HEPATITIS C
UNDER ONE ROOF
Cornwall is a largely rural and sparsely populated county – it has a population of around 565,000 and covers more than 1,000 square miles . With many areas of high deprivation , it also has high levels of injecting drug users and historically has had high levels of hepatitis C infection as a consequence .
Cornwall developed an integrated model of care for people with hepatitis C , incorporating partnerships between hospitalbased hepatology and drug and alcohol services , and spanning testing , treatment and care . Since 2008 , the model has incorporated and facilitated community-based treatment and reduced the barriers to accessing treatment . This has led to a significant increase in the number of at-risk individuals tested for hepatitis C , a significant improvement in attendance rates and a marked increase in the number of people accessing hepatitis C treatment .
If the UK is to reach its hepatitis
If the UK is to reach its hepatitis C elimination target by 2025 , we need to make treatment more accessible across the country
Bringing hepatitis C treatment into drug services can help achieve elimination targets , says Helen Hampton
C elimination target by 2025 , we need to make treatment more accessible across the country . The most effective way of doing this is to replicate the hepatitis C treatment models that bring treatment to the point of contact for drug and alcohol service users .
Professor Graham Foster , national clinical lead for Operational Delivery Networks ( ODNs ) at NHS England , recently said of hepatitis C treatment models , ‘ the more intense the treatment in drug services , the quicker you get to elimination . So that means we have got to change the model … we ’ ve got to have treatment within the addiction centres .’
Bringing treatment into drug services is key for service users to follow through on treatment , as it ’ s the familiar face the service user knows already . Stigma can act as a barrier to attending a medical setting , and service users also report poor access to transport links , hospital phobia and unstable housing as the main reasons for not attending hospital appointments .
WithYou ’ s hepatitis C treatment model in Cornwall , however , allows service users to be seen by a prescriber and receive their medication quicker and at a venue that suits them , whether that ’ s at the centre , partner agency or their home . This not only benefits the service user in increasing the likelihood of successfully clearing the virus , but the wider community in reducing the risk of transmission .
Our successes with this model were only achieved by the support of the drug and alcohol service , the Hepatitis C Trust and the Royal Cornwall Hospital . The dedicated hepatitis C peer lead and the support they provide to service users through their journey has been instrumental .
A flexible service user-focussed model is vital to success . Recently I travelled to a service user ’ s caravan to arrange their hepatitis C treatment , taking a portable fibroscan and medication . I believe if we ’ re going to eliminate hepatitis C then we need to ensure service users don ’ t have to jump through hoops to get treated .
Service users provide feedback on the ease of accessibility and speed of treatment – a recent comment was , ‘ OMG that ’ s brilliant . I can ’ t believe it ’ s so quick , and I can get everything that I need without having to travel up to the hospital .’ Narissa Kelland , advanced clinical practitioner at Health For Homeless , who are a referring partner , said the approach is ‘ wonderfully supportive and flexible , whilst keen to integrate and unveil new ways of working in order to meet the needs of the patient population ’.
Learning from our Cornwall approach , we ’ ve expanded the programme into North Somerset . WithYou in North Somerset started with a variation of this treatment model which proved to be extremely successful . The local hepatology department at the Bristol Royal Infirmary ( BRI ) introduced a hepatitis C outreach clinic at our drug service in North Somerset . Local service users often don ’ t want to travel to the hospital if it ’ s not an easy journey for them – since the BRI started running a clinic at WithYou , the uptake for hepatitis C treatment rose from 25 per cent to 80 per cent .
As we got closer to elimination and the numbers of positive hepatitis C diagnosis reduced , this approach became unsustainable for the hospital . From our experience in Cornwall , we were able to offer an alternative solution – our WithYou nurse practitioner , James Brazier , took on the role of delivering hepatitis C treatment under an honorary prescribing contract with the BRI . James was trained by the BRI to assess and prescribe , working as part of the multidisciplinary team , making decisions regarding treatment . This has helped to free up hospital resources and reduce the time between diagnosis and start of treatment .
This treatment model serves as an excellent example of how NHS providers can work together with third-sector providers to develop a regional hepatitis C management model which is fully cognisant of the often-complex needs of people with hepatitis C , and which works in an innovative way to address these needs .
This treatment model could be rolled out more widely across the UK in drug and alcohol services . Emma Lamond , national improvement manager and hepatitis C elimination project co-lead at WithYou , is currently planning to develop this treatment model for other areas . Whilst a rural model , it can be adapted for use in areas where the need for community-based treatment is just as pressing .
Helen Hampton is national BBV lead at WithYou
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