phase i update: prevention & education community outreach
DESCRIPTION
Phase I Update: Prevention & Education Community Outreach. Justin Schofield Hepatitis C MCN Manager. Co-ordination Prevention Testing Treatment, Care & Support Education, training & awareness raising Surveillance and monitoring. Sep 2006 – Aug 2008 £4M new monies - PowerPoint PPT PresentationTRANSCRIPT
Phase I Update:
Prevention & Education
Community Outreach
Justin SchofieldHepatitis C MCN Manager
Phase I Action Plan
1. Co-ordination
2. Prevention
3. Testing
4. Treatment, Care & Support
5. Education, training & awareness raising
6. Surveillance and monitoring
• Sep 2006 – Aug 2008
• £4M new monies
• Initial local developments
• Period of national needs assessment to inform Phase II
HCV Prevention: NEX
• Access to needle exchange facilities (NEX)– Glasgow
• Highest number of syringes distributed by pharmacy services in Scotland.
• 213 syringes per injector per annum(above national average)
– Clyde• Lower numbers of syringes distributed• 57 syringes per injector per annum
(lowest in Scotland)
NEX Provision: Glasgow
Pharmacy provision:• 39 NEX pharmacy sites
• Average 6.2 per CH(C)P
• Funding– BBV Prevention monies
– Phase I HCV Action Plan funds enabled recruitment of additional 10 pharmacies
• Glasgow Addiction Services provide management
• NEX packs contain:– Needles, syringes, swabs,
citric acid, cin bin, health promotion info
Fixed Sites:
• Drug Crisis Centre:
– Almost 24-hr access
• Base 75:
– Health & Social work
– Women involved in prostitution
• Hunter St Health Service:
– Homeless health services
NEX Provision: Clyde
Pharmacy provision:• 10 NEX pharmacy sites
– 2 pre-existing
– 8 new funded by Phase I Action Plan monies
• Glasgow Addiction Services provide management
• Provision of NEX packs(same as Glasgow)
Fixed Sites• Part of wider harm reduction
model– Incl. wound management,
BBV / pregnancy testing,HAV & HBV vaccination
• Lennox, Inverclyde & Greenock drug services
• Pick & mix provision,incl. paraphernalia
NEX Activity & Returns 2006/07
Organisation n/s issued returned return rate
Glasgow Pharmacies 668,565 475,481 71%
Lennox Service 62,422 53,920 86%
Hunter Street 14,300 11,542 81%
Crisis Centre 153,895 77,180 50%
Inverclyde service 28,323 32,328 114%
Renfrew Service 24,905 21,350 86%
952,410 671,801 71%Total Total Average
* Return rate > 100% due to peoplereturning N/S collected elsewhere
*
HCV Prevention & Education
• C-Level– Voluntary sector provider, funded by Health Board
– Peer education to people at risk of HCV(Community Rehabs, Prisons, Drug Services)
– Training to a range of organisations
• Board HCV Training & Education group– NEX training
– HCV Awareness training for health & social care staff
– Peer-led safer injecting interventions
– NEX client survey re: paraphernalia
– Outreach / backpacking pilot
Phase I Update:
Community Outreach
Justin SchofieldHepatitis C MCN Manager
Community Outreach Project
Aims• Provide support, information &
advice to HCV infected individuals accessing addiction services.
• Improve the referral process.
• Increase access to treatment.
• Reduce the default rate amongst those referred for treatment (50%-70% DNA)
• Establish and maintain effective links between the CATs, tertiary treatment centres, voluntary sector, primary care and other addiction services.
• Pilot sites– 4 x CATs
• South (Gorbals)• South-East (Castlemilk)• North-East (Easterhouse)• West (Drumchapel)
– 3 x Community Rehabs• South-East Alternatives• New Horizon• Momentum
• Tertiary Care– 2.0 WTE Clinical Nurse
Specialists– 0.5 WTE clerical support
Community Outreach Project
• Activity: Testing & Info– 328 clients referred to
CNS at CAT– 218 attended
• DNA rate 33%– 122 HCV test
• 63 (52%) chronic infection
• Activity: Hospital Care– 50 referred to Hospital
• 20 appts in future• 30 had appts.
– 19 attended– DNA rate 37%
• Evaluation & Learning (Prof Avril Taylor)– Service attracted clients
– Retention rate at clinic higher than in tertiary sector
– Difficulties in setting up and implementing service but main problems dealt with and intra-team relationships improved
– Majority view that service should continue
– Overwhelming client support for service
Phase I Update:
Treatment, Care & Support
Dr Ray FoxConsultant in Infectious Diseases, Brownlee CentreLead Clinician, Hepatitis C Managed Care Network
National Action Plan: Phase I
• Action Plan:– NHS Boards will develop and improve local
community-based hepatitis C treatment, care & support services
• NHSGGC Managed Care Network– Mapping of current provision– Analysis of need– Determine local priorities– Inform initial investment plans
Phase I Developments
• Clinical Nurse Specialists– 3 new nurses working at Brownlee, Glasgow Royal,
Inverclyde Royal & Royal Alexandra hospitals• Supporting increase in clinical caseloads, including
assessment and treatment
• Dietetics– 1 new Dietician working across Glasgow city
hospitals• Providing dietetic input to patient care• Assessing dietetic needs of people accessing HCV care
services to inform future development
Phase I Developments cont.
• Outpatient Clinic provision– Refurbishment of Ward 7B at Gartnavel General
as dedicated hepatitis C outpatient clinic space– To be shared by Gartnavel Gastroenterology and
Brownlee Infectious Disease teams– Increase clinical capacity– Improve patient experience of care– Opens Autumn 2008
Clinical Audit
Introduction
• Aims1. Baseline data on current clinical activity2. Publish aggregate findings and provide hospital-
specific data to each treatment centre
• Outcome indicators:– Sustained Viral Response (SVR)
[undetectable viral RNA6 months after end of treatment]
– Number patients commencing treatment– Number who completed course of treatment– Response to treatment by viral genotype
Methodology
• Anonymised data from local copies of ‘National Hepatitis C Clinical Database’
• All patients who commenced treatment during 2006
Treatment
Dec 06
SVR?
Nov 07 May 08
48 weeks 26 weeks
Patient characteristics
• 125 patients commenced treatment
• Mean age = 39 years (range 20 to 69)
• Two thirds male
• 76% genotype 2 & 3, 24% genotype 1 & 4
• Three were co-infected with HIV
• 10% recorded diagnosis of cirrhosis
• 86% completed treatment
Outcomes of treatmentTreatment outcomes for all patients by genotype
10% 9% 10%
17%8% 10%
17%
3%6%
13%
7%
9%
43%
72%65%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
G1&4 G2&3 All patients
Sustained ViralResponse
Relapse
No response
Treatment Incomplete
Missing
(n=30) (n=95) (N=125)
Increasing number of patients starting treatment
Number of patients commencing treatment by treatment centre
21
39
46
49
18
30
36
41
0 10 20 30 40 50 60
Southern General& Victoria Infirmary
Gartnavel General
Glasgow Royal Infirmary
Brownlee Centre
2006
2007