Summary
Inclusion Recovery took over the adult substance misuse service that runs across Hampshire in July. It started P2P (peer-to-peer) Hepatitis C Mentoring in partnership with The Hepatitis C Trust, where trained mentors deliver talks and presentations to peers and professionals with the aim of increasing awareness and testing for hepatitis C, interspersing volunteers’ own life experiences with key messages, risk factors and treatment options.
The P2P team has carried out 11 testing events where those identified at risk of HCV were offered an oral swab test to check for antibodies, with a £5 gift voucher incentive to the first 25 people tested at each event. To date 53 people have been diagnosed and 21 are being currently actively supported.
Challenge
Hampshire has several areas with higher than average levels of deprivation, and research people living there are less likely to seek help and support, despite having increased healthcare needs. There is a high prevalence of HCV in Havant and increased risk in the New Forest with pockets of entrenched IV drug users sharing equipment – one infection can be tracked to eight new ones there, which shows that one test is not sufficient for people to assure themselves they have not contracted HCV and ongoing re-tests will be required.
Objectives
To reduce NHS costs through earlier identification, support and treatment of HCV; to reduce onward transmission of the virus; and to improve the quality of life for those living with HCV through on-going one to one mentoring and peer support groups.
Solution
In February 2014 the team ran a 100-site testing roadshow in partnership with The Hepatitis C Trust called Love Yourself – Get Tested, and has since hosted a further 11 events. At each of these there are refreshments, P2P mentors on hand to answer any questions and a £5 voucher incentive for those tested.
After improving HCV detection rates, the data showed that a high percentage of those diagnosed had not attended their initial appointments at the local hepatology units. Overwhelmingly the clients had two main issues: fear and inability to get to the hospitals. Having established a need for ongoing support, the team purchased two pay-as-you-go mobiles and created business cards with the dedicated mobile number and email addresses that clients can contact for support. A secure spreadsheet system allowed clients to be tracked so a mentor could accompany them to appointments.
Results
To date 352 clients have been screened and 345 tested for HCV antibodies – of these, the team has diagnosed 53 with antibodies, and referred them for PCR tests. So far 47 clients have chronic HCV. P2P mentors have been in regular contact, actively supporting 31 clients across Hampshire by accompanying them to their appointments, thus helping reduce costs from missed appointments and supporting them with anxieties, thereby improving their quality of life. To date, 21 of these clients are still engaged with treatment pathways and two more have successfully completed treatment. To date 352 clients have been screened and 345 tested for HCV antibodies – of these, the team has diagnosed 53 with antibodies, and referred them for PCR tests. So far 47 clients have chronic HCV. P2P mentors have been in regular contact, actively supporting 31 clients across Hampshire by accompanying them to their appointments, thus helping reduce costs from missed appointments and supporting them with anxieties, thereby improving their quality of life. To date, 21 of these clients are still engaged with treatment pathways and two more have successfully completed treatment.
Learnings
One barrier has been that some hepatology nurse specialists said they could not work with mentors who were previously their patients, although it is hoped that opening up recruitment and training should solve this issue moving forward. The £5 voucher continues to be a useful incentive and good promotion tool. Being associated with The Hepatitis C Trust has added credibility and allowed the team to build its own reputation.
Evaluation
Success of testing events is measured primarily by the numbers tested, although qualitative feedback is also sought from clients, stakeholders and partner agencies through evaluation forms, community and governance meetings and informal conversations.
The achievements of the P2P project are monitored via anonymous feedback forms, data collected from testing events and through sharing information with the local hepatology nurse specialists.
All the clients who asked for additional support were contacted and throughout our testing events, those identified as hepatitis C antibody reactive were followed up weekly for the first four weeks. Since then, those wanting ongoing support have had regular contact with a P2P mentor. The vast majority have found the support, information and personal experience to be invaluable in their diagnosis and referral pathway. The clients who were supported in getting to outpatients appointments have largely said they would not have attended their appointments otherwise. Having space and time after appointments to digest information and to have it explained in non-technical language by the mentor has proved to be highly effective in retaining clients in care pathways.
