Rapid point of care hepatitis C RNA testing for people experiencing homelessness

Bonnet, Phillipe, Daly, Sorcha, Morris, Danny, Reid, Leila, Vojt, Gabriele, Smith, Stuart and Halford, Rachel (2024) Rapid point of care hepatitis C RNA testing for people experiencing homelessness.

Abstract

Background: Significant numbers of people who inject drugs (PWID) are poorly engaged with drug treatment services, identify as being socially excluded and unable to navigate often complex and lengthy hepatitis C (HCV) testing and treatment pathways. Many are street homeless or residing in temporary accommodation where safe injecting behaviors are compromised by insecure settings, leading to elevated injecting harms and increased rates of HCV infection. Description of model of care/intervention: The Hepatitis C Trust (HCT) is a peer-led UK NGO. HCT’s Birmingham Peer Team, working with partners in the NHS and homelessness sector, developed an outreach model to engage, test and treat people experiencing homelessness and in need of HCV testing in and around Birmingham – the UK’s second largest city. Following a successful pilot in 2020 the rapid testing and treatment model has expanded to engage people through drug services, prisons and street outreach as well as homelessness settings. Staff with lived experience of HCV and drug use provide point of care antibody tests and RNA testing using an on-site or mobile GeneXpert device. Antibody and RNA results are delivered within 60 minutes. The team developed a rapid referral pathway with local health services enabling people to move from testing to treatment within a few days. All RNA+ve individuals were offered pan-genotypic treatments, delivered by the peer and Hepatology Clinical Nurse Specialist (CNS) at the testing venue, or other setting requested by the patient. Effectiveness: 1176 people were tested between September 2020 and March 2023: 83% male, average age 43.6. 53% reported current or previous injecting. 326 (29%) had never previously had an HCV test. 452 tests (38%) identified HCV antibodies; 446 people were tested for RNA, and 198 tests identified HCV RNA. 137 people had begun treatment by March 2023. Conclusion and next steps: While rates of HCV in the UK are coming down, taking a strong outreach approach with immediate RNA testing and treatment continues to identify large numbers of people with untreated HCV.

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Contributors

Author: Gabriele Vojt

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