Good practice examples
UNITED KINGDOM – Hillcrest Futures
Treatment-on-site; testing-in-homeless-centres-and-pharmacies; prison-work; hepatitis-reference-nurse;
TEST; LINK; TREAT-ext; PWUD+;
Where – Services provided:
needles and syringes exchange, drop-in centre; opioid substitution therapy (OST).
Who – Target groups:
people who use drugs (PWUD) or inject drugs (PWID); sex workers; men-who-have-sex-with-men (MSM); young people at-risk; people experiencing homelessness.
How – Team composition:
peer workers; volunteers; nurses; hepatitis reference nurse.
Hillcrest Futures is a harm reduction service provider based in Dundee and contracted by the National Health Service (NHS) in the Tayside region of Scotland and includes a needle exchange service and drop-in service.
Hillcrest Futures includes women-only groups with female staff, focusing on women involved in commercial sexual exploitation or at-risk of domestic abuse. It runs clinics targeted at steroid users, offering liver function tests to support their engagement. Hillcrest Futures welcomes anyone who needs their services, such as under-represented groups, including people from black and minority ethnic populations.
NHS Tayside and the University of Dundee approached Hillcrest Futures for support in their research study on eradicating viral hepatitis C in PWID through utilising their effective relationships with service users and in encouraging them to be tested for HCV as well as HBV and HIV. They tested a high number of people with Dry Blood Spot Tests (DBST) and supported their access to treatment throughout the study which proved that their outreach work in homeless hostels and local pharmacies had increased the number of tests conducted and participants accessing treatment.
Awareness & Prevention
Senior support workers of Hillcrest Futures regularly provide BBV awareness training for external agencies who may have contact with people who inject drugs (PWID) and promote dry blood spot tests during engagement in hostels through brief interventions that lead to the uptake of tests. They also attend well-being events in community settings and prisons, promoting BBV services and awareness. The involvement of senior support workers who have actual lived experience works very well and is based on their skills, knowledge and level of confidence.
Hillcrest Futures regularly hands out educational materials and information folders to staff and clients and organise viral hepatitis awareness campaigns such as the ‘BIG C Event’ with partners including the NHS and the Hepatitis C Trust.
Dry blood spot testing is always offered by Hillcrest Futures to their clients unless a client has previously had an HCV infection. If so, an IV blood test is carried out by BBV nurses based on the drop-in service where venepuncture, PCR, RNA, and Fibroscan testing are also available. If the result is positive for HCV, a specialist BBV nurse discusses the treatment options and starts the process of gaining the client’s consent for treatment. A full blood sample is then taken from the client to determine the strain of the virus.
Hillcrest Futures has no specific counselling protocol. However, clients are given emotional support and are closely monitored by their specialist nurse. Those at Stage 3 have a one-hour meeting with study staff every two weeks and, together, they complete a booklet consisting of reminder strategies for taking their medication. A medical doctor might also hold further talks.
Treatment & Care
Treatment is provided through the mainstream NHS service which operates out of the same premises as the needle exchange. The partnership works very well, with people who test positive for HCV moving seamlessly into treatment.
Hillcrest Futures initially identifies individuals at risk of HCV and with chronic HCV because an individual being tested and diagnosed within the service can be linked to care immediately after their eligibility for treatment is checked. Accordingly, the client adheres to the treatment process through regular contact with staff and receives an Ensure protein drink as an incentive while collecting their medication. The provision of protein drinks promotes good health and encourages individuals to go to appointments and to undertake the final blood test to determine viral clearance.
Although their hepatitis services are fully equipped and match current requirements, Hillcrest Futures requires additional funding to improve equipment and services with more educational and training materials for staff and more informative content for clients.
In addition, Hillcrest Futures would like to offer supervised drug consumption rooms (DCR’s) for safer injecting, to prevent overdose and to reduce the spread of blood-borne diseases while allowing more clients to have access to their services. A further challenge is to identify and access hidden populations, such as steroid users and those who may have injected in the past but are no longer in services.
Advocacy, Sustainability and Transferability
Hillcrest Futures has recently benefited from the positive engagement with, and the full support of, the Dundee Member of the Scottish Parliament (MSP) whose visit to the service resulted in the Scottish Government launching its new Scottish Drug and Alcohol Strategy at Hillcrest Futures. Their funding is secured every 4 years through a competitive tendering process, and the benefits of their services are well understood and represented at the political level.
All factors, including Dry Blood Spot Testing and treatment of HCV, as well as the prevention of BBVs, are targeted at vulnerable people and those with a chaotic lifestyle, including support to PWID through the distribution of sterile injecting equipment and related paraphernalia.
c/o De Regenboog Groep
European Harm Reduction
1013 GE Amsterdam
tel. +31 20 570 7829
fax.+31 20 420 3528
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