Centerforce Hepatitis C-Infected Peer Health Educator Training

1. Centerforce Hepatitis C-Infected Peer Health Educator Training DAY 5

2. Day 5 Schedule

3. Module 15: Review of Main Messages and Tools of the Training By the end of this module, participants will: • Review the main messages from each module of the training • Have these main messages as reference sheets for themselves when they are providing peer health education to others living with Hep C. 3

4. Main MessagesCultural Awareness & Humility • Culture influences how we perceive the world as well as our values and actions • We cannot know someone’s culture, or should not assume it, without hearing it from that person themselves – this is cultural humility

5. Main MessagesHow Individuals Change Behavior • People’s health behaviors are influenced not only by their own thoughts, ideas, experiences and desires (intrapersonal), but also by • other people (interpersonal), • community, • organizations to which they belong (employer, health insurance, religious groups, etc), • socio-political culture (larger society and politics) • People change their health behaviors in stages and, sometimes, relapse or regress back to engaging in those same behaviors even after they’ve changed.

6. Main MessagesClient Centered We cannot force people to change their health behaviors—for someone to be successful in making a change, they have to make the decision for themselves about how and when they want to make a change in their lives. Our jobs as peer health educators is to provide our peers with information, ideas, and support in making this decision and the change that they choose for themselves. 6

7. Review & Main Messages LIVER BASICS What is a vital organ? List two things that your liver does for your body? The liver is a “non-complaining organ” – what does that term mean? Can the liver regenerate itself? What can happen if the liver has to process a lot of substances over long periods of time, such as alcohol? What were the three most important messages or “bottom lines” for you about the liver? 7

8. Hepatitis CReview & Main Messages • How long does a Hepatitis C infection last? • What percentage of adults who become infected have acute Hepatitis C and what percentage become chronically infected? • What body fluid is Hepatitis C found in? • Who has Hepatitis C in these body fluid? • How do people get Hepatitis C? • What’s a vaccine? • Is there a vaccine for Hepatitis C? • How do you prevent yourself from getting Hepatitis C? • If you’ve had Hepatitis C and cleared it, can you get it again? 8

9. Review & Main Messages BASIC HEP C TESTS What does an antibody test tell you? What can an antibody test not tell you? What does a viral load test tell you? How many main genotypes are there of Hep C? 9

10. Hepatitis C TreatmentsReview & Main Messages • General Treatment Guidelines: in order to get on treatment, generally required that: • Overall health is stable • Have active, chronic Hep C • Have elevated ALT’s • Do not have decompensated cirrhosis 10

11. Hepatitis C TreatmentsReview & Main Messages • Goals of Treatment • To clear the Hep C Virus from the body • To improve inflammation and scarring • To slow disease progression • To improve symptoms and quality of life 11

12. Hepatitis C TreatmentsReview & Main Messages • Types of Current* Hep C Treatments: • For those with Genotype 1: antiretrovirals + pegylated Interferon + Ribavirin • For those with Genotypes 2 and 3: pegylated Interferon + Ribavirin • Old Treatment for Hep C Genotype 1: Pegylated Interferon + Ribavirin 12

13. Hepatitis C TreatmentsReview & Main Messages • AVERAGE Treatment Success Rates • For those with Genotype 1: • Current Treatment – • For those who have never been treated 62 to 88% of people have a SVR • For those who “failed” on prior treatments, 32 to 88% of people have a SVR • Older Treatment – • 40-50% of people have an SVR after 1 year of treatment • For those with Genotypes 2 & 3: • 80% of people have an SVR after 6 months of treatment 13

14. Side Effects of Hep C Treatment Review & Main Messages • At least 60% of people on Hep C Treatment experience Side Effects • Vary in severity from mild to moderate to severe • Usually worse during first few weeks of treatment • There are many different side effects associated with Pegylated Interferon, including (but not limited to): • Feeling flu-like (low grade fever, fatigue, muscle/joint pain, nausea and vomiting, diarrhea, irritability) • Headaches • Mental health side effects (irritability, depression, mania, anxiety, personality changes) 14

