Introduction There is a poor level of uptake of HCV/HIV testing in the UK particularly in the substance misuse community.1 This patient group employ a non-health centric paradigm with poor attendance to standard hospital outpatient appointments and engagement in health professional orientated screening programmes. Traditional testing requires venous access which can be difficult psychologically and practically in this group due to previous/ongoing IVDU. In addition the delay of up to 1 week for results has limited the success of improving access to services and subsequent follow-up for this patient group.
Methods New testing technology employing mouth swab testing with results available within 30 min were developed (OraQuick HIV/HCV testing kits, OraSure Technologies). Key workers from substance misuse agencies were selected and trained in blood-borne virus awareness, consent, harm minimisation and in the use of the point of care testing for HIV/HCV. These “Champions” who have daily contact with the substance misuse community offered screening for HCV/HIV. This model differed from previous attempts to engage this community in that it was not dependent on trained health care professionals for accessing and testing this community. Supervision of all “Champions” was shared between the DAAT manager, BBV nurse consultant and the relevant service managers.
Results In this pilot study 4 Champions tested 200 service users in comparison to 80 in the previous year using a non-Champion nurse based structure. Of the 200 patients screened, 32 were reactive for HCV infection. Of these 28 were HCV-PCR positive. 7/28 (25%) are currently undergoing a course of standard treatment. 19/28 (67.8%) are engaged in alcohol reduction or drug rehabilitation with a view to future treatment for HCV. 1/28 (3.6%) has moved out of area and only 1/28 (3.6%) was lost to follow-up.
Conclusion This innovative model has significantly improved access to testing and treatment for patients with HCV in the substance misuse community. Training selected key workers as champions allowed them to facilitate access to services for patients with substance misuse. Local Commissioners have further extended the scope of this project to allow training of six “champions” in the Asian community to improve access to testing and treatment for HCV in this community with a high prevalence of HCV.
Competing interests None declared.
Reference 1. Swan D, et al. Barriers to and facilitators of hepatitis C testing, management and treatment among current and former injecting drug users: a qualitative exploration. AIDS Patient Care STDS 2010;24:753–62.