” This format included:
- Demonstrated shared decision making between providers and their patients as well as between and among patient peers
- Surveys conducted among both the patients and their providers, which enabled PRIME to synthesize powerful impact data
- An opportunity for patients to request and receive screening for HCV as part of the program
- Implementation methods to assist clinics in establishing new HCV screening and referral protocols in and through their facilities
- Sustainability of the project through a leave-behind toolkit, and commitment from each clinic to continue to regularly execute the program long after PRIME exits the project
The program design and execution demanded innovative solutions to new challenges in conducting continuing education (CE) programs for healthcare professionals and patients. PRIME’s approach included:
- Our research team conducted documented interviews with eligible substance abuse/addiction clinics across the country to identify their current approaches to HCV screening and referral for treatment (if any), to ascertain their willingness and ability to adapt new policies for screening and referral, and to ensure their commitment to the sustainability of the project
- Our compliance team developed new procedures for CE program execution, including adoption of specific HIPAA-compliant strategies to ensure confidentiality and promote trust among clinicians and patients/clients so that the relevant outcomes data could be collected in a compliant manner
- Our meeting solutions team provided training to our program facilitators to promote awareness about the problems of stigmatization and marginalization of people with a history of substance abuse/addiction
- Our content team established key instructional design strategies to promote interprofessional engagement in the multi-accredited program, addressing the diverse learning needs of substance abuse/addiction specialists of various professional backgrounds, including physicians, behavioral counselors, psychologists, midlevel practitioners, and social workers
Positive Educational Impact
In the 10 substance abuse/addiction centers, providers and patients completed baseline and post-education surveys that assessed their relevant HCV knowledge and their attitudes and barriers toward key stages of screening and testing in the HCV care cascade. For the providers, key educational outcomes are summarized as follows:
- 88 percent indicated that the education prompted action plans for encouraging their patients to get tested for HCV.
- 77 percent engaged in sustainable self-directed HCV educational activities.
- 71 percent continued their commitment to conducting future collaborative learning sessions with the resources provided through the program.
- 53 percent encouraged their clinics to implement new HCV testing procedures
- The number of providers who reported high levels of confidence in counseling patients about HCV testing and treatment increased by more than 50 percent.
Some examples of the positive educational impact among substance abuse patients include significant pre- to post-activity increases in the percentages of patients who correctly answered questions about HCV symptoms (+40 percent), associations between HCV and liver cancer (+25 percent), risky behaviors that cause HCV (+45 percent), requirements for HCV treatment (+41 percent), and risks of HCV reinfection after a cure (+32 percent). These outcomes are especially relevant because, in marginalized groups, patients’ gains in HCV knowledge are associated with closing gaps in the HCV care cascade.7
Based upon lessons learned and an acute need for similar programs in substance abuse centers across the U.S., PRIME is conducting a new Train-the-Trainer program in substance abuse clinics supported by AbbVie Inc. and Gilead Sciences Inc. in 2017. Information will be shared at the upcoming Alliance Industry Summit — to be held on May 22–24, 2017, in Philadelphia — where PRIME’s president, Kathleen Moreo, and Victoria Hunter, an addiction clinic counselor and program participant, will provide highlights of this award-winning program. Moreo and Hunter will address the perspectives of a participating substance abuse/addiction center and a CE provider, including their barriers and successes in implementing this sustainable model.
- Centers for Disease Control and Prevention. Hepatitis C FAQs for health professionals. http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. Accessed 3/13/17.
- Lankenau SE, Kecojevic A, Silva K. Associations between prescription opioid injection and HCV among young injection drug users. Drugs. 2015;22(1):35-42.
- National Academies of Sciences, Engineering, and Medicine. Eliminating the public health problem of hepatitis B and C in the US: Phase I report. Washington, DC: The National Academies Press; 2016.
- Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. BMJ Qual Saf. 2016;25(7):509-517.
- Moreo K, Sapir T, Greene L. Comparing patient and provider perceptions of engagement and care in chronic diseases. J Contin Educ Health Prof. 2016;36(Suppl 1):S44-S45.
- Sapir T, Moreo KF, Greene LS, et al. Assessing patient and provider perceptions of factors associated with patient engagement in asthma care. Ann Am Thorac Soc. 2017; Epub ahead of print.
- Zeremski M, Zibbell JE, Martinez AD, et al. HCV control among persons who inject drugs requires overcoming barriers to care. World J Gastroenterol. 2013;19(44):7846-7851.