Counseling and SupportSuccessful HCV care programs offer education and counseling, beginning at the initial screening for HCV antibodies.55-57,67-70 Counseling and education must be an ongoing part of care, regardless of whether HCV treatment is initiated. In the context of HCV treatment, these valuable services support adherence to HCV treatment and remain beneficial after treatment has been completed (see box, Essential Elements of HCV Education and Support). HCV counseling must include an alcohol abuse component, because in some cases, abstaining from alcohol may be the most important intervention for HCV. A safe amount of alcohol intake for people with chronic HCV has not been identified.71-72 Thus, it is particularly important for providers to assess alcohol use in coinfected patients, and then offer information, resources, and support on reducing or abstaining from alcohol. Alcohol consumption, particularly more than 50 g per day (approximately four mixed drinks or glasses of wine or beer) causes and accelerates liver damage in people with HCV and increases HCV viral load, which may compromise the efficacy of HCV treatment.23,73-75 Options to help patients reduce or eliminate alcohol intake include referral to counseling, 12-step programs, alcohol treatment programs, and pharmacotherapy with naltrexone or acamprosate.76-78 Alameda County Medical Center’s coinfection clinic is an example of a successful program. One component is a weekly education and support group, which began in February 2002. Each 2-hour meeting includes lunch and an educational session, which is followed by an opportunity for members to share experiences and socialize. Initially, mono- and coinfected patients treated for HCV at other sites were recruited as mentors. After the first group participant initiated HCV treatment without serious side effects, a “snowball effect” was reported: Within a few months, six participants had started HCV treatment. Although demographically diverse, the group is quite cohesive. Participants call one another between meetings, offer each other transportation to medical appointments, and continue to visit long after they have completed HCV treatment.57-68 For reasons ranging from the nature of HCV progression to the efficacy of available treatments, as well as the cost of treatments, most people living with HCV, regardless of HIV status, will never undergo HCV drug treatment. In fact, the U.S. Department of Veterans Affairs has identified 270,000 HCV-infected veterans since implementing HCV screening and testing, yet between 1996 and 2003, just 8 percent were ever treated.79
| |||