It is widely recognised that stigmatised, marginalised and socially excluded groups, such as PWID, face barriers accessing healthcare services. Understanding these barriers can determine the responses needed to overcome them and increase access to hepatitis B and hepatitis C testing.
BARRIERS TO TESTING FOR VULNARABLE GROUPS: STIGMATISATION
Stigmatisation, marginalisation, cultural and social isolation, negative impact on employment prospects, positive diagnosis and judgement from healthcare workers are some of the main barriers to testing.
OVERCOMING THE BARRIERS:
Effective testing and treatment of both hepatitis B and C requires a high level of interpersonal and communication skills on the part of the healthcare worker. For example, healthcare workers should be able to effectively and respectfully engage service users in conversations about sexual behaviours and injecting drug use, in a way that is individualised, sensitive to cultural diversity and needs.
The fear for many people – of being diagnosed with hepatitis – and the implications for their future health and for the health of others cannot be underestimated. Effective, considered and respectful engagement may be the the firts essential step to effective managemnet.
PRE-AND POST-TEST DISCUSSION
- Hepatitis B or C testing should always be voluntary, confidential and done with informed consent.
- Testing should be accompanied with a discussion about the test, its benefits, and the implications for both positive and negative test results.
- Although a small number of people may not need it, for most, pre- and post- test discussion provides a necessary opportunity to provide clear and up-to-date information about hepatitis B and hepatitis C.
- Ideally, the same person should provide both pre- and post test discussion as this helps to build trust and rapport.
- These discussions provide important preventive and health promotion information and should encourage continued engagement with healthcare services.
- Individualised to the person’s needs, pre and post-test discussions ensures the individual receives appropriate support, before, while waiting and when receiving their result.
PRE-AND POST-TEST DISCUSSION CHECKLIST
Have issues of confidentiality and anxiety been addressed?
Has the offer been accompanied by an agreed mechanism for providing the result?
Has the offer been phrased in a way that suits the person‘s age, culture and literacy level and is respectful and non-judgmental and avoids stigmatisation and blaming language?
Has the offer taken into account potential barriers to testing such as the stigma associated with hepatitis B and C or lack of access to services?
Is the person aware of the legal requirements for notifying hepatitis B and hepatitis C?
Has the offer included information to enable people to make informed choices about their care should they test positive?
Has the offer included guidance and practical harm reduction support to reduce their risk of hepatitis B and C infection including access to NSP and OST?
Has the offer been accompanied by details of support available for clinical and non-clinical needs, both while waiting for test results and following diagnosis?
- Set up local screening, referral and treatment facilities for the general population, and especially for high-risk groups.
- Ensure early identification of chronically infected pregnant women.
- Implement routine testing for blood donors, with referral to a specialist for those testing positive.
- Provide free-of-charge, anonymous testing for all.
- Deliver targeted, low-barrier testing activities for high-risk groups.
- Develop standard protocols.
- Include liver enzyme testing in routine medical check ups
Hepatitis B and C – an action plan for saving lives in Europe, 2016
The Correlation Hepatitis C and Drug Use Initiative received an unrestricted grant by Gilead Ltd.