Transcript Document

Siobhan Fahey
Programme Manager of the
Greater Manchester Hepatitis C
Strategy
Greater Manchester Hepatitis C
Strategy
The purpose of the GM Hepatitis C Strategy is
to develop a collaborative, coordinated
approach to addressing hepatitis C across
Greater Manchester in line with national
guidance, and to develop local services to
meet the increasing need and demand for
services within the population
GM HCV Strategy
Funded by the 10 Greater Manchester
PCT’s
Supported by the 10 Greater
Manchester Directors of Public
Health
The first funded Hepatitis C Strategy
in England and Wales
Progress of Strategy….
Greater
Manchester
Hepatitis C
Strategy
formed in
2005. Led by
GMHPU
Health Care
Needs
Assessment
carried out
by GMHPU
Greater
Manchester
Hepatitis C
Strategy
defined
DPH’s
across
Greater
Manchester
supported
strategy
Funded by
Association
of Greater
Manchester
PCT’s
Programme
started
January 2008
Ongoing Projects with
Outcome Aims
Treatment
GM Treatment Guidelines – Individualised Treatment
Testing
Dried Blood Spot Implementation Pilot
Prison
Strategy – increased Prevention, testing, treatment
Research and
Workforce
Development
Training mapping reports, JSNA, Community
Development Project, Health Equity Audit
BBV Prevention
Evidence Based Strategy
Surveillance
City Region Report
Communication
Social Marketing campaigns, website, newsletter
Service Redesign
Collaboratively commissioned improved Service
Pathway
Treatment Project
The GMHCV Strategy Treatment Guidelines were
accepted in full by the Greater Manchester Medicine
Management Group August 2009.
The two controversial proposals were:
• Individualised treatment for HCV
• Use of Erythropoiten and Filgrastrim to improve EVR
Prison Project
• The draft Strategy is in process of being agreed
upon
• A Specialist HCV Treatment Nurse has been
employed to provide an Inreach HCV Treatment
Service into four local prisons
Research and Workforce
Development Project
Joint Strategic Needs Assessment (October
2009) Each PCT will receive a separate report
with comparison across PCTs
Health Equity Audit
Specialist Nurse Training Mapping
and many other projects
Blood borne Virus Prevention
Project
Strategy completion is awaiting Greater
Manchester Joint Strategic Needs
Assessment prior to completion
(October 2009)
To be based on Needle Exchange NICE
Guidelines (2008)
Surveillance Project
NW HCV Report for the CMO (2009)
Greater Manchester report to be
produced later this year
Communication Project
Current Injecting Drug Users
People who have ever injected World Hepatitis Day
(May 19th 2009) Social Marketing campaign with Xfm and
Rock FM
World Hepatitis Day 2010
People born in high-risk countries Stalls held at Oldham
and Manchester Mela’s, DH Conference for health care
workers in Asian areas GM with DH early 2010
Using social marketing techniques to target
people who have injected drugs in the past
Community Development Worker
Service Redesign Project
The aim of the project is to improve
Hepatitis C services for adults from
testing to post-treatment, across,
primary, community, prison, secondary
and tertiary services
Dried Blood Spot Testing
Implementation Pilot
Steering Group and Evaluation
Team
S Fahey
Programme Manager GM Hepatitis C Strategy
A Verma
Clinical Lecturer University of Manchester
K Harrison
Research Fellow University of Manchester
S Wilson
Training Co-ordinator GMW NHS Trust
Dr Klapper
Consultant Clinical Virologist Manchester Medical
Microbiology Services
D Carr
Shared Care Facilitator Manchester Drug Services
L Collier
Service Manager Manchester Drug Services
B Brown
Clinical Scientist Manchester Medical Microbiology
Services
A Pilkington
Research Assistant University of Manchester
Why increase HCV testing in
IDU and ex IDU
• Antiviral therapy, to improve quality of life and
prevent cirrhosis of the liver and liver cancer
• Reduction in alcohol consumption, to slow
progression of liver disease
• Behavior change, to reduce spread of HCV
Aims of Pilot Project
To examine the feasibility of HCV DBST by drug workers in
practice:
•
Development and implementation of a training scheme
for HCV DBST for drug workers
•
Train all drug workers across Greater Manchester
•
Increase in HCV testing in drug services by drug
workers
Savings realised by Project
No Orasure test kits purchased
No use of Specialist Nurse time to obtain neck
samples
No cost of blood samples
Outcomes and Performance
Measures
• To provide each DAAT with DBST kits: antibody,
confirmatory, PCR and Genotype test from March 2008 until
January 2010
• Development of audience tested Dried Blood Spot leaflet
• All drug workers trained to deliver HCV DBST across Greater
Manchester
• Design of a sustainable, high quality training course
• Provision of DBST reports for each PCT area 1 month post
training.
