O6 Hepatitis C test and treat roadshow – reaching homeless communities across the west midlands, UK

Abstract

<h3>Background</h3> 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 &amp; 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. An adapted MDT referral form was created and approved by Birmingham and West Midlands Operational Delivery Network who also supplied HCV antibody tests as well approving pan genotypic regimens for all patients identified as as part of the project. <h3>Description of model of care/intervention</h3> The model provided point of care testing and treatment for PWID in 14 hostels and other settings used by street homeless, delivered by the Peer Support Lead. Those identified at risk were offered HCV rapid antibody screening and subsequently tested for HCV RNA with Cepheid GeneXpert. All RNA+ve individuals were referred to the respective hospital Hepatology MDT and approved 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. <h3>Effectiveness</h3> 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 39 have commenced treatment with treatment arranged for a further 2 patients. One person declined treatment. Seven were additionally referred for drug and alcohol treatment. <h3>Conclusion and Next Steps</h3> The project has been a resounding success, well received by homeless PWID, hepatology treatment teams, hostel and homeless services, reflecting the constructive impact on collaborative working. 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.