Theme: Models of Care Year: 2023
Background:
Hepatitis C (HCV) assessment and treatment delivery within the South Yorkshire HCV Operational Delivery Network (ODN) has shifted from secondary care to predominantly community outreach and drug treatment service (DTS) and prison in-reach clinics. In spite of this, in February 2022 the ODN was aware of 350 HCV RNA+ patients who had not been able to access or fully engage with HCV care and remained untreated. We aimed to pilot a mobile clinic, to improve HCV care and treatment access for these patients.
Description of model of care/intervention:
A clinic van was acquired, staffed with HCV specialist nurse, peer worker and driver and equipped with point-of-care Matrix Diagnostics blood-borne virus serology and Cepheid® GeneXpert® HCV RNA testing, portable FibroScan™ and pan-genotypic directly-acting antivirals, enabling single visit diagnosis or HCV RNA confirmation, assessment and treatment initiation. A dedicated co-ordinator planned weekly van activity, grouping known HCV RNA+ patients by post code, contacting patients in advance to plan home visits. Van assessment was also offered to new HCV RNA+ patients.
Effectiveness:
Within 8 months, 45/350 known HCV RNA+ patients (12.9%) completed van assessment, of whom 41 (91%) initiated treatment (SVR data pending). 164/350 (46.8%) were assessed and treated in other settings: 80 (48.7%) through non-van-based community outreach or home assessments; 37 (22.5%) in DTSs; 15 (9.1%) in prison; and 32 (19.5%) in secondary care. An additional 67 new HCV RNA+ patients completed van assessment, of whom 62 (92.5%) initiated treatment.
Conclusion and next steps:
A mobile van-based HCV clinic offers improved access to HCV assessment and treatment for both historic HCV RNA+ patients, unable to access or engage with other secondary care, community, DTS and prison clinics, as well as for new HCV RNA+ patients. Treatment initiation was high (90%) in both historic and new HCV RNA+ patients completing van assessment.