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The Inclusion Telford Incentives for Treatment Pilot

Over the last 9 months Inclusion Telford have been utilising incentives to engage service users in hepatitis C treatment with some very positive results.

Prior to March 2021 Inclusions team in Telford (https://www.telfordstars.org/) and their local Hepatology clinical nurse specialist, identified a number of factors which were barriers to service users engaging in hepatitis C treatment.  They identified that they did not want to attend appointments in a clinical setting due to prior awareness of previous hepatitis treatment causing anxiety. Also, service users often couldn’t afford transport to these locations. Inclusion Telford coordinated a meeting with the Birmingham ODN, Hep C U Later and the Hepatitis C Trust to strengthen their joint hepatitis C treatment pathway.

In March 2021 Inclusion Telford and related local agencies agreed on what methods could be used to engage service users in treatment, particularly with those who had a known hepatitis C infections for many years.  Initial data showed that there were thirty-six people who required hepatitis C treatment and despite a dedicated Hepatology specialist attending the service regularly service users declined the offer of treatment and many declined to attend appointments.

“I am really proud to have been a part of the Hep C partnership pilot in Telford. We were always dedicated in making a difference for the residents of Telford however, we knew doing the same thing and expecting a different outcome was not appropriate and a waste of valuable resources.

We are fortunate to have a robust recovery community in Telford and by working closely with them and listening to their thoughts and feelings about what would help led us to shape the services differently.

The excellent outcomes are a testament to the hard work and commitment of the partnerships in Telford and good lessons for us to learn in terms of being more creative with our service delivery.”

Michelle Astbury, Inclusion Telford Clinical Lead

Pilot Outline:

It was agreed by Inclusion Telford that as a pilot incentives would be offered to service users at different stages of the hepatitis C treatment pathway commencing in April 2021.  This included a £5 Love to Shop voucher at the initial assessment, a £10 voucher for completing treatment and a £15 voucher at the end of treatment upon giving a sustained virological result (SVR) test.  Additionally, peer support was offered by Telford After Care Team (TACT) and taxis were used flexibly (for 95% of appointments), paid for and arranged by the Inclusion Telford staff.

Pilot Preparation:

Set amounts of funding were agreed within Inclusion for each element of the pilot and a spreadsheet was created to monitor each intervention each service user received.

The Hepatology specialist and the BBV Lead from Inclusion Telford completed a deep data dive exercise prior to the pilot, looking through previous case notes and sharing appropriate data on where service users had already been treated.  This exercise reduced those needing hepatitis C treatment to thirty-one.

Recovery staff at Inclusion Telford were given additional training on hepatitis C by the Hepatitis C Trust, they then rolled this training out collaboratively with the Hepatitis C Trust to service user representatives in the local area.  All recovery staff were supportive of the pilot.

Additionally, the team engaged in many supportive activities to promote hepatitis C awareness, testing and treatment, including going on a live radio show. Leaflets were sent out to appropriate businesses and staff completed outreach testing on a bus in the local area for World Hepatitis Day.

Results of the Pilot:

Out of the thirty-one service users requiring treatment twenty-two received incentives, all of which completed treatment and a SVR.  Of the remaining nine some were already part-way through hepatitis C treatment, one was transferred to prison, one transferred out of area and the remaining handful disengaged.

The first clinic had 100% attendance and each clinic following that has had a minimum of 75% attendance.

Service User Feedback and Findings:

The feedback from the service users on which elements of the pilot (the vouchers, taxis or peer support) had the biggest influence on their uptake of treatment was that the taxis were most beneficial.  Many reported that having the cost paid and the organisation of the taxi done for them helped them to engage.  Feedback from Inclusion Telford was that overall the taxis were used appropriately, however, a few cancelled at the last minute and one person did not use the taxi to get to their treatment destination.

“Initially getting to and from appointments was identified as the main barrier and by offering that transport it removed the barrier. We felt this was the most important element of getting people to treatment”

Della Brown, NMP, Telford Stars

Prior to being engaged through the pilot many service users were unaware of the newer hepatitis C treatments and reported being fearful of treatment as a result of what they had heard from their peers.  One service user said having the new treatment ‘was like a dream’, another said ‘the treatment wasn’t as bad as I expected’.

“I thought it was going to be bad…I had put off treatment before as I thought it was the old treatment but it was really good.”

“I had put off having the treatment as a family member had gone through it and it put me off but it was amazing and I’m really happy I’ve done it.”

Quotes from service users who had treatment as a result of the pilot

Staff at Telford Stars reported that part of the success of the pilot was that two different sites were offered as clinics within the community, enabling service users to choose where they accessed treatment.

One of the added benefits of the pilot has been how its successes have prompted staff to think creatively about the future hepatitis C related work they can do, it has fed into ideas which tackle some of the barriers that remain for treating hepatitis C.  As a result of their outstanding work, the pilot team also received a Recovery Conference Award.

“I have been lucky enough to be involved with this project. I have found this work so rewarding as we are supporting the people who I feel have been demonized and criminalised by society.  I feel that being kind and understanding goes a long way in making people feel valued, and gives people hope for the future. Being able to offer transport to and from their appointments has made a massive difference to people engaging and attending appointments, it makes people feel cared about. I also feel privileged to have worked alongside Della, the nurse leading on the pilot, who has shown great empathy and humility towards the patients creating trust and rapport.”

Jamie McLaren, Support Worker, Inclusion Telford

Whilst the pilot continues, utilising the methods of incentives, taxis and peer support, Telford Stars are confident it will continue to have a positive impact on the uptake of treatment amongst its service users.

 

Deanne Burch, Hepatitis C Elimination Coordinator for Hep C U Later (NHS Addiction Providers Alliance)

Della Brown, Non-Medical Prescriber & BBV Lead for Inclusion Telford Stars (Midlands Partnership NHS Foundation Trust)

Jamie McLaren, Support Worker for Inclusion Telford Stars (Midlands Partnership NHS Foundation Trust)