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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

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Phase i update prevention education community outreach

Phase I Update:Prevention & EducationCommunity Outreach

Justin Schofield

Hepatitis C MCN Manager

Phase i action plan




Treatment, Care & Support

Education, training & awareness raising

Surveillance and monitoring

Sep 2006 – Aug 2008

£4M new monies

Initial local developments

Period of national needs assessment to inform Phase II

Phase I Action Plan

Hcv prevention nex
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


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: Glasgow

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 Provision: Clyde

Nex activity returns 2006 07
NEX Activity & Returns 2006/07


* Return rate > 100% due to peoplereturning N/S collected elsewhere

Hcv prevention education
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

Phase I Update:Community Outreach

Justin Schofield

Hepatitis C MCN Manager

Community outreach project


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


Tertiary Care

2.0 WTE Clinical Nurse Specialists

0.5 WTE clerical support

Community Outreach Project

Community outreach project1

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

Community Outreach Project

Phase i update treatment care support

Phase I Update:Treatment, Care & Support

Dr Ray Fox

Consultant in Infectious Diseases, Brownlee Centre

Lead Clinician, Hepatitis C Managed Care Network

National action plan phase i
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
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
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


  • Aims

    • Baseline data on current clinical activity

    • 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


Dec 06

Nov 07

May 08



48 weeks

26 weeks


  • Anonymised data from local copies of ‘National Hepatitis C Clinical Database’

  • All patients who commenced treatment during 2006

Patient characteristics
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