28 July 2021
Name: Professor John Dillon
Location: Dundee, Scotland
Job title: Professor of hepatology and gastroenterology, University of Dundee and consultant hepatologist at NHS Tayside
Specialisms: HCV, task shifting, outreach
In our special edition Meet the Members to coincide with #WorldHepatitisDay 2021, we caught up with Professor John Dillon to discuss how his team in Tayside, Scotland became the first region in the world to effectively eliminate hepatitis C.
John shares his advice for others looking to do the same, discusses how COVID-19 has impacted this incredible achievement, and talks about his other areas of interest such as task-shifting.
The team in Tayside effectively eliminated hepatitis C from their region in 2020. What were your top three key learnings?
Keep it local: We want people to travel as little as possible for HCV diagnosis and cure. In an ideal world, you do the care somewhere they’re already going as that makes it a lot easier and less scary.
Keep it simple: You also want to make as few additional impositions upon people as possible; get rid of unnecessary blood tests, unnecessary fibrosis assessments, unnecessary turning up for treatment et cetera. Give them their drugs to take away rather than making them turn up for daily pick up. Do anything you can to simplify the process of treatment.
Keep it known: Try to deliver the care through someone they already know and trust, as that makes it much easier to deliver the care someone needs.
My advice for the elimination of HCV is keep it local, keep it simple, keep it known.
How has COVID-19 impacted this achievement?
We’re very dependent on footfall through the local places that we use for HCV diagnosis and treatment. So, when COVID hit lots of these places became very concerned about it and closed down or adapted their opening hours.
For example, our pharmacies dispensing Opiate Substitution Therapy (OST) changed from being daily pickup to weekly. While this is good for our people picking up OST, it reduced the frequency with which we were having contact with people. There were hidden advantages though; a lot of those venues became less crowded and less time-pressured meaning there was more time to have conversations about things like hepatitis C.
Footfall in the needle exchanges was also reduced because it became one person in, one person out. There wasn’t the same degree of hanging around and chatting which was a definite downside. Because of this, we developed additional outreach services, such as using food vans going round dropping off food parcels for people who we knew were vulnerable. We used those vans to distribute needles and also to do some dried blood spot testing.
They’re the sort of adaptations we’ve done during COVID, and they’re things we will continue after COVID too. As the pandemic comes to an end we’ll see what impact it has had on infection rates. The pick up of needles and paraphernalia has gone down, so we may see more reinfections that will have to deal with.
Talk to us about task shifting – why should this be of interest for people looking to eliminate hep C?
Task-shifting comes back to the concept of keeping it local, keeping it simple, keeping it known. If you can make the tasks associated with HCV treatment simpler, you can therefore keep more of them local and you can keep more of them by known people, because those tasks can be shifted to people who already have a care role within the environment.
The premise of task shifting is that workers who are already in contact with the people we are trying to reach for their hepatitis C can be upskilled to do things like dried blood spot testing, to do the information giving around infection, and to support people through treatment.
Task shifting makes treatment easier for the patient and expands the workforce ability to deliver HCV diagnosis and cure. And those are all things that we want to aim for when trying to work towards elimination.
What is the one thing that you’ve come across in your career that you think everyone should know if they work with people who use drugs?
I think the first thing you need to know – or rather, remember – because it is very obvious, is that people who use drugs are people. Like you and I, they have had life experiences, some of which have been very challenging. I think the first and most important thing is to remember that they are people, and how you interact with them should reflect that.
If you treat them as a person, they’ll treat you as a person. That’s probably the most important thing, I think we often lose sight of that. We professionalise our relationships into ‘them’ and ‘us’, which adds to the stigma in many health care relationships.
Why should someone join INHSU?
INHSU brings together people who you don’t expect to be together with. I’m a consultant hepatologist, which makes me a hyper-specialised teaching hospital doctor. In some ways, I live in an ivory tower.
INHSU brings me into contact with all sorts of people that I wouldn’t normally have any academic contact with; social scientists, patient advocates, people who use drugs, the whole gamut of people across all of those groups.
If you’re interested in trying to make your care pathway more efficient and better, you need to know about all of the potential pathways that you will find at INHSU. INHSU is very good at allowing people to interact with people they wouldn’t normally (in their professional silos) get to interact with. I think that as we think about hepatitis C elimination and moving forward it seems like a daunting task, but the colleagues you find at INHSU will help get you on the road to success.