15. Side Effects of Hep C Treatment Review & Main Messages • There are also many different side effects associated with Ribivirin, including (but not limited to): • Side effects similar to those from Pegylated Interferon: • Headache • Fatigue • Diarrhea • Irritability • Other side effects: • Birth defects and miscarriages • Anemia • Rash (itching) • Dry cough • Nasal stuffiness, sinusitis • Shortness of breath 15

16. Side Effects of Hep C Treatment Review & Main Messages • General recommendations for dealing with side effects: (specific recommendations for each effect in earlier slides) • Take a week or two off of work when start treatment • Time interferon injections before bedtime • Drink plenty of non-caffeinated, non-alcoholic beverages • Eat small amounts of food throughout the day • Avoid acidic or spicy foods • Get plenty of rest • Create, rely on support systems (friends, family, peers) • Try relaxation techniques 16

17. Hepatitis C Disease ProgressionReview & Main Messages • 75 to 85 of every 100 adults infected with Hep C will develop Chronic Hep C • Without treatment: • 5 to 20 will develop cirrhosis • 1-5 will die of cirrhosis or liver cancer • Disease Progression usually happens over a 10 to 40 year period • Steatosis, or fatty liver increases the risk of progression of liver damage caused by Hep C • To prevent or treat steatosis: • Follow diet recommendations • Exercise • Maintain a healthy weight 17

18. Hepatitis C Disease ProgressionReview & Main Messages • Chronic Hepatitis C Liver Disease can lead to Fibrosis • Fibrosis is the accumulation of tough, fibrous scar tissue • Fibrosis affects the liver’s ability to do its 500 jobs • Fibrosis does not occur or progress at the same rate in all people • Factors that increase progression of Fibrosis: • Over age 50, being male, compromised immune system, use of alcohol, steatosis, insulin resistance • Fibrosis can lead to cirrhosis or severe scarring of the liver (happens in 10-25% of peoel with chronic Hep C) 18

19. Hepatitis C Disease ProgressionReview & Main Messages • Many people with Fibrosis and Compensated Cirrhosis experience no symptoms • It is important to be monitored by your doctor • Decompensated Cirrhosis is when the liver is so heavily scarred it is not able to function properly • There are a lot of symptoms and life-threatening complications • Liver cancer develops in 3-5% of people with chronic HCV • Risk factors include age, steatosis, and cirrhosis 19

20. Hepatitis C Disease ProgressionReview & Main Messages Ways to slow Hep C Disease Progression • Hep C medical treatment • Regular exercise and rest • Stress reduction • Eating a healthy, well balanced diet (low in fat) • Don’t use recreational drugs • Don’t drink alcohol • Take prescription drugs only as prescribed by your doctor • Don’t take any other drugs or herbal remedies without consulting with your doctor • Get vaccinated against Hep A and B • Stay away from poisonous liquids and fumes 20

21. Review & Main Messages TESTS TO MONITOR HCV DISEASE What is a liver biopsy? Why are liver biopsies done? Does the viral load tell you how much damage has happened to the liver? What does one normal ALT test tell you about what is going on in your liver? Generally speaking, what do high levels of ALT, AST, or Bilirubin mean? Why do doctors look at Platelet levels or Prothrombin time? 21

22. Hep C Co-infectionReview & Main Messages • Being infected with both Chronic Hep C and another infectious disease can put a great strain on your body, and possibly your liver; • Having both HIV and Chronic Hep C seems to make the Hep C disease progress faster; • If you have both HIV and Chronic Hep C, you need to get your HIV under control before starting Hep C treatment; • If you have chronic Hep C and have not had Hep B, it is very important to get vaccinated against Hep B. 22

23. Review & Main Messages: General Health & Wellness • Things you can do to support your general health and wellness: • Minimize stress • Exercise • Good time management • Meditation and prayer • Rest when you are tired • Plan for relaxation and naps in your day • Learn to say “no” • See your doctor or clinician for regular check-ups 23

24. Review & Main Messages: General Health & Wellness • Things you can do to support your general health and wellness (continued): 4. Get the Hep A and Hep B vaccines 5. Eat a healthy and balanced diet 6. Stop drinking alcohol 7. Check in with your doctor about any drugs or herbs you want to take 8. Join a support group 9. Try not to worry too much 10. Stay away from or protect yourself from chemicals. 24

25. Review & Main Messages DISCLOSURE Work on accepting your HCV status before considering disclosing. Gather all information you can about your health before you disclose. Use Worksheet 3.1 to help you make a decision about whether to disclose, listing all the pro’s and con’s of disclosing, your expectations, and your ability to handle the worst case scenario. Use Worksheet 3.2 to help you prepare to disclose, practicing answers to possible questions and having information available for the person to whom you disclose. Use Worksheet 3.3 on the day you disclose to make sure you have created the right space in which to disclose and that you cover all of the important topics. 25

26. Review & Main Messages DISCLOSURE 1. When you disclose to your loved one, they may feel guilt, anger, fear, and/or grief. 2. Sometimes people who are grieving go through 5 stages, this is normal. The last and final stage is acceptance. 26

27. Review & Main Messages (cont’d) 3. You can support your loved one by encouraging them to: let go of their guilt, not be impacted by every piece of information they hear about Hep C, talking to others about their feelings (including, possibly, you), and taking care of themselves by doing things that bring them joy. 4. Reinforce with your loved one that they cannot get Hepatitis C from casual contact with you and they are very unlikely to get it from you from sex. 27

28. Review & Main Messages SOCIAL SUPPORT & STIGMA Social Support is one of the important needs of people living with Hepatitis C. What is social support? What is the benefit of social support? Where can we get social support? How can you find a support group? What is stigma? How can we manage stigma? 28

29. Module 16: 1:1 outreach skills By the end of this module, participants will be able to: • List the purpose, benefits, and guidelines to outreach • Conduct 1:1 outreach with their peers 29

30. Module 16 1:1 Outreach • What is 1:1 Outreach? • An effective tool for reaching your Peers • Meeting with peers one on one or in small groups of 1 to 4 people • Discussing health, emotional and psychological well being.

31. 1:1 Outreach • Purpose: Discuss issues relevant to the individual or group • Topics: health , family issues, medical issues, etc. • Approach: providing undivided attention to the Peer. • Outcome: increased knowledge and a direction to move forward.

32. Benefits of 1:1 Outreach • Increased knowledge • Stopping false information from being disseminated; • Possible improved overall health and well being • Ability to get questions answered that they might not otherwise feel comfortable asking

33. Guidelines for 1:1 Outreach • Find out what person is seeking: • Some people may just need to vent or talk • others may need direction or information regarding various health topics. • Respond respectively, do not judge. • Identify what Stage of Change the person may be in. • Provide desired and appropriate information. • Offer advice only if asked • Maintain everyone’s privacy

34. Guidelines for 1:1 Outreach (cont’d) • DO NOT give a diagnosis (you are not a clinician). • DO NOT offer counseling (you are not a therapist). • Be aware of your limits and own them: • If you do not know the answer to a question, explain that you don’t. Tell the individual that you will find the information and get back to them. • Be reliable (do what you say you are going to do)

35. Guidelines for 1:1 Outreach (cont’d) • Be: • Available • Approachable • Up to date (continue to learn) • Flexible • Patient • Compassionate (non-judgemental) • Honest

36. Outreach Skills Practice • A Peer Educator approaches two individuals who appear to be getting/giving tattoos. What information can the Peer Educator provide the individuals to change their behaviors? • A Peer Educator is approached by someone in the yard wanting to talk about their sister who was recently diagnosed with HCV.

37. Outreach Skills Practice (cont) • A Peer Educator overhears a roommate talking about HBV. The roommate tells another roommate that you get HBV from dirty toilet seats. What do you do as a Peer Educator? • While walking to chow, you are approached by a friend and she tells you that her co-worker in the kitchen had HAV. They’re worried that her co-worker is going to get others sick.

38. Closing and Graduation By the end of this module participants will Complete a Post training Survey. Participate in closing circle that recognizes the bonds formed and skills learned, and the sense of community created by the training program Receive certificates of completion.