13 November 2021
As part of the INHSU 2021 conference, Jason Farrell, Consultant for Correlation – European Harm Reduction Network (C-EHRN) in the Netherlands, led a session on HCV testing in community by the community.
Jason spoke about the need for peer support across all aspects of the care cascade, and the new ‘HCV Testing Starter Kit’ being launched at the 5th European Harm Reduction Conference in November 2021.
Through the kit – and sessions like this one – Jason and his fellow speakers hope to raise awareness of the vital role that community testing can play in eradicating hepatitis C amongst people who use drugs.
In addition to raising awareness, the HCV Community Testing Starter Kit has also been developed as a capacity building tool/ manual to assist drug user organizations and harm reduction services implement HCV community testing. The starter kit and information it provides is based upon lessons learned by organisations who have been successful providing peer delivered testing services.
He was joined by Jonas Demant Hansen from The Users Academy in Denmark, Astrid Leicht from Fixpunkt in Germany, Rui Morais from CASO in Portugal, and Mrs Tessa Windelinckx from Free Clinic Antwerp in Belgium. Below are the main takeaways from the session.
1. Peers can help you to reach more people
Jonas Demant Hansen from The Users Academy shared their model of care being used to find and treat hepatitis C in Denmark.
The original model was delivered via a mobile clinic, with the model of care gradually becoming more flexible – sometimes a van, sometimes a bicycle, a room or shelter, or, newly-added mail order home testing.
While nurses and doctors help with the actual testing, peers play a vital role in reaching new people and maximising the number of people screened and linked to care.
Peers have even set up community Facebook groups of people who use drugs, to share local testing opportunities.
“Working with local organisations and communities helps to create a more safe, open and inclusive environment,” Jonas explained. “As well as reaching more people, patients are more secure about what happens after the test too, as they have the support from a peer who’s been through similar experiences.”
2. Community testing should be adapted to each environment
Rui Morais from CASO in Portugal is also on the board of the European Network of People who Use Drugs (EuroNPUD). Rui discussed how – to make the UN’s 2030 goal of health and wellbeing – we cannot leave people behind. Community testing and other peer-supported services will play a vital role in ensuring this doesn’t happen.
Talking of the soon-to-be-released HCV Testing Starter Kit he said: “We have included all necessary steps and we hope it will be a useful tool. But it will still need to be adapted to different contexts, subcultures and communities, as every setting is different, with different needs and requirements.”
Rui also spoke of how empowering peer support can be for those delivering it. “People who use drugs can be confident in themselves that they are helping one another and creating this environment that has no moral judgement,” he explained. “It’s a collaborative process.”
3. Integrate into existing services
Astrid Leicht from Fixpunkt in Berlin, Germany shared a valuable case study about a pilot scheme of how peer testing will be integrated into existing services, to demonstrate success before a wider roll-out.
Social workers and community peer workers who were already employed as staff of the organisation are trained to perform HCV / HIV rapid rests, counselling, and referral for further diagnosis within Fixpunkt, as well as offering other linkages to care.
One of the main learnings of this case study was to have a clear mission and values to ensure that all collaborating partners shared the same vision. At Fixpunkt this involved ‘soft skills’ such as no judgement and open-mindedness, as well as tangible considerations such as anonymity and data protection.
4. Don’t be afraid of the barriers
Mrs Tessa Windelinckx, from Free Clinic Antwerp in Belgium, gave an honest account of the barriers to self-testing but encouraged service providers, community organisations and clinicians not to be put off.
Tessa explained some of the barriers facing The Antwerp Model, an integrated model of care in Belgium. These included:
- In Belgium, medical screening can only be done by trained medical personnel, meaning peers can only motivate people for screening. The result also has to be given by trained personnel only
- Privacy and confidentiality are absolutely key. “People are resistant if they think they will be seen getting tested, or their results will not be private,” explained Tessa
- Some people in Belgium cannot access treatment due to visa status
- Hep C is not a priority for everyone. Some people who take drugs are not interested in being tested due to competing priorities
“It’s important to know that there will be hurdles,” explained Tessa. “But just keep going. We can overcome them.”
5. Make it clear what peers are there to help with
Another interesting insight from Tessa was a detailed look at the four areas of The Antwerp Project model of care; a low threshold drug service (Free Clinic), needle exchange, ZNA Stuivenberg (a ‘streetwise’ hepatologist that offers consultation once a week), and the C-Buddy Peer Support program.
There are clear roles and responsibilities for the peers. These include guiding the patient through the HCV diagnosis and treatment process, helping with things like appointment and scheduling reminders, patient navigation at the hospital, and translating medical terminology.
Clear guidelines like this for peers can help set expectations for peer workers as well as the people they’re working within the community.
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