Student volunteers screen drug users for viral hepatitis

Abstract

Context and setting Our medical school is located in an urban area with high rates of injection drug use and viral hepatitis. The viral hepatitis integration project (VHIP) provides injection drug users with viral hepatitis vaccination, screening and treatment referral services. These services are co-located with a streetside, mobile syringe exchange in a neighbourhood in which illicit drug use is highly prevalent. Year 1 and 2 students from our medical school (located < 5 miles away) volunteer to perform phlebotomy, vaccinate and counsel syringe exchange clients about viral hepatitis. Why the idea was necessary Substance abuse disorders are common among patients, yet few medical students have exposure to drug users prior to their clinical rotations. Little time is devoted to formal teaching about these complex disorders in medical school. Most student contact with drug users occurs in inpatient settings where complicated social dynamics interfere with productive communication and learning. At the VHIP, students provide care in an environment that is familiar and comfortable for the drug users. Further, many pre-clinical students wish to provide care to underserved populations. Drug users are generally appreciative of outreach and assistance from health care providers. We developed the VHIP to meet the needs of both students and syringe exchange clients. What was done Year 1 and 2 medical students volunteer to work with the VHIP, which integrates viral hepatitis services into community-based programmes for drug users. Through the VHIP, syringe exchange clients are offered on-site health counselling, testing and vaccination for viral hepatitis (and influenza), and referral for further evaluation and treatment of hepatitis. We hold annual training sessions for students in which a VHIP doctor and Physician Assistant describe the VHIP, discuss basic information about hepatitis C, explain the philosophy of harm reduction, and demonstrate safe vaccination techniques. Medical students attend the VHIP in pairs; each pair includes one experienced and one novice volunteer. Students are accompanied by the VHIP programme co-ordinator and a health care provider (doctor or Physician Assistant) with expertise in addiction medicine. Through observation and from talking to project staff and participants, students learn about drug use and its medical sequelae, harm reduction and syringe exchange. Medical students work closely with medical providers and the project co-ordinator to recruit clients, provide counselling about hepatitis screening and vaccination, perform phlebotomy, and administer vaccines to VHIP participants. The medical providers deliver ongoing supervision and support of the students, both on-site and in quarterly meetings. Additionally, medical providers model professional and compassionate behaviour in caring for active drug users. Evaluation of results and impact To date, 36 medical students have participated in the VHIP. Students have provided vaccinations, viral hepatitis screening, and health counselling to over 200 syringe exchange clients. A self-administered, open-ended survey of student volunteers revealed that they valued learning about the lives of drug users, practising skills in vaccination and phlebotomy, and having the chance to work with underserved patients. All the students found the experience enjoyable, and many expressed a wish to have more opportunities to volunteer in similar settings.