HARD MILES
would be key to this . ‘ There are still people in London who don ’ t know about direct-acting antivirals – not just patients , but also professionals including GPs – so there ’ s definitely communications work to be done as well .’
REVOLUTIONARY STRATEGY While the events of the last year had tested everyone to the limit , said clinical lead of the pan-London street outreach Find & Treat service , Dr Al Story , the Everyone In strategy had been ‘ quite revolutionary – it was an amazing achievement to get so many people off the street and into accommodation .’ Rough sleeping had been increasing in London for almost a decade and had become ‘ one of those problems that people had been conceiving as intractable and impossible – but it ’ s amazing what can be done with the political commitment ’.
Having thousands of people in accommodation represented ‘ amazing opportunity ’, he stated . ‘ We were given the green light to seize this opportunity and offer a full BBV screen to as many people as we could ’, in partnership with a number of other organisations . The model was peer-led diagnosis and treatment initiation , ideally within a day – ‘ and the vast majority of people we ’ ve engaged with have started treatment within 48-72 hours . We ’ ve been trying to take what was once a war of attrition – multiple appointments – and squash it into an outreach encounter that can be done in literally a few hours .’
In terms of the data , what was
most striking was the ‘ staggering number ’ – almost half – who had never been tested , he stressed . ‘ We know the population we work with can present some unique challenges but we ’ ve been delivering tuberculosis services to this same population for many , many years and we achieve outcomes that are better than in the general population .’ The team had also been expanding its work to the street sex worker population , he said . ‘ So far just 30 women have been screened but the findings are quite mind-blowing . A very high proportion are homeless , a quarter are rough sleeping and almost half are currently injecting . There ’ s a very high undetected reservoir of hep C in that population , and a great opportunity to take services to people .’
COVID had ‘ blown a greater wedge in what were already quite marked health inequalities ’, he stated . ‘ We ’ ve seen an increase in rough sleepers , and many people new to the streets are coming out of job loss and loss of housing tenure . And I think we haven ’ t seen the half of this yet .’ On a more optimistic note , the use of peers offered ‘ an amazing opportunity ’, he told the conference . ‘ They ’ re not corrupted by medical training , they remain completely open-minded and agnostic and responsive to patients ’ needs , and I think with the right tools and support they can lead the revolution here .’
NEW MODELS One example was shared by the Hepatitis C Trust ’ s senior peer support lead , Imran Shaukat . ‘ When COVID hit we had to adopt to a completely new model ,’ he said . ‘ A lot of clinical staff were deployed to ICU wards , meaning the charity had issues keeping the service going , so all the peers got together and almost reinvented the service . We absolutely adapted – we started doing the medication delivery and keeping in touch with people on
‘ There ’ s a concept that ’ s difficult to process , and it ’ s that COVID isn ’ t going anywhere ,’ warned Dr Emily Phipps . ‘ It ’ s here to stay and there ’ s going to be a long road back to any kind of normality . Instead of putting things off we should be looking at how we can work in this new context – there ’ s been some really innovative new delivery models that have come out of the pandemic , including lots more outreach work and delivering needles and syringes by post . But what ’ s really important to emphasise is the need to really evaluate these new methods so we can understand the impact .’ This was particularly the case with people who might have difficulty accessing services because they were digitally excluded , she stressed . the phone – and even though the pandemic was psychologically and physically challenging the silver lining was that we were working very closely with our partner organisations and found that coworking was just the way forward . It just naturally happened , and that relationship ’ s continued . That ’ s the key to elimination – everyone coming together under one goal .’
Peers were also able to engage very effectively with people not in drug services , he pointed out . ‘ But my worry is that as the numbers are going down resources will start to be pulled back and leave us open to further spikes of the virus .’
‘ The elimination agenda is a great objective , but these will be hard miles – the last few cases are the hardest ,’ said Story . ‘ From a cocommissioning perspective there ’ s real safety in numbers here – it makes great economic and practical and epidemiological sense to join up . And , most importantly , it makes sense for patients .’ DDN
Jozef Micic / dreamstime . com
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