POW! Breaking barriers to hep C care in the Suburbs

Peer-reviewed science: NUAA workers Bree and Kylie testing samples in Riverwood, March 9.

Through the Peers on Wheels (POW) project, NUAA has partnered with The Kirby Institute, NSW Health, and selected Local Health Districts, to work towards eliminating hep C through outreach, testing and offering treatment options. At the heart of the project is a van, with a Point of Care Testing (POCT) machine and a skilled peer workforce.

The aim is to remove barriers to hep C treatment among people who inject drugs by going to where people live and providing the service without stigma. The POW team has visited various regional cities and towns and rural communities around NSW, but Users News caught up with them in Riverwood in the suburbs of Sydney.

In a community centre on a quiet street in the not-exactly bustling suburb of Riverwood, peer workers from NUAA could be found taking blood samples from community members and putting them into a chunky piece of scientific machinery, the POCT machine.

This machine is what the Peers on Wheels project uses to test blood samples — bringing rapid, free, accessible hep C testing to where people live in NSW. The NUAA workers expertly operate the sophisticated machine, thanks to training from Flinders University’s International Centre for Point-of-Care Testing.

One aim of the POW project is “investing in the skills and capacity of the peer workforce.”

Watching the samples being taken and tested it was clear that workers who have living or lived experience of using drugs are just as capable as any other workers at acquiring technical skills. But what was also clear from watching the team in action is that a peer workforce has additional skills that come from their living or lived experience that make them more effective at getting health services out into the community than other workers.

People who inject drugs are vulnerable to hep C because it is a blood borne virus. The goal of eliminating hep C is achievable because the treatments that have been available since 2016 are effective, reasonably simple (a couple of months of taking pills) and provided free by the government, and because technology such as the POCT machine means you can get a blood test and know whether or not you have the hep C virus an hour later.

However, there are barriers that prevent or discourage people from accessing health services and the job of the POW van is to drive straight through those barriers!

Stigma of drug use, particularly injecting drug use, is an important barrier. People who inject drugs have usually experienced stigma from healthcare services at some time, including feeling disrespected and having health needs ignored. Going to a doctor or clinic can seem like an unpleasant and pointless thing to do.

The living and lived experience of the POW team means they can talk in a way that is meaningful, relatable and believable. Being able to identify who in a suburban street might use IV drugs, approach them, establish a rapport and convince them to come and get a test involves skills that no college course teaches!

Providing equipment and information so people can use safer injecting practises is key to eliminating hep C and when the POW van visits a community, it brings a large amount of NSP supples along with information about NUAA’s mail-order NSP service. These NSP supplies were popular with community members getting tested.

Users News spoke to some of the people getting tested. “Some neighbours of mine just did this themselves, and they pointed this out to me and said you can go up the road and do a blood test for hep C,” Simon, age 55, told us. “I used to do health checks and blood tests every year and then for the last 10 years I haven’t. Then last year I had a test and I came back negative. But I do inject drugs.”

It was clear that being able to be open about their drug use was a factor for several of those accessing the service, and having peer workers doing the tests means that people know they won’t be judged for their lifestyle choices.

Jarvis had previously had hep C and had been cured. “Now I’m going to see if I’m still clear because I’ve had my share of needles since then,” he said.

In the past, when testing and treatment of hep C was more expensive, people sometimes experienced judgement from health workers if they got reinfected with hep after having previously had successful treatment. This has changed. Now the message is it that doesn’t matter how many times you have had treatment in the past, if you think you might be infected with the hep C virus, get tested and get cured.

“They gave me the medication in jail. I was all clean and I had a box left. Then I got locked up again and I had a test. I said, ‘I’ve still got a box left,’ and they said sometimes people can be cured off the first box. I’ve been shooting dirty since so I thought I might have the test again today,” Gavin said.

Both testing and treatment have improved. Charlie told UN: “Originally I got blood tested and they diagnosed me with hep C. It was a 3-day process — they jabbed me a million times or whatever. The nurses ended up getting a blood sample off me on the third day. So then I got diagnosed with it. I did the course but I haven’t been back to find out if I’m positive or not yet. This was probably a few years ago now.”

Not only does technology like the POCT machine and dried blood spot (DBS) testing make the testing process quicker and less painful (just a little prick!), the treatment has also got easier. Horror stories about Interferon and its side-effects have put many people off from seeking treatment. However this treatment has been replaced by “direct acting antivirals” (DAAs), which basically just means taking pills for a couple of months, with few or no side effects.

“I was diagnosed when I was in jail. I was given interferon. Because I’m diabetic, I feel lethargic anyway but the Interferon gave me nausea, diarrhoea, headaches,” Sam told UN.

Gavin reported no side effects from when he took the DAAs. “I did the program with the pills. I’ve done that course and got rid of my hep C. But I might have had it back since,” he said.

Jarvis said he experienced “not much side effects. I was dizzy and tired for the first few days, but after that I felt alright.”

“I didn’t get many side-effects, which was good. They told me originally to wait when I got diagnosed with it, because they said that Interferon had a lot of side-effects and they were getting very close to bringing out the new tablet form [DAAs] and they told me I’d be best off waiting, which I did,” Charlie said.

The POW project is a good example of what a peer workforce can achieve: Going out to the communities where people live, talking to people in language that tells them they will be listened to and understood and being able to tap into community networks to get the word out. The POW project also offers financial incentives to get tested. This is important because poverty can be a serious barrier to accessing healthcare.

As Sam explained: “I found out by word of mouth on the street, from one of the other clients that you had today. He knows around the circles in the community where we live that we do use, so he asked, and walked me up here, which is great. The money was an incentive too because we’re struggling — since this epidemic food has become really expensive. Because I’m a diabetic, I’ve got to eat fresh veggies and the like.”

Further reading: Peers On Wheels: The New Van that is Revolutionising Hep C Healthcare | Interview with MJ