Theme: Models of Care Year: 2024
Background: Emergency-Department (ED) opt-out screening for hepatitis-C (HCV) antibodies launched in March 2023 at Royal Sussex County Hospital as part of a wider strategy commissioned by NHS-England to achieve HCV elimination. A rigorous pathway was put in place, utilising peer-support (PS) workers to ensure those who went on to test HCV-RNA positive were linked into care efficiently and appropriately.
Description of Model of Care: PS colleagues work in collaboration with the hepatitis nursing team to enhance healthcare delivery for vulnerable people, specifically those experiencing homelessness and people who use drugs (PWUD). Following a positive HCV diagnosis, individuals are triaged by the nursing team to determine their best point of contact, and if deemed appropriate, they are offered PS. If they accept, individuals are supported throughout their treatment, providing liaison, advocacy and an individual-centred service.
Effectiveness: Since ED opt-out screening for HCV commenced, 43 individuals have screened HCV-RNA positive with an average age of 50. 90% of individuals who were offered PS consented and 67% have since commenced antiviral therapy. 89% of those who consented engaged with the service primarily via the peers. Feedback has been consistently positive indicating that such a service delivery model has benefits above and beyond physical health.
Conclusion and next steps: Use of PS resulted in high levels of engagement and HCV-treatment uptake in a difficult to reach cohort. Our data highlights the success of PS to engage vulnerable individuals. By utilising PS, we can bridge a gap for those experiencing healthcare inequalities related to homelessness and for PWUD. In addition, the impact of mass screening through ED enabled us to reach individuals that would not usually engage via traditional testing routes. The key to success was provision of holistic support (logistic, emotional, financial) thus ensuring overall well-being. Such novel interventions need to be assessed and researched at a national level to help achieve HCV elimination.
Download abstract Download poster