Hepatitis C test and treat roadshow – reaching homeless communities

Author: Philippe Bonnet

Theme: Models of Care Year: 2021

Background: Significant numbers of people who inject drugs (PWID) are poorly engaged with drug treatment services, identify as being socially excluded and unable to navigate complex and lengthy hepatitis C (HCV) testing and treatment pathways. Many are street homeless or residing in temporary accommodation where safe injecting behaviors are compromised by insecure settings, leading to elevated injecting harms and increased rates of HCV infection. Led by the Hepatitis C Trust Peer Support Lead, The Hepatitis C Test & Treat Roadshow was developed to provide testing and treatment for PWID, in homeless settings across a number of deprived urban areas in the West Midlands, UK. Description of model of care/intervention: The model provided point of care testing and treatment for PWID in 14 hostels and other settings used by street homeless. Those identified at risk were offered HCV rapid antibody screening and subsequently tested for HCV RNA with Cepheid GeneXpert. All RNA+ve individuals were offered pan-genotypic treatments, delivered by the peer and Hepatology Clinical Nurse Specialist (CNS) at the testing venue, or other setting requested by the patient, usually within 2 weeks but with some local variation. Effectiveness: The project was attractive to the target communities who reported ease of access and engagement in contrast to previously experienced barriers to treatment. 141 were screened for HCV antibodies. 42 were subsequently tested HCV RNA+ve. To date 35 commenced treatment with treatment arranged for a further 6 patients. One person declined treatment. Conclusion and next steps: The project has been a resounding success, well received by homeless PWID and hepatology treatment teams. Birmingham Operational Delivery Network (ODN) has planned to introduce the model across the West Midlands, with additional peer support capacity to engage homeless PWID through workshop delivery prior to testing and to facilitate treatment starts. Disclosure of Interest Statement: The Hepatitis C Trust has received funding via the NHS England elimination agenda through Gilead Sciences to fund the role of Peer Support Lead, West Midlands.

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