Peer-led, point of care RNA testing for people experiencing homelessness

Author: Philippe Bonnet, Leila Reid, Sorcha Daly, Danny Morris, Rachel Halford, Danny Morris

Theme: Models of Care Year: 2023

Many people who inject drugs are not well engaged in drug treatment. They may be missed by standard HCV testing programmes. For people living on the street or in temporary accommodation, opportunities for safer injecting are particularly compromised, leading to elevated injecting harms and increased rates of HCV.

Description of model of care/intervention:
The Hepatitis C Trust (HCT) is a peer-led UK NGO. HCT’s Birmingham Peer Team, working with partners in the NHS and homelessness sector, developed an outreach model to engage, test and treat people experiencing homelessness and in need of HCV testing in and around Birmingham – the UK’s second largest city. 
Following a successful pilot in 2020 (presented previously at INHSU) the rapid testing and treatment model has expanded to engage people through drug services, prisons and street outreach as well as homelessness settings. Staff with lived experience of HCV and drug use provide point of care antibody tests and RNA testing using an on-site or mobile GeneXpert device. Antibody and RNA results are delivered within 90 minutes. The team developed a rapid referral pathway with local health services enabling people to move from testing to treatment within a few days. 

1176 people were tested between September 2020 and March 2023: 83% male, average age 43.6. 53% reported current or previous injecting. 326 (29%) had never previously had an HCV test. 452 tests (38%) identified HCV antibodies; 446 people were tested for RNA, and 198 tests identified HCV RNA. 137 people had begun treatment by March 2023.

Conclusion and next steps:
While rates of HCV in the UK are coming down, taking a strong outreach approach with immediate RNA testing and treatment continues to identify large numbers of people with untreated HCV.

Disclosure of Interest Statement: 
HCT received a GeneXpert device from Cepheid for the pilot, and funding for community work from Gilead, Abbvie, MSD & NHS England. 

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