Western Australia (WA) covers a vast land mass and is the world’s second-largest subdivision of land. It’s immense expanse covers everything from large coastal communities to tiny desert towns. Peer Based Harm Reduction Western Australia (PBHRWA) is a small organisation that provides a third of the state’s sterile injecting equipment each year.
PBHR is committed to constantly refining its model of care and adapting its health and harm reduction services to ensure they are suitable and accessible for people who use drugs.
As a peer-based organisation run by and for people who use or have used drugs, it has grown significantly since its inception. It is now known as an organisation where people can access sterile injecting equipment from a friendly face, in a safe space. As the primary harm reduction organisation for Western Australia, PBHR has also grown the services that are wrapped around the provision of sterile injecting equipment.
From exchange supplies to hepatitis C treatment
As PBHRWA’s footprint has continued to grow, so has the regional team based in southwest WA. Jodie Savage leads their work in the region and splits her time between the Bunbury office and conducting the mobile van-based outreach. This approach has been crucial when it comes to developing deep ties into small communities where stigma and discrimination towards drug users is high.
Monty first heard about PBHRWA through a friend who vouched for the service and he quickly found himself regularly dropping in to exchange supplies at the Southwest office, which operates out of an old home. During these visits, Monty developed a close relationship with Jodie and eventually shared with her that he’d been living with hepatitis C for many years. Jodie and the team were able to undertake the required tests to confirm Monty’s status and ensure he could begin treatment as soon as possible.
It was with PBHRWA’s support that Monty was able to complete his Direct Acting Antiviral (DAA) medications and clear his hepatitis C, which meant a great deal to him.
If I couldn’t make it to the peer harm reduction, they would bring them to us every Monday morning in different containers, marked for each day. They’re an unbelievable organisation.
Monty, client
Mobile clinic helps increase reach
Such a wide range of people access the service, so we carry as much equipment as possible in the van to fulfil the needs of whoever may access us. As you go through the van, you have the exchange at the front, and then we have a fully fitted nurses’ station in the back.
Training more people to test for HCV
Recently Jodie and other PBHRWA staff in Perth completed their phlebotomy accreditation which has broadened the number of staff that can draw blood. This means more staff can assist with taking blood, which helps alleviate the large workload which previously rested solely on Nurse Practitioner, Leanne Myers, who is based in Perth.
Jodie’s now able to do testing on the van when she does outreach deliveries. She does the blood, then talks to me or Julie, the nurse down in Bunbury, and then I’m involved when that patient is nearly ready for treatment, and I go down and do an assessment. So a lot of that footwork and background work has been done already.
Leanne joined PBHRWA in 2015 when the exciting new DAA medications were entering the market in Australia. The new game-changing medicine introduced the perfect conditions for nurse practitioners like Leanne to apply for the appropriate accreditation to prescribe DAA treatment for people living with hepatitis C.
Integrating peers into the program
As a peer-led organisation, PBHRWA is no stranger to thinking creatively and using its limited resources to serve its community. In 2017 when Leanne began prescribing DAA, the organisation hired a hepatitis C case management worker whose primary role was to support community members through treatment with the aim of devolving care and using a non-traditional medical model and taking care of the patient.
Over the past five years, Leanne has worked closely with Paul J, PBHRWA’s case manager, to support people through treatment.
I think the most important component of our model of care is the peer worker role and the role that Paul J plays. There’s a lot of work behind the scenes that must be done, and Paul does that.
Leanne Myers, Nurse Practitioner
Many community members that go on to access hepatitis C through PBHRWA initially access the needle exchange for months or years before they feel ready to engage with the organisation about some of their broader health needs.
Making a difference to the lives of locals
Sandy has lived in WA her entire life; accessing health services in Perth has been difficult due to life as a mother with a big family and also to avoid stigma and discrimination regarding drug use. More than four years ago, Sandy was introduced to Leanne and Paul through a friend that vouched for the pair and encouraged Sandy to undergo the hepatitis C treatment. Due to difficult circumstances, Sandy wasn’t able to experience her hepatitis C treatment at the time; however, in 2022, Paul and Leanne managed to connect with her again.
Paul came out to see us where we were living, and we started from there, and they’ve been fantastic. I got a month (of medication) at a time, and Paul used to come around and drop them off, which saved us going out. I’d make sure they were right next to my cup of tea. Paul’s picked me up and taken me for blood tests because I have problems with them. They’re always there for you if you need them, just a phone call away. It’s been fantastic and they give you all the information you need and always do their best to help you out.
Sandy, like countless other community members who were treated for hepatitis C with the support of PBHRWA, was elated when Leanne and Paul shared the news that she had cleared her hepatitis C. Between 2017 and 2022, Peer Based Harm Reduction has prescribed hepatitis C treatments for 165 people, with only 13 people yet to complete their final confirmatory SVR12tests.
I wouldn’t change my job for the world. Hepatitis C is now so easily treated, and it is a great way for people to engage with their health. Perhaps for some, it’s a first point for people to make a change in their lives.