Summary
Hampshire Operational Model of Effective Recovery (HOMER) is the adult substance misuse service that runs across the county of Hampshire. HOMER offers a range of holistic recovery-based interventions, including opportunities to mentor and volunteer. Under this umbrella in 2012, the team set up P2P (peer to peer) hepatitis C mentoring, run in partnership with The Hepatitis C Trust.
This group launched a hepatitis C testing roadshow called Love Yourself – Get Tested. The team visited 10 sites over five days and service users identified at risk of hepatitis C were invited to attend and offered an oral swab test to check for hepatitis C antibodies. All service users diagnosed with antibodies had a care pathway put in place.
Challenge
Hampshire’s population is both rural and urban, with several areas experiencing higher than average levels of deprivation. Residents of deprived areas are less likely to seek help and support, despite greater healthcare needs. There is a high prevalence of HCV in Havant and increased risk in the New Forest, with entrenched intravenous drug users sharing equipment.
Laboratory reports of HCV have increased markedly in recent years across the South East region, with NHS Southampton General Hospital sixth in the country for HCV hospital admissions in 2011/12.
While headway is being made, a significant number of clients have yet to be tested. Ongoing re-tests are also needed and testing needs to be extended to at-risk people sharing drug paraphernalia.
Objectives
The project had three key objectives. Firstly, to cut costs through early identification and treatment of HCV, before it can cause potentially fatal liver damage. The Roadshow aimed to test 200 people deemed at risk, and the project was designed to help overcome poor patient attendance by supporting clients through treatment.
Secondly, to reduce onward transmission of HCV, by means of early detection, education and awareness.
Finally, to improve the quality of life for those with HCV, through one-to-one mentoring, peer support groups and information allowing them to manage their condition. This includes targeted intervention such as healthy living events for those opting not to have treatment.
Solution
The CRI team was involved in The Hepatitis C Trust’s Roadshow as part of World Hepatitis Day 2013, and felt this could help target service users at risk of Hepatitis C, raising awareness and offering ongoing support. The roadshow took place during Valentine’s Week, using the slogan ‘Love Yourself – Get Tested’.
CRI booked the outreach testing van, created invitations and invited the service users most at risk. Hampshire Operational Model of Effective Recovery (HOMER) operates out of 10 main sites, referring to four different hepatology units. Hepatology nurse specialists from three hospitals were on site at four of the events.
One of the barriers to testing in HOMER has been gaining intravenous access or having clinical facilities to undertake dried blood spot testing, so the team really liked the idea of using oral mouth swabs.
Results
Each of the 10 hubs hosted a Hepatitis C awareness event, with mentors on hand. Thirty one people were diagnosed with Hepatitis C antibodies, 27 of them new diagnoses. Four people knew their status and attended to get the £5 incentive voucher – this worked well as an engagement tool, and CRI has supported them to re-engage with their treatment pathway.
Several of the clients diagnosed have since been accompanied to appointments.CRI screened 220 people. They also spent time educating active service users, including intravenous drugs users. The team discovered two couples with Hepatitis C antibodies and one woman who was 8½ months pregnant.
All 31 clients left with a thorough understanding of how to avoid onward transmission.
Learnings
Evaluation
The project’s success was measured primarily by numbers tested, but qualitative feedback was also collected. Six weeks after the event, The Hepatitis C Trust sent out a form ‘Testing van outcomes: What’s happened as a result of your testing van visit?’
Service users wanting additional support were contacted and those identified as Hepatitis C antibody-reactive were followed up weekly for the first four weeks. Ongoing support has been provided where required.
Of the 31 cases identified (17 per cent of those tested), two are antibody positive (natural clearance in the acute phase), and 17 have chronic Hepatitis C. Twenty three people are actively engaging with care pathways and the remainder will be contacted again in due course.
