Liver disease knowledge and acceptability of non-invasive liver fibrosis assessment among people who inject drugs in the drug and alcohol setting: The LiveRLife Study

• PWID had moderate levels of HCV and liver disease knowledge.
• PWID stated high willingness to receive HCV treatment.
• Frequency of injection drug use was independently associated with knowledge.
• Transient elastography (TE) was the most preferred liver disease assessment method pre- and post-TE.
• Nearly one-fifth of participants had either severe fibrosis or cirrhosis.

BackgroundThe 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 campaign.MethodsThe LiveRLife campaign involved three phases: (1) campaign resource development; (2) campaign resource testing; and (3) campaign 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.ResultsOf 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 sample. 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 ≤7.4 kPa), 13% moderate fibrosis (F2, ≥7.5 to ≤9.4 kPa), 10% severe fibrosis (F3, ≥9.5 to ≤12.4 kPa), and 9% had cirrhosis (F4, ≥12.5 kPa).ConclusionLiver 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.