Built on a concept developed in rural Africa, the BBV Champions is a model to address the shortfall in detection on Hepatitis C in the UK – using local available resources to raise awareness, offer testing, provide provisional results and support service users into the treatment pathway.
It has had a significant impact in Reading, Berkshire, in increasing uptake of testing in two high prevalence communities: substance misusers and the local Pakistani population. BBV Champions provides an effective structure to identify significantly more people infected by HCV and to guide them into treatment services which will have an impact on future infection rates and a reduction in advanced liver disease associated with late diagnosis and limited monitoring.
The majority of people infected by HCV in the UK come from ‘hard to reach’ communities. The main focus on testing is around people who use drugs - and while the majority of new infections in the UK are through this route, it does not reflect the profile of patients seen in viral hepatitis clinics requiring treatment. Many patients are diagnosed only after presenting to their GPs with deranged liver function tests suggesting that harm has already been done to the liver. National Treatment Agency (NTA) guidelines recommend that all service users engaged with substance misuse services be tested for HIV and HCV annually – but in Reading, with only one BBV nurse (relying on venous blood samples ELISA tested at the local hospital), this was an unattainable task.
There were various objectives, including to identify local communities likely to be affected by HCV, to explore and identify resources in the local community that might support a testing programme and to develop a robust structure - from sourcing key workers to clarifying a pathway to clinical treatment services, and to identify stakeholders and get them on board, offering training. It was also important to raise awareness of HCV in a constructive and enlightened way, avoiding the risk of stigmatising communities.
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