• Improved skills (knowledge, confidence and competence)
among drug workers involved in HCV testing.
• Identification drug workers perceptions regarding the training
programme
• Increase in HCV testing
Marketing to Drug Services
• Meeting with every drug service
Manager in Greater Manchester
• Meeting with Drug and Alcohol lead in
the two NHS trusts who provide drug
treatment
• Report to DAAT Managers meeting
Training Programme
• Designed by GMW, independently evaluated by
University of Manchester
• Following pilot evaluation of training developed
further in conjunction with University and
GMHCVS
• Participatory approach
• Local case studies used
Training Programme
• Designed by GMW, independently evaluated by
University of Manchester
• Following pilot evaluation of training developed
further in conjunction with University and
GMHCVS
• Participatory approach
• Local case studies used
Training Programme
• Designed by GMW, independently evaluated by
University of Manchester
• Following pilot evaluation of training developed
further in conjunction with University and
GMHCVS
• Participatory approach
• Local case studies used
Training Programme
1st day’s training: Hepatitis C Knowledge for
Drug Workers
2nd day’s training: Skills involved in
Hepatitis C testing using DBST including
pre and post test discussion
DBST Implementation Pilot
Early data…….
Professional Background of
Trainees
7%
27%
Related Degree/Higher Level Qualifica
34%
Registered Nurse
Vocational Qualification
None/Unknow n
32%
Knowledge
Tested with use of questionnaire
Pre-training knowledge different across areas
Following training significant increase in
knowledge
This was repeated 6 month post training
Confidence
Confidence in performing DBST increased
from 36% pre-training to 97% post training
Confidence in pre and post test counseling
rose post training, but fell again 6 month
later
PCT
No. of Staff within Core
Drug Service
No. Trained
% Trained
Manchester
70
37
53
Oldham
23
23
100
Tameside
31
16
52
Salford
54
22
41
Ashton Leigh & Wigan
24
17
71
Trafford
15
3
20
Bolton
100
22
22
Bury
20
33
165
Rochdale
32
33
103
Stockport
15
15
100
Total
384
221
58
PCT area
Number of kits
Manchester
450
Salford
200
Tameside & Glossop
200
Oldham
200
Trafford
75
Bolton
150
Ashton Leigh & Wigan
150
Rochdale
150
Bury
100
Stockport
100
Total
1775
Staff Opinions on overall
programme
•
•
•
•
•
•
Training excellent
HCV content good
Important that drug workers test
More testing is carried out
Clients like it
Testing more accessible, builds on staff/client
relationships
Staff Opinions on overall
programme
•
•
•
•
•
•
Problems with ordering kits
Delay in kit delivery
Too much pre and post test discussion training
False negatives
Excessive bleeders
Sign off of competency certification, not enough
staff able to complete sign off
• Not enough contact with GM HCV Strategy
Service Manager Opinions on
overall programme
•
•
•
•
Part of drug worker role
Uptake varies from base to base
Testing rates increased
Service users more confident of being tested
Service Managers Opinions on
overall programme
•
•
•
•
Excessive bleeding
False negatives
No HIV testing training or funding
Sign off of competency certification, not enough
staff able to complete sign off
• Not enough info on kit storage, drying
• Unclear referral pathway
• Concerns regarding future commissioning
DAAT Managers Opinions on
overall programme
• Training well received
BUT
• Training too long, too much detail
• Requirement for updates
• Concerns over future commissioning
• Problems with obtaining further test kits
• Concerns re inappropriate onward referrals
• Poor communication with GM HCV Strategy
Did pilot increase testing?
Difficult to baseline as individual drug
agencies sent samples in to lab via a third
party
Comparison will be made of testing pre,
during and post implantation across Greater
Manchester
Early recommendations
Project lead to market training, administrate Project an
provide leadership
More marketing of project to drug services
More drug services involved in planning implementatio
Better communication with drug services
National Programme of Hepatitis C screening of IDU
and ex IDU
gmhepc.org.uk