Treatment for Hepatitis C (HCV) is changing, less complex treatment regimens with an all oral therapy which has a shorter duration, minimal side effects and with improved outcomes. At Kings College Hospital, London we recognised that any initiative to try and eliminate hepatitis C had to include proactively engaging with the under-served population groups to improve access to treatment and equity of care. There is a plethora of evidence that individuals identified as “marginalised” and underserved groups in society ie, people who inject drugs (PWIDs), homeless/hostels, historically have a lifestyle with a number of cultural and practical factors which ultimately inhibits access to HCV treatment/healthcare. Without treatment individuals can develop serious HCV related liver disease including hepatocellular carcinoma (HCC).
Harris et al 2016, advised that providing realistic pathways for increasing access to HCV treatment has both individual and wider public health benefits in significantly improving health and wellbeing of people with HCV, reducing HCV related mortality and end stage liver disease (ESLD), and reducing HCV infection/future transmission.
A working partnership between Kings College Hospital, and the Hepatitis C Trust developed the “Follow me” project. This is a programme which develops a network of Peers to reach into the community of marginalised groups with the aim to provide relatable education on the benefits of HCV treatment based on their personal experience and facilitate HCV testing. For individuals testing positive, the peers support attendance at HCV treatment appointments – (data will be provided in the presentation). The “Follow me” project is to:
- Provide “Buddy” support, in particular to newly diagnosed people and those accessing treatment.
- Patients known to local drugs services/hostels that have previously tested HCV+ and have disengaged will be linked to the Peers.
- Peers will have the ability to make direct referrals to the clinic.
This treatment programme design demonstrates how engagement with this patient group can be very successful with very good treatment outcomes. Peers are a very effective way to engage patients into treatment and improve equity of care - with a co-ordinated approach it works very well.
Audience Take Away:
- Vulnerable groups in our society require equitable access to care. Using Peers is a positive way to engage with individuals who are perceived as “difficult to reach” – is it perhaps more truthful to say that we (healthcare organisations) encourage “barriers” which ultimately inhibits access to healthcare.
- The patient group ARE concerned about their health and do want to treat hepatitis C – we should challenge stereotypical ideas, which can be a barrier, and redesign our services to “fit the patient group” – involve service users.
- Engaging with more complex patients does have opportunities to co-ordinate other aspects of their health.
- Explore ways to design innovative approaches to healthcare for under-served patient populations.