Good practice examples
BELGIUM – Free Clinic
Treatment-on-site; case-management; paid-peer-workers; C-Buddy; advocacy-on-drug-policy;
TEST; TREAT; LTA; OUT; PWUD+; PEER; NURSE; MULTI
Where – Services provided:
low-threshold drug service and counselling; opioid substitution therapy; drop-in centre; outreach/street-work; work activation; C-Buddy; case management for PWUD with children.
Who – Target groups:
people who use drugs or inject drugs (PWUD); sex workers; men-who-have-sex-with-men (MSM); young people at risk; female PWUD; people experiencing homelessness.
How – Team composition:
social workers; peer workers (paid and volunteer); nurses; hepatitis reference nurse; medical doctors; GIG (Health Promotion in Injecting Drug use) – needle exchange coordination Antwerp; GIG coordinator Flemish part of Belgium (strong cooperation with local hepatologist).
Free Clinic is a harm reduction service provider based in Antwerp, Belgium since 1975. In 2009, they started to develop a complete peer involvement system specifically to support former and current people who use drugs (PWUD) following Hepatitis C treatment. Specifically, thanks to this programme, and their entire array of services in general, Free Clinic has been able to provide support along the whole care continuum, thereby bridging the limited access to conventional health care that is experienced by PWUD.
Although Free Clinic started by specifically targeting most marginalised groups, over the years they have broadened their focus, e.g. to people who use amphetamines, a specific target group who, at present, are insufficiently supported within the scope of social and/or harm reduction services.
Awareness & Prevention
Free Clinic awareness and prevention campaigns are extended to every centre in Antwerp, offering services to PWUD who are in need of HCV support or guidance. For example, the swab2know is an annual campaign organised in cooperation with ZNA, the hepatology unit at a large community hospital in Antwerp.
The information methods used by Free Clinic include handouts / printed materials, media content – such as movies, documentaries, pictures, etc. – as well as counselling plus internal and external educative sessions, such as workshops and trainings.
The Free Clinic team includes a Hepatitis C nurse and a medical doctor who arrange special trainings and materials for their staff.
Free Clinic offers onsite testing for both staff and clients. For staff, the organisation provides HCV and HBV testing as well as vaccinations for Hepatitis A and B. For clients, Free Clinic employs a rapid diagnostic test, venipuncture, PCR and RNA test, and HCV core antigen assay. Adding to this, HIV, STI and HBV tests can be offered upon request.
Complementing these regular activities, Free Clinic participates in the European HIV/HCV Testing Week and organises an awareness week at their needle exchange programme, offering clients a quick test (finger prick). Considering that Free Clinic is able to do PCR on-the-spot, Fibroscan-elastography (referral to ZNA) is also an available service for their clients.
Pre- and post-test counseling is carried out by counselors, nurses, medical doctors and/or peer workers. Although Free Clinic follows a protocol for this activity, counseling is carried out using general written guidelines.
Treatment & Care
For people with an active Hepatitis C infection, Free Clinic provides support through both on-site treatment and externally, and through self-management support. Although Free Clinic does not have a signed referral agreement with a local hospital or medical facility, the organisation is fully integrated within the cascade of care. This collaboration is structured under the so-called Antwerp Model, meaning that Hepatitis C services do not occur ‘under one roof’. For example, a free consultation is available at the hospital with the Hepatologist once a week (an 8-minute walk from Free Clinic); no appointments have to be made.
The organisation requires additional staff, funding for equipment and services, and greater opportunities to hire, train and support peer workers to match demand for services.
Advocacy, Sustainability and Transferability
Since 2016, Free Clinic has received financial support from the Flemish Government. Currently, the organisation is sustainable and structurally sound with funding until 2023.
Free Clinic is actively involved in stakeholder collaboration and discussions on drug user health. The organisation is also active in advocating on drug policy, both at the local and national levels.
Supporting their development and efficiency, Free Clinic monitors and evaluates the knowledge and skills of its staff, volunteers and peers in a systematic and documented way. Their HCV programme has an evaluation system, including an annual monitoring report to government using an anonymous and encrypted client registry, including contact data, date of screening and start of treatment.
For other service providers aiming to implement and/or improve HCV programmes, Free Clinic recommends building a team with as many skills and backgrounds as possible, with enough determination to implement the activities despite potential difficulties. A strategy to achieve this should be built through relations and links with other organisational experts in a range of disciplines.