From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe

Abstract

Background HCV infection disproportionately affects underserved populations such as homeless individuals, people who inject drugs and prison populations. Peer advocacy can enable active engagement with healthcare services and increase the likelihood of favourable treatment outcomes. Objectives This observational study aims to assess the burden of disease in these underserved populations and describe the role of peer support in linking these individuals to specialist treatment services. Methods Services were identified if they had a high proportion of individuals with risk factors for HCV, such as injecting drug use or homelessness. Individuals were screened for HCV using point-of-care tests and a portable FibroScan. All positive cases received peer support for linkage to specialist care. Information was gathered on risk factors, demographics and follow-up information regarding linkage to care and treatment outcomes. Results A total of 461 individuals were screened, of which 197 (42.7%) were chronically infected with HCV. Referral was made to secondary care for 176 (89.3%) and all received peer support, with 104 (52.8%) individuals engaged with treatment centres. Of these, 89 (85.6%) started treatment and 76 (85.4%) had a favourable outcome. Factors associated with not being approved for treatment were recent homelessness, younger age and current crack cocaine injecting. Conclusions Highly trained peer support workers working as part of a specialist outreach clinical team help to identify a high proportion of individuals exposed to HCV, achieve high rates of engagement with treatment services and maintain high rates of treatment success amongst a population with complex needs.

Engaging the Community in Designing a Hepatitis C Virus Treatment Program for Adults Experiencing Homelessness

“…PEH and those unstably housed are often designated as "hard to reach" by the medical and scientific community, and as such, little research exists into interventions that explore infectious disease treatment programs in this population (Hanlon et al, 2018). While recent research has explored therapeutic relationships between homeless individuals and healthcare providers (Moore-Nadler et al, 2020), the need for culturally sensitive treatment studies is important to understand, explain, and tailor to the complex sociocultural factors that create the conditions for both low participation and low HCV completion rates among PEH with curative HCV interventions (Hanlon et al, 2018;Lambert et al, 2019;Surey et al, 2019). Addressing the sociocultural factors from within a PEH community context is foundational to any HCV intervention among homeless adults (Dombrowski et al, 2016).…”

“…Peer advocates, either in leadership or in supportive roles, offer undeniable therapeutic benefits of rapport, built with personal self-disclosure (MacLellan et al, 2017;Surey et al, 2019). Given the vast social and emotional stigma, deprivation, and disparities that PEH manage daily, the core value of trust, in the treatment team and process, is essential (Skeer et al, 2018;Treloar et al, 2013).…”

“…Education that raises consciousness of the improved HCV treatment, its availability to PEH, the shorter treatment course duration, and the limited negative treatment responses compared to prior protocols should be promoted within the entire community and may facilitate the uptake of the daily DAA medication (Skeer et al, 2018;Williams et al, 2019). Diligent care coordination, from screening to treatment to ongoing follow-up, encourages retention and movement of homeless adults through an HCV intervention care continuum (Benitez et al, 2020;Ho et al, 2015;Surey et al, 2019). Substance use treatment linked to HCV services may likewise be critical for certain PEH participants (Lambdin et al, 2017) as well as on-site clinics and financial incentivization (Brown et al, 2019;Ghose et al, 2019).…”

“…Access to healthcare, linkage to treatment, and consistent engagement with services pose challenges in the design and execution of culturally sensitive interventions to cure infectious disease in marginalized groups, such as PEH (Surey et al, 2019). Prior qualitative research has identified challenges PEH experience navigating complex systems (Henwood et al, 2018;Moore-Nadler et al, 2020).…”

HepCare Europe: a new user-friendly hepatitis C care service model. What have we learned? What are the remaining challenges?

“…The HepFriend work package aims to utilize peer support in the community to increase awareness of the risk of HCV, the importance of testing and disease severity assessment, and provide treatment support 16 . Indeed, various educational interventions, such as HCV peer education, have been previously demonstrated to enhance HCV treatment initiation and engagement within opioid substitution programmes 17 .…”