Testing and treatment of Hepatitis C through community pharmacist-led care
by Public Health Directorate, NHS Tayside
This initiative has established an innovative delivery model for testing and treatment of Hepatitis C in a population receiving opioid replacement therapy (ORT) from its community pharmacy.
The greatest risk of acquiring HCV in the UK is through injecting drug use and the largest single infected group is the cohort prescribed ORT – but only small numbers of highly motivated patients from this cohort make it through current NHS pathways to be offered HCV antiviral therapy. Using focus groups, the team explored perceptions of using community pharmacy services to access testing and treatment, and set up a discreet choice experiment to identify the most valued attributes of a service. Patient outcomes are currently being assessed.
"This is a fantastic model and is the way forward, with potential to replicate in GP practices. It is particularly effective for substance misusers. It meets national objectives, shows great community awareness, especially within the Asian community."
Individualised patient centred care in a very deprived area
by Royal Alexandra Hospital Paisley, Inverclyde Royal Infirmary & NHS Greater Glasgow & Clyde
The catchment for this initiative includes the area with the highest estimated prevalence of problem drug use in Scotland, which means HCV infection prevalence is high with many people unaware of their infection.
The team developed a patient-centred service embraced by all colleagues and service users to increase HCV testing and treatment. Early access programmes have shown cost savings to the Trust and expanding links with addiction centres and the local prison to reach out to difficult-to-engage patients has also been important. Testing in the areas with highest problem drug use has increased by more than 80%, with testing yields up in the community and numbers of patients treated increasing yearly by up to 19.6 %.
"This is a good, simple, highly effective model with potential to replicate for long-term disease management."
Viral Hepatitis outreach clinic with Addaction
by University Hospitals Bristol (Bristol Royal Infirmary)
This partnership programme comprises an outreach viral hepatitis clinic embedded with a drug and alcohol treatment centre. Thus it integrates a number of approaches that have shown a substantial increase in testing and treatment of those with a history of injection drug use - a typically hard-to-reach population.
An evidence-based approach combines a community based treatment service with peer education and workforce development, and in the first year 24 people with hepatitis C have been treated. The clinic was set up fortnightly with a specialist nurse travelling from Bristol Royal Infirmary (BRI) to see patients referred by Addaction and local GPs. Addaction contacted and encouraged patients to attend prior to the clinic. Patients identified as needing support were given assistance with travel to the BRI for radiological investigations.
"All patients targeted by the outreach clinics are going to do well. It is great to see this kind of programme in action with a good uptake in treatment."