28 July 2021
In this blog for World Hepatitis Day, Mark Leonard, Groundswell Homeless Health Caseworker, gives an overview of his Hepatitis C peer support work: what it is, how we test for it and how services have adapted during COVID-19.
My name is Mark Leonard, and I am a Homeless Health Caseworker for Groundswell. Using a peer support approach, I support people experiencing homelessness to access healthcare. This includes taking people to health appointments and advocating for them if needed.
For the past two years, I’ve spent two days a week working with the UCLH Find & Treat team, who visit people experiencing homelessness in London hostels and day centres. The team focus on blood-borne viruses which include Hepatitis C, Hepatitis B and HIV, and sexually transmitted infections such as Syphilis, Gonorrhoea, Chlamydia and Trichomonas.
When someone experiencing homelessness is diagnosed with Hepatitis C (Hep C), I can offer them peer support. This means if they have any questions regarding treatment or if they need support getting to their appointments, a peer (someone with experience of homelessness) will be able to help guide them through their treatment journey.
What is Hepatitis C?
Hepatitis C is a virus that affects your liver. It can be very serious if it’s not treated. You can catch it from contact with the blood of an infected person, for example by sharing needles. This means it can be quite common amongst drug users. It’s very rare to catch it from having sex.
There are often no symptoms of Hep C at first. Some people get symptoms like muscle aches, a high temperature, tiredness, and tummy pain. These days, treatment is not as scary as it used to be. It can usually be easily treated by taking antiviral medicine for several weeks.
The risk of catching Hep C can be reduced by not sharing needles, razors or toothbrushes with other people.
How we test for it
We do this by doing a Hep C antibody mouth swab, which is rubbed around the gums for a minute or so. We then put the swab into a solution and wait for 15 minutes.
If the test comes back with one line you are negative. Two lines does not mean you have Hep C, it just means you may already have antibodies. If this is the case, we would take a small bit of blood from the finger to send to a lab, where the blood is checked for the ‘viral load’ (how much Hep C virus you have). If needed, we will then start you on treatment.
The Find & Treat team also test for Hep C alongside HIV, Hep B and syphilis using a POCT (point of care test) through evening sexual health outreach sessions for sex workers. These are all easily treatable and if needed, people are referred to the clinics in the area for ongoing treatment.
The role of peer support
Providing peer support plays a big role in testing for Hep C. With a peer there, someone with a shared experience of homelessness, patients are usually more trusting and motivated to take a test. If they have any questions, peers are there to provide support and can sit down and explain things.
It’s not just about saying “have a test, take your medicine”, it’s about listening to the person as a whole, talking about what else is going on in their lives and other ways we can support them with their healthcare needs.
We can work out whether we can help them with accessing other health services, such as if they’re not registered with a GP, we can help them with that. For me, peer support is crucial for both the issue you’re there for, and all the other bits surrounding the issue, and signposting people for the parts we cannot directly help with.
How we adapted when COVID-19 came last year
When COVID-19 hit last year, we had to change the way we support our clients through their Hep C treatment quickly.
Because of restrictions, people could not collect their Hep C medication from clinics, and testing stopped. There were also lots of new people put in hotels across London. We decided that we could visit and test these people affected by homelessness in their hotels or other accommodation as they were not able to access services.
The main change made was taking clinics directly to patients through home visits. We spoke with the clinical leaders in the area about what different patients needed, for example dropping off their meds and taking blood tests to check their viral load.
In 2020 during lockdown we tested over 1,200 people, working in partnership with many organisations across London. We helped train other peer workers to safely test for blood born viruses including Hep C in the community and supported over 100 people into care.
What next?
As the COVID-19 restrictions are slowly being lifted, we are working with the clinics to see how we can still support their services when they start to see clients face-to-face, and targeting the clients who want to go to the clinic rather than have a home visit.
We have a new Hep C van being launched today, paid for by NHS England which will now enable us to expand our testing and treatment support.
Flexible and remote appointments are now more common and patients often like this style of interaction. We’ve got to think about what works for them, and things like delivering medication, checking in on people and taking end of treatment tests where they’re staying can make a huge difference to people’s health outcomes.
How to refer in London
If you work in a London hostel setting and would like the Find & Treat team to provide screening at your service, or if you have any questions, just email: [email protected].
Groundswell offers Homeless Health Peer Advocacy for a range of physical and mental health issues across nine central London boroughs, to find out what we can offer and how to refer click here or email [email protected].
We have partners operating HHPA services in various parts of the country, if you would like to explore having a similar service in your area you can find out more here.