HCV Testing Starter Kit

The following information provides guidance to establish peer-delivered viral hepatitis C (HCV) community testing services for people who use drugs. The information contained in this HCV Community Testing Starter Kit is based upon the experiences of drug user organisations currently providing HCV community testing in European countries.

HCV Testing in the Community by the Community

Community-based testing refers to an approach by which targeted testing services are implemented in community settings so that they can be accessed, and used, by affected and marginalised people who may be unable, or