Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia

• Peer workers were trusted information sources for opioid substitution (OST) clients.
• Peer workers mediated between OST client and staff to produce better relationships.
• Peer workers can prepare clients for hepatitis C care.
• Peer workers are low cost and can contribute to effective use of health resources.
• Peer workers can change support adherence to hepatitis C treatment.

AimPeer support services have been shown to be beneficial in increasing uptake and adherence to treatment in other areas but few examples of these services exist in hepatitis C (HCV) care. This study examined the performance of two community-controlled peer support services operating within a larger study aimed at increasing access to HCV care and treatment for opiate substitution treatment (OST) clients, ETHOS.MethodsSemi-structured interviews were conducted in two clinics with three groups of participants: clients (n = 31), staff (n = 8) and peer workers (n = 3) and examined the operation of the service in relation to process, outputs and impacts.ResultsThere was a very strong positive response to the peer worker services reported by staff and clients who had and had not interacted with a peer worker. A number of changes were reported that were not explicit goals of the service including providing access to additional services for clients and staff, peer workers acting as mediators between clients and staff and a less tangible notion of a changing “feel” of the clinic to a more positive and client-friendly social and physical space. Explicit goals of the service were also reported in peer workers supporting clients to consider and prepare for treatment (via blood tests and other assessments) as well as provide information and support about treatment.ConclusionsThe peer support service was acceptable to clients and clinic staff. All groups of participants noted that the service met its goals of engaging clients, building trusting relationships and providing instrumental support for clients to access HCV treatment. Peer workers may also contribute to more effective deployment of health resources by preparing clients for clinical engagement with HCV health workers.