Theme: Models of Care Year: 2024
Background: Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) and Bristol Drugs Project (BDP) are part of Bristol ROADS (Recovery Orientated Alcohol and Drugs Service) drug treatment system. Both organisations collaborate with Hep C U Later (HCUL).
UKHSA data showed high levels of RNA+ in Bristol but low levels of treatment uptake. In 2017, out of
114 people currently or recently (<2y) injecting drugs, although 49% were approved for treatment, only 46% actually started (26 people). High levels of new infections continued with 36 new diagnoses in January-May 2020.
As of 31/12/2021, BDP had 245 people who were RNA+, further analysis of data showed over 185 had been diagnosed >5 years previously. An innovative way was needed to address this.
Description of model of care/intervention/program: In 2022, HCUL funding was secured to employ a Hep C Assertive Engagement Worker to work alongside the AWP BBV Specialist Nurse and lead on a multi-agency approach to re/engage the 245 RNA+. Care records were searched and people stratified into lists depending on needs, including priority people with cirrhosis; those dispensed treatment and lost to follow up; outstanding SVRs.
The worker offered intensive support to re/engage people, fundamentally giving them time, utilising mobile phones and sim cards, incentive vouchers and accompanying people to appointments or being with them for telephone assessments.
Effectiveness: Over 200 people have now been treated. This project has ensured meaningful professional relationships with robust and ongoing support, a truly person centered approach. The unconditional care and time has been invaluable in engaging people, many of whom reported multiple barriers and inequalities during their original treatment pathway.
Conclusion and next steps: this project has been essential in engaging these RNA+ into treatment and therefore significantly reduced onward transmission rates. Work continues to monitor reinfections and ensure robust harm reduction initiatives.