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EPCA 2021 person-centred care award winner: The Leicester Operational Delivery Network hepatitis C team

The Leicester Operational Delivery Network (ODN) hepatitis C team were delighted and thrilled to receive the EPCA 2021 patient-centred care award, reflecting and recognising the amazing work carried out by the team over the past five years.

Professor Martin Wiselka, ODN clinical lead, writes on behalf of the Leicester ODN Team.

The ODN includes centres in Leicester, Kettering and Northampton, and is one of 22 ODNs throughout England that were set up to coordinate effective treatment for hepatitis C and deliver the Department of Health's vision to eliminate hepatitis C as a public health problem.

The major risk factors for hepatitis C include previous intravenous drug use and living in a country with high prevalence of hepatitis C. These patients are under-served and healthcare is hard to access.

Hepatitis C is often known as the silent disease, as there may be no symptoms until complications develop, including chronic liver disease, cirrhosis and hepatocellular carcinoma. As a result, many patients are undiagnosed or diagnosed late, and those who have tested positive are often difficult to engage with hospital care and treatment.

'We were particularly proud of our efforts in eliminating hepatitis C from two of our local prisons, Gartree and Stocken, during September 2020. This involved a team of nurses entering the prison, gaining the confidence of the prison staff and inmates, testing over 95% of prisoners and treating those who were found to be positive.'

Since 2015, effective treatment for hepatitis C has been freely available, with a course of tablets lasting between eight and 12 weeks, leading to a cure in over 95% of patients with few side effects. There is also increasing evidence that the elimination of hepatitis C also leads to other significant lifestyle changes and added benefits.

The EPCA patient-centred care award reflects the efforts and innovative practice of the team to identify patients with hepatitis C and initiate treatment. These initiatives have included setting up Cepheid PCR testing capability in local pharmacies serving patients receiving substitution therapy and needle exchange, as well as high intensity test and treat (HITT) programmes in local prisons.

We were particularly proud of our efforts in eliminating hepatitis C from two of our local prisons, Gartree and Stocken, during September 2020. This involved a team of nurses entering the prison, gaining the confidence of the prison staff and inmates, testing over 95% of prisoners and treating those who were found to be positive.

The COVID-19 pandemic and lockdown measures have generally reduced access to drug treatment services and hostels, although these are now reopening to medical care. The team worked particularly hard in the run up to World Hepatitis Day, on 28 July 2021, when testing events were held at a large number of centers, including the Y Project homeless center, CGL Northampton, The Bridge project in Leicester and the Dawn Centre hostel in Leicester. The team performed the most tests ever carried out in one week, including 150 tests in Leicester prison. The tests identified a large number of previously unknown cases.

In addition to medical staff and specialist nurses, the team has been greatly assisted by the appointment of four peer support workers in collaboration with the Hepatitis C Trust. The peer support workers have lived with the experience of hepatitis C and are able to access patients who would not normally attend hospital clinics and they deliver testing and treatment to many community centers.

We are actively pursuing a look back exercise to identify untreated patients who previously tested positive for hepatitis C and have also started an ambitious project to eliminate hepatitis C in a whole town, involving the Lakeside Surgeries in Corby.

The ODN team has demonstrated teamwork at its best and most productive. Winning the EPCA 2021 person-centred care award has helped the whole project and motivated our team.

The award has spurred the increasing rates of testing and treatment. The ODN has now exceeded its planned number of cases treated per month, despite the numerous challenges of the COVID-19 pandemic and lockdown. The award will be used to support a celebratory ODN regional meeting and allow our work to continue.