Theme: Models of Care Year: 2022
Hepatitis C virus (HCV) infection in high income countries disproportionally affects the inclusion
health population, who are underserved by traditional healthcare systems. Advancements in pointof-care (POC) diagnostics, pan-genotypic treatment options, and the use of peer support workers
(PSWs), have significantly improved progression through the cascade of care for this group. However
those that remain infected are increasingly difficult to reach and further decentralisation will be
required to achieve HCV elimination.
Description of model of care/intervention:
We piloted a peer-led, same-day model of care for the diagnosis and management of HCV in people
experiencing homelessness in London. Point-of-care tests including oral swab HCV antibody tests,
Genexpert PCR and liver elastography were conducted by a PSW as part of an outreach service.
Chronic HCV infected individuals were then discussed via a virtual multi-disciplinary team meeting
using a secure mobile phone messaging service. Those with no significant liver fibrosis or drug
interactions were prescribed pan-genotypic regimens to facilitate same day initiation of treatment.
All received peer support throughout treatment and no medical appointments in secondary care
hospitals were required.
Nine patients were enrolled, with all successfully completing treatment and eight achieving SVR12.
There were some technological and administrative delays but the majority had treatment dispensed
within 24 hours.
Conclusion and next steps:
This model of care is effective at successfully engaging and maintaining an extremely vulnerable
group on HCV treatment, who would otherwise have been at very high risk for being lost-to-followup. This model is could be used for other diseases that can be diagnosed using POC technology using
the same peer-led approach.
Disclosure of Interest Statement: