Summary

Challenge

A needs assessment of hepatitis C knowledge, awareness, testing and treatment pathways in Greater Manchester reported several findings consistent across all service areas working with drug users.

These showed a lack of confidence among staff, caused by low knowledge levels and managerial processes that focused on the ‘drug dependency’ and less on the method or consequences of the drug use.

Many workers reported a ‘fatalistic approach’ to assuming all those who inject drugs would have hepatitis C, which led them to ask ‘what’s the point in testing’, when the treatments were still so long, often unpleasant and HCV-positive service users were seen as having poor outcomes.

Objectives

The objective was to train 150 people to work with drug users across the 10 greater Manchester local authorities, so that services could deliver the training within their work areas and promote BBV prevention with ‘champions’ or ‘identified BBV leads’.

Designated workers formed a network across greater Manchester to promote a consistent approach and share best practice in BBV prevention. Five champions were needed for each of the 10 areas.

They included staff from drug services, criminal justice services and housing and homeless support services.Despite changes to commissioning through service redesigns, re-tendering processes and financial restraints, there remains a strong network of services that have embraced the training resource and continue to use it.

Solution

The project was time-limited to two years, with the conception, development and production of the resource pack dominating the first six months. This included three short films. The first featured three ex-service users who had been treated for Hepatitis C and had histories of injecting drug use and complex co-morbidity issues. They were involved in rolling out the first wave of training. All three are now in full time employment providing support to people who are newly diagnosed or considering being tested for hepatitis C. They are also all in recovery from their own substance dependency.

The second was a short animation created to show the transmission risk factors for Hepatitis C and HIV. At under four minutes, it is suitable for using as a video clip embedded in a website. The third film demonstrated an ‘example’ of an intervention on hepatitis C within a needle exchange service.

Results

More than 500 individuals working with drug users across Greater Manchester have received training from ‘Pass it on’. Of these, 72 attended the full two days training to become proficient in delivering the training themselves, 109 attended a single day of awareness training, including use of the Dried Blood Spot Testing (DBST) kits, and the remainder received basic awareness training.

Contracts for drug services now suggest ‘Pass it on’ training as a means of meeting their harm reduction outcomes and Hepatitis C nurses have reported an increase in referrals into treatment following the training.

DBST for Hepatitis C is now offered to every service user and recorded as accepted or refused with outcome measures attached.

Learnings

The involvement of service users Mark, Sue and Stewart (the Hepatitis C service users) was crucial.

Activities to develop skills for workers around Hepatitis C discussions with their clients helped  facilitate learning with action-based learners. Feedback showed that many training participants had been out of educational settings for some time, which had affected their confidence.

The promotion and understanding of the needle exchange setting is crucial for those working with injecting drug users. Exchanges have in the past been isolating and often misunderstood, even by partner agencies. The introduction of needle exchanges as a pragmatic response to HIV is a necessary historic reminder of why this controversial activity started. 

Evaluation

A twelve month follow-up was arranged with group of 12 services who had undertaken the training. All 12 were still using ‘Pass it on’ as a training tool. Five had a designated BBV champion. All 12 agreed that more service users were taking the test, and that staff were more confident in discussing HCV with clients.

Responses from staff included: ‘Hearing the service users talk about their experience of living with hepatitis C and the treatment experience was moving and powerful’.

A client said:  ‘Hearing Sue speaking on the film got me thinking. If she can do all this treatment as a grandmother, then it puts me to shame at my age to be scared to go through it.’