Providing cell phones and peer support is effective at engaging people who experience criminalization in hepatitis C care.

Author: Sofia Bartlett, Nicola Gale, Julia Santana Parrilla, Amrit Tiwana, Pam Young, Mo Korchinski, Nancy Desrosiers, Alnoor Ramji, Shawn Sharma, Brian Conway, Chris Fraser, Ankita Takkar, Daryl Luster, Deb Schmitz, Kristy Kerr, Jason Wong, Ruth Elwood Martin

Theme: Models of Care Year: 2023

People who experience criminalization (PWEC), including people who use drugs or who are incarcerated, have high prevalence of hepatitis C virus (HCV) infection. PWEC are often unsuccessfully reached by care providers, resulting in low HCV treatment uptake. A key reason for this is PWEC frequently do not have stable a contact number. Strategies to address this and enhance engagement in HCV care among PWEC are needed.

Description of model of care/intervention:
‘Test Link Call’ (TLC) launched in British Columbia, Canada in October 2021. It provides PWEC living with HCV a free cell phone and 6 month plan, plus connection to a Peer Health Mentor (PHM) to support engagement in HCV care. PHMs receive referrals from correctional centres and meet clients at release to provide phone and connect to care. A network of 11 services identify additional PWEC through outreach or among those that present for care, and have cell phones on site to provide immediately.

Over 15 months, 205 PWEC enrolled in TLC. Semi-structured interviews were conducted with clients (n=10), PHMs (n=3) and care providers (n=5). Interviewees described TLC as highly effective at increasing engagement in HCV care among PWEC, with five themes emerging to explain why:
1) sense of personal value;
2) convenience in accessing care;
3) communication and trust;
4) social connection; and
5) motivation to change.

In-depth data collection was conducted in October 2022. Date were analysed to create an HCV care cascade (Figure 1). Overall, 49% (74/151) of clients had no fixed address and 38% (58/151) were on opioid agonist therapy (OAT). Among clients who received a prescription, 81% (58/72) started HCV treatment.

Conclusion and next steps:
TLC effectively engages PWEC in HCV care. We are currently expanding this model to support engagement in care among PWEC for other sexually transmitted and blood-borne infections.

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