Drug services team
The Hepatitis C Trust has a team of 5 staff dedicated to working with drug service providers. Approximately 90% of chronic HCV infections acquired in the UK are among people who inject drugs or who have injected drugs in the past. Joint development and implementation of patient centred hepatitis C interventions with providers such as Addaction, CRI & Blenheim CDP will be crucial in realising the Trust's aim of elimination within the UK. We work in partnership with these organisations to deliver the following interventions within drug service settings:
Drug workers in the UK are often the first and only point of care for people affected by substance misuse. The level of trust that is built up between the worker and the service user provides the best opportunity to deliver healthcare messages into this hard to reach community. It is therefore essential that staff at drug services have a good understanding of hepatitis C. Testing uptake is hugely dependent on the skills, knowledge and confidence of the staff offering the test. Staff confidence in this area also generates a greater adherence by service users to ongoing care referral pathways.
As part of THCT drug service team, we provide a range of workforce development training packages to nationwide community drug service providers. Ultimately staff should be:
- Knowledgeable about safer practice
- Confident in discussing and offering hepatitis C testing
- Knowledgeable about the referral process
- Knowledgeable about local integrated care pathways to support
Peer to Peer Education
Peer-led education shows that individuals can learn more effectively from within their own peer group. Research has shown that peer educators can have a greater validity and empathy with clients because they have direct experience of the problems they are facing. Consequently, they are more likely to engage with people who would otherwise be unlikely to access services, and can support them more effectively.
The Hepatitis C Trust has run a peer-to-peer education (P2P) programme since August 2010. Peer educators with a HCV story are trained to deliver a message regarding the importance of testing and attending hospital appointments. This increases the likelihood of diagnosed patients going on to access specialist monitoring and where appropriate, treatment. The programme provides key messages about hepatitis C prevention, diagnosis, treatment and care to people attending drug services.
Through partnership work with Addaction, one of the UK’s largest drug service providers, we investigated if a sustainable peer led model could be implemented within Addaction’s service delivery. This was successful, and with minimal resource requirement other than initial setup and an existing volunteer network, our P2P programs now run throughout Addaction in the UK and have also been adopted by other providers. THCT oversees the management of these programmes.
Drug services have played the major part in diagnosing these people with most services being commissioned to offer at least 90% of their service users a test for hepatitis C. Of these, all living with hepatitis C should be referred to see a consultant at their local hospital. However, there are still a significant number of service users remaining undiagnosed and, more importantly, not engaging with specialist care when known to be living with hepatitis C.
We currently deliver a buddying programme that trains selected volunteers to personally support people through testing, treatment and care. In services where we have implemented this programme, the offer of a buddy is made after every positive diagnosis of hepatitis C. A buddy will accompany each individual to their hospital appointment, and throughout the treatment episode. Buddies also help patients to digest and understand some of the complex language used as they progress through the care pathway.
With initial funding from Comic Relief, we have developed a role tasked with improving the care pathways for drug users at risk of hepatitis C. The pathway coordinator conducts an initial audit of hepatitis C service delivery alongside major drug service providers, reviewing existing work and ensuring its continuance, and implementing the learned best practice into their broader service delivery. Recommendations are made for improvement as well as identifying and coordinating the delivery of any additional interventions required. The pathway coordinator documents local pathways so that providers can understand them, it is essential that staff know that these pathways exist.
We hope that, as partnerships mature, we will be able to help identify a model of ‘treatment in the community’, offering hepatitis C treatment to people in settings that are much easier for them to access. The long term aim is that the clinical staff within drug services will prescribe and administer hepatitis C treatment within its own services, offering people a choice other than having to visit a treatment centre.
If you would like any further information on the work of the drug services team or would like to discuss how they might support the work of your service, contact Stuart Smith firstname.lastname@example.org or call him on 020 7089 6223.