Barriers
All recovery workers acknowledged staff lack of confidence, lack of education or fear were barriers to testing with the majority identifying the need for training. Some identified peers as highly effective trainers where passion and making the subject feel important were vital to gain their buy in.
Regarding day to day tasks many stated testing was important but admitted it was much lower down their list of priorities in comparison to managing other risks, especially with a high caseload/workload.
Some acknowledged personal and service user frustration at repeatedly offering testing.
Some disclosed their own anxiety around testing and feeling ‘out of the habit’, whilst others stated they lacked the opportunities to do it if a BBV lead did the majority of testing. Additionally, for some there was a confusing cross-over of roles within services and sometimes testing was seen as a primarily clinical intervention. Infection control risks were mentioned by two recovery workers with one being concerned about their personal risk of infection and another being concerned about the safe disposal of clinical waste in the community.
It was also perceived that service users can experience fear and anxiety and some may not have the knowledge as to why they might require testing or awareness of the newer treatments. One recovery worker suggested services users might decline being subjected to too many interventions in one appointment. Stigma and readiness to engage with treatment was suggested to be linked with the motivation to accept testing.
Covid-19, the lockdown of services and the subsequent decrease in footfall were strongly felt by the recovery workers to be barriers. Recovery workers spoke of lack of outreach and advertising the testing offer being factors, as well as lack of money and restrictive policies. They felt lack of discussion and focus on testing in teams and mixed messages from management about what to prioritise played a role.
Solutions
The recovery workers identified key solutions to the majority of barriers which covered four themes – education, resources, culture and organisational processes, shifting focus. The staff wanted inspirational education, strategically placed leaflets, peer support, flexible resources (vans/vouchers/food/transport) and a focus on outreach. Flexibility, consistency, having a lead, patient flow, routine testing, wrap-around services, community support and team cultures were mentioned throughout.
One recovery worker expressed how we needed to proactively target service users who attended the needle exchange.
It is clear from the barriers observed by recovery workers that complexities remain in accomplishing high rates of testing to reach and sustain micro-elimination. However, despite the barriers, recovery workers saw multiple parallel solutions and if we want to reach our joint objective we have a duty to listen and be responsive.
Written by Deanne Burch, Hepatitis C Elimination Coordinator for Hep C U Later
With special thanks to the recovery workers who took part for their valuable insights