Liver Disease Burden and Clinical Follow-Up during a Liver Health Promotion Intervention Integrating Non-Invasive Liver Disease Screening in Drug and Alcohol Settings: The Liverlife Study

Author: Grebely J, Marshall AD, Krahe M, Erratt A, Telenta J, Treloar C, Jones SC, Bath N, How-Chow D, Byrne J, Harvey P, Dunlop A, Applegate TL, Lamoury F, Mowat Y, Jauncey M, Read P, Gilliver R, Smith J, Collie T, and Dore GJ

Theme: Clinical Research Year: 2016

Grebely J1
, Marshall AD1
, Krahe M2
, Erratt A1
, Telenta J3
, Treloar C4
, Jones SC3
, Bath N6
How-Chow D7
, Byrne J8
, Harvey P9
, Dunlop A10,11
, Applegate TL
, Lamoury F1
, Mowat Y1
Jauncey M12, Read P1,13, Gilliver R13, Smith J14, Collie T15, and Dore GJ1
1The Kirby Institute, UNSW Australia, NSW Australia; 2Menzies Health Institute Queensland,
Griffith University, QLD Australia; 3Centre for Health and Social Research, Australian
Catholic University, VIC Australia; 4Centre for Social Research in Health, UNSW Australia,
NSW Australia; 5NSW Users and AIDS Association, Inc., NSW Australia; 6NSW Health, 7St
Vincent’s Hospital Sydney, NSW Australia; 8Australian Injecting and Illicit Drug Users
League, ACT Australia; 9Hepatitis NSW, Australia; 10University of Newcastle, Newcastle,
NSW, Australia, 11Drug and Alcohol Clinical Services, Hunter New England Local Health
District, Newcastle, NSW, Australia; 12Sydney Medically Supervised Injecting Centre, NSW,
Australia; 13Kirketon Road Centre, NSW Australia; 14Matthew Talbot Hostel, St Vincent de
Paul Society NSW Support Services, NSW Australia; 15Coffs Harbour Drug and Alcohol
Service, NSW, Australia
Background: Liver disease burden among people who inject drugs (PWID) is high, yet few
strategies to enhance liver disease screening have been evaluated. The aim of this study
was to assess factors associated with severe fibrosis/cirrhosis and follow-up among PWID
participating in a liver health promotion campaign.
Methods: The LiveRLife campaign involved: 1) educational resource development; 2)
resource testing; and 3) implementation. Between May-October 2014, participants were
enrolled in an observational cohort study with recruitment from four clinics in Australia (one
community-based primary health care clinic, two opioid substitution treatment clinics, and
one medically supervised injecting centre). Participants received educational material,
clinical assessment, transient elastography (TE) assessment, dried blood spot testing, and
completed a knowledge survey. Qualitative HCV RNA testing was performed on dried blood
spots collected from the study.
Results: Of 253 participants (mean age=43), 68% were male, 71% had injected in the past
month, and 68% were HCV RNA+. Overall, 68% had no/mild fibrosis (F0/F1, ≥2.5 – ≤7.4
kPa), 13% moderate fibrosis (F2, ≥7.5 – ≤9.4 kPa), 10% severe fibrosis (F3, ≥9.5 – ≤12.4
kPa), and 9% had cirrhosis (F4, ≥12.5 kPa). The proportion of people with severe
fibrosis/cirrhosis (F3/F4, 19%) was higher in those who were >50 years (33% vs. 15%,
P=0.003), male (23% vs. 11%, P=0.069), and those HCV RNA+ (24% vs. 10%, P=0.011). In
adjusted analysis, age >50 years (OR 2.91, 95%CI, 1.42, 5.95) and being HCV RNA+ (OR
2.61, 95%CI, 1.08, 6.28) were associated with severe fibrosis/cirrhosis (F3/F4). Sixty percent
(n=152) returned for a follow-up nurse/specialist assessment.
Conclusion: Liver disease burden in this population was high and was associated with age
>50 years and HCV RNA positive status. The majority of people assessed for liver disease
returned for a follow- up assessment by a nurse/specialist, supporting the inclusion of TE in
HCV-related care.
Disclosure of Interest Statement: The study was supported in part by a research grant
from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions
expressed in this paper are those of the authors and do not necessarily represent those of
Merck Sharp & Dohme Corp. The Kirby Institute is funded by the Australian Government
Department of Health and Ageing. The views expressed in this publication do not
necessarily represent the position of the Australian Government. GD is supported by a
National Health and Medical Research Council Practitioner Research Fellowships. JG is
supported by a National Health and Medical Research Council Career Development
Fellowship. SJ is supported by an Australian Research Council Future Fellowship.

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