Targeted HCV testing in Bristol Emergency Department: Peer-led engagement of clients with complex needs


HCV Action, January 2023

Key points:

• The aim of the Emergency Department Peer Support Lead project is to improve the uptake of HCV testing in at-risk patients attending Bristol Royal Infirmary ED, using point-of-care testing on-site, conducted by the Hepatitis C Trust peer support worker and supported by the BRI hepatology team to provide treatment for any HCV-RNA positive patient identified within four weeks of a positive test.

• Target groups for screening are people who currently or have formerly injected drugs, those experiencing homelessness, ED High Impact Users and those already known to be hepatitis C positive – many of these communities present with multiple needs and experience significant health inequalities.

• The Hepatitis C Trust’s Alex Caulder works in the emergency department of Bristol Royal Infirmary to find, test, and treat people who are at risk of having hepatitis C. Although there are examples of opt -out ED testing across England, it is the only peer-led service based in a hospital.

• His role is embedded tightly with the rest of the ED support teams, effectively working in collaboration with the Homeless Support, High Impact Users and Drug and Alcohol teams to identify and engage high-risk patients, many of whom present with multiple needs and experience significant health inequalities.

• The patients often stay in the ED for a short period of time and are not otherwise engaging with health and social care services, offering a unique and short window of opportunity to provide an intervention around hepatitis C and signpost and refer on to other health and social care services. Since February 2022, Alex has so far engaged with 132 people and tested 110, 29 of whom were HCV positive, with 23 having started on treatment.

By J Pope

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