ARUD hepatitis C peer-to-peer programme By Oliver Wehrli, Swiss Hepatitis C Association

Swiss Hepatitis C Association (SHCA) is a Swiss civil society organisation which fights to ensure all hepatitis patients in Switzerland get access to treatment and medication through their health insurance. They provide advice, support for those affected by hepatitis, educate patients, authorities and the public about hepatitis C and promote and support the development of regional peer-to-peer groups.

The campaign

It is estimated that 0.7 percent of the general population in Switzerland live with hepatitis C. This figure, however, shoots up amongst high-risk populations such as people who inject drugs (PWIDs). Whilst Switzerland does now have unlimited access to direct acting anti-viral drugs (DAAs), there are great gaps in the cascade of care offered. A lack of awareness amongst patients, civil society and government officials alike contribute to the low testing rates and poor linkage to care in our country.

To change this we must actively find the missing millions and support them on their journey to care and treatment.

Earlier this year, we teamed up with ARUD Center for Addiction Medicine to develop a hepatitis C peer-to-peer project with the aim of reaching out to one such at-risk group, PWIDs, to educate them about viral hepatitis and encourage them to get tested, as well as to increase the number of people who have successfully completed treatment and prevent re-infections.

A key component of the project is our use of surveys with the PWIDs we engage with to assess knowledge change on viral hepatitis and find out what impact free or cheaper testing would have on their ability to access services. This survey is the reported back to ARUD’s medical research team.

The framework of the project was originally initiated by our Board member and Medical Advisor Dr Philip Bruggmann, as well as Luis Falcato, both from ARUD. They noted the ability of peer-to-peer services to reach out to at-risk communities such as PWIDs, survey them to find out the population needs and encourage them to get tested and treatment.

After receiving financial contributions from the Swiss Federal Office of Public Health and the pharmaceutical industry, they recruited two members from our organisation and four ARUD patients as peers to develop the project.

Our peers now visit drug facility centres across Zurich, Basel and Bern to find people who are at-risk and reach out to them. They distribute flyers about hepatitis C and try to get into conversation with facility visitors to build a rapport. Once a relationship is established they educate visitors on hepatitis and take the survey. The surveys are not compulsory and can be answered anonymously. They take about 20 minutes and our peers conduct them in the privacy of the drug facilities on a tablet.

These surveys give us a better idea of the needs of the PWID community to get tested and treated and helps our project ensure that it represents the interests of PWIDs with chronic hepatitis C.

Top tips for success

We found that the following factors have made our activity a success:

  • The peers can communicate with the PWID community on a personal level as they themselves have had hepatitis C and used drugs. This means we are able to gain the trust of and reach more people.
  • Due to their backgrounds, the peers can credibly explain that getting tested is easy and free through our and ARUD’s facilities, as well as that treatment is harmless, simple and available to everyone.
  • Since our peers work at ARUD, they are well networked and so can find an examination or treatment option for all possible hepatitis cases.

 

Challenges

  • Our peers are constantly trying to find new places and facilities to reach out to. Unfortunately, it is not always so easy to get permission to enter such places. We have to make our case. Thankfully, it becomes very clear very quickly that our peers do useful work and will not disturb the operation of facilities.
  • Testing is limited to anti-body testing. RNA tests, to confirm chronic viral hepatitis C, are expensive and can only be done by visiting a doctor.

Achievements to date

  • Our peers work across Zurich, Basel and Bern
  • So far, 150 surveys have been carried out.
  • In two facilities in Zurich, an additional 35 visitors were tested for hepatitis C with the Ora-Quick rapid test.

Key learnings

  1. The peers improve the knowledge of hepatitis C in the institutions they are active in. As a result, more patients start treatment.
  2. Treatment adherence increases and patients are less afraid of side effects when accompanied by peers.
  3. The peers work very cost efficiently and are a valuable addition to the treatment apparatus. Through their cooperation, the rights of patients are regarded more.

Find out more

If you’re interested in finding out more about how to build your own evidence base by surveying people living with viral hepatitis to determine what impact free or cheaper testing would have on their ability to access services, contact SHCA at oli.wehrli@hepc.ch.