BLOOD BORNE VIRAL HEPATITIS ACTION PLAN FOR WALES

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BLOOD BORNE VIRAL HEPATITIS ACTION PLAN FOR WALES
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Background

• 2004 BBV strategy group convened,
  design and begin research programme
  to inform strategy
• 2005/2006 Complete research programme
  Conference held
• 2007 Action Plan for Wales submitted to WAG

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Evidence from service users and providers

• Patients perspective on existing services for
  treatment and support
• Service providers
• Questionnaire survey and interviews with
• Clinical nurse specialists and Consultants
• Community Drug Teams
• All G.P.s across Wales

• Service users
• Prospective cohort study of current Injecting
  drug users (IDUs) from across South Wales
• Prevalence estimate of serious and injecting drug
  users across Wales
• Needs Assessment of health and substance misuse
  services across Wales
• Qualitative study on needle and syringe exchange
  provision and barriers to use.

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Much to be gained from an effective response
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Key findings

• The majority of HCV infection in Wales remains
  undiagnosed
• 75 of HCV positive IDUs interviewed in the
  incidence study were unaware of their sero-status
• HBV vaccination rates are poor
• Homelessness increases risk of HCV transmission
• Service provision for substitution treatment and
  psycho social intervention does not meet the
  level of need identified (OST associated with
  lower HCV incidence)
• Harm reduction services including needle exchange
  are patchy in some areas of Wales
• Coverage of specialist services across Wales
  needs to be improved
• Number of individuals undergoing treatment for
  HCV is unacceptably low
• Dried blood spot testing effective means to
  increase diagnosis

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Feedback from BBV hepatitis Conference

• High prioritisation given to
• Services provided in prisons and drug services,
  hepatitis B vaccination and testing for blood
  borne viruses. Educational programmes for staff
  and service users.
• Networks to enable provision of treatment and
  support to patients in all community settings.
  Ensuring continuity of care and access to support
  from diagnosis to treatment and follow up
• Address barriers to treatment and achieve
  national consensus on who will be treated, where
  and when. Implement NICE guidance across Wales

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Structure of Action Plan

• 3 main strands
• Awareness raising and harm reduction
• Diagnosis
• - Treatment and care pathways

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Awareness raising and harm minimisation

• Education within drug services / outreach, prison
  population, homeless, young people, excluded
  children - and all those who work with these
  groups
• General awareness raising in the population of
  Wales to reach those who may have a history of
  risk
• Strengthen needle exchange services with relevant
  information through development of All Wales
  Needle Exchange Forum

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Increasing diagnoses

• Development and expansion across Wales of Dried
  Blood Spot testing for BBVs in substance misuse
  services trial results published - encouraging
• Awareness and diagnosis in Primary Care settings

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Treatment and Care Pathways

• Development of clinical networks nurse led
• Treatment where appropriate in community settings
  and prisons
• Clearly defined referral and care pathways for
  primary care
• Support staff to reduce DNAs
• Psychological / psychiatric support
• Monitoring and evaluation at all stages of
  process
• Establishment of comprehensive surveillance
  system

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Proposed clinical network
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The Welsh Action plan

• Some actions supported by existing budgets other
  require funding
• Each NHS trust in Wales to have
• Better resourced treatment centres
• Support for BBV diagnosis/treatment with SMS
• Prison based public health nurse specialist
• Roll out of DBS to SMS in all areas of Wales
• Wales based DBS testing

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The Welsh Action plan

• Proposed clinical network
• Each NHS trust in Wales to have additional
• Clinical Nurse Specialist (band 7)
• Additional session/week from Consultant
  Psychiatrist Consultant Gastro/Hepatologist
• CPN post (band 6)
• Administrative post support (band 4)
• Community based HCV support worker (band 6)
• Prison based public health nurse specialist (band
  7)
• Roll out of dried blood spot testing to SMS in
  all areas of Wales

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BBV hepatitis Action Plan

• 4 year costed plan with time frame for actions
• Where are we now?
• Diagnosis and surveillance group
  Treatment group
  Prevention group
• All to be tasked with overseeing implementation
  reporting to project group and ultimately WAG

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Improving diagnosis in prisons

• Habit with health prevention interventions to
  introduce then think about evaluation often
  only have one window of opportunity
• Stepped wedge randomised control trial control
  for confounding / trends

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