Rough sleepers blood-borne viruses (BBV) testing project

During lockdown, a partnership between the Brighton-based HIV charity the Martin Fisher Foundation and not for profit organisation EmERGE mHealth, saw the launch of a hepatitis and HIV screening programme for temporarily housed rough sleepers in Brighton & Hove

Funded by Gilead Sciences, the project saw outreach workers from Brighton & Sussex University Hospitals NHS Trust (BSUH) and Terrence Higgins Trust (THT), aided by St Mungo’s support workers and Brighton Housing Trust (BHT) offer screening and sexual health assessments to homeless individuals, many of whom have had difficulty accessing traditional services. A simple finger-prick sample was obtained for lab analysis, giving highly accurate results. Personal protective equipment (PPE) was used for face-to-face interactions and clients were offered a £5 food voucher for their time and engagement.

Dr Gillian Dean

Dr Gillian Dean, trustee of the Martin Fisher Foundation and consultant HIV physician, said:

The Covid-19 response gave us a once in a lifetime chance to reach out to this traditionally ‘hard-to-find’ group and offer them screening. The project supports the Brighton & Hove Towards Zero HIV initiative, while also working towards the national target eliminating hepatitis C.

Marc Tweed

Marc Tweed, centre manager at THT Brighton, said:

At the heart of the project is working in partnership with a network of professionals in the city, drawing on their specialist knowledge and skills to ensure that what we are offering meets the complex and diverse needs of the people we want to engage with.

It is vital during the Covid-19 pandemic that we don’t forget about other viruses which are still affecting people. We must continue to adapt and innovate testing services through developing fantastic new ideas such as this one so we can reach and support those who are most vulnerable in our communities.

The project ran for 13 weeks from the Britannia, Kings and Brighton hotels, and the YHA and Phoenix Halls where 270 people were housed. After three months, the fantastic outreach workers, Abby Smith-Hatton (BSUH) and Marek Coskry (THT), had approached 97% of clients, with 72% (n=192) taking the tests. The main reasons for declining were people were ‘already aware of their status’ or had ‘low perceived risk’. Sixteen per cent (31/192) tested positive for previous Hepatitis C (antibody) with 13 of these having active infection (RNA positive). The project has also provided a reengagement opportunity for known HIV patients who had partly disengaged from care. A few vulnerable clients were diagnosed with STIs and engaged with Brighton & Hove Sexual Health & Contraception (SHAC) services.

For the 179 clients who didn’t have active infection, many expressed gratitude and relief to know they were ‘all clear’. Of the 13 clients with active Hepatitis C, many were surprised to learn that the infection is now completely curable by taking just one tablet a day for only eight-12 weeks, with very few side effects. Most have engaged with services and either decided to start treatment straight away or plan to start at some point in the future.

Each patient needs a tailored engagement plan to succeed with the journey from testing through to completing the course. Engaging clients following diagnosis has been challenging for the project, but made easier with the wrap around care provided by the outreach workers, named St Mungo’s key-workers, the community hepatitis nurses and ARCH healthcare (primary care services). Moving forward, the project plans to continue this unique collaboration and continue offering BBV testing to rough sleepers in Brighton & Hove through to spring 2021.

Terrence Higgins Trust: www.tht.org.uk

Martin Fisher Foundation: www.themartinfisherfoundation.org

EmERGE mHealth Ltd: www.emergemhealth.com

St Mungo’s: www.mungos.org

Brighton & Sussex University Hospitals NHS Trust: www.bsuh.nhs.uk

Brighton Housing Trust: www.bht.org.uk