A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care

Background: HCV treatment among people who inject drugs (PWID) is low. Education programs may be suitable strategies to improve patients' knowledge about their condition and to overcome barriers to access treatment. Methods: The Health Educational Program (HEP) consisted of patient workshops and educational videos and leaflets, and healthcare professionals' workshops. HEP was implemented at seven substance dependence treatment centers (STDC) in Portugal. The study comprised two cross-sectional evaluations conducted before and after HEP. At both evaluations, adult patients with confirmed HCV diagnosis and registered in the STDC were consecutively included. For patients that completed both evaluations, the overall knowledge score were calculated and compared with McNemar test. Linear regression modelling was used to evaluate factors associated with baseline knowledge. Rates of referral and attendance to referral specialist, treatment proposal, initiation and retention at both evaluations were also compared with McNemar test. Results: Overall, 504 patients with chronic hepatitis C were included: 78 % male, mean age 42.3 +/- 6.6 years, 14 % school education <= 4 years, disease duration 11.0 +/- 6.0 years and 26 % HIV co-infected. A higher baseline knowledge was independently associated with educational level = 10 years (regression coefficient [B] = 15.13, p < 0.001), current use of intravenous drugs (B = 7.99, p = 0.038), previous referral for treatment (B = 4.26, p = 0.008) and previous HCV treatment (B = 5.40, p = 0.003). Following HEP, mean knowledge score increased from 69 % to 79 % (p < 0.001). The rate of patient referral to a liver specialist increased from 56.2 % to 67.5 % (p < 0.001). Conclusions: An HEP conducted at STDCs improved significantly patient knowledge about hepatitis C, even among patients with a high baseline knowledge. The HEP has also increased the rate of referral to the liver specialist and showed a great potential to support healthcare professionals in managing HCV. Education programs may promote treatment access among PWID, a population that represents the majority of HCV infected patients.