Theme: Models of Care Year: 2021
Background: Acknowledging the lengthy process for diagnosis of HCV within HMP Swansea and subsequent referral to a specialist nurse service it was determined that a new model of testing and treating would be required to ensure timely access to treatment. Combining point of care anti-HCV screening and in-house point of care HCV PCR confirmation with development of an accelerated treatment pathway, HCV screening has been conducted in HMP Swansea on an opt-out basis. With all screening conducted by prison nursing staff within pre-existing interventions during the first 24 hours in custody lead time for referral for HCV treatment has been reduced from around 10 weeks to as little as 24 hours. Micro-elimination of HCV was declared on 05.09.19, whereby all incarcerated men had either been tested PCR negative or were on HCV treatment. 110 patients were screened for anti-HCV in the six months prior to the pathway launch contrasting with 835 patients screened in the subsequent six months with number of patients commencing treatment being four and 32 within the same time periods. Implementation has incurred no additional labour costs to nursing teams as all interventions could be carried out within existing clinic times, and opt-out testing for all men has opened a discussion amongst the target population about HCV and led to a reduction in stigma; men treated successfully through the new strategy have been witnessed to be encouraging others to engage with BBV services to improve their health outcomes. The accelerated pathway has driven huge improvements in access to testing and treating through point of care intervention for those at greatest risk of hepatitis-C infection and has shown an increase in the number of service users treated for chronic HCV infection. Further implementation in similar settings ought to be shown to test the efficacy of the Swansea model. Description of model of care/intervention: Effectiveness: Conclusion and next steps: Disclosure of Interest Statement: No grants encouraging choice of particular pharmaceutical were received in relation to this project. The POCT PCR hardware was received on loan from Cepheid.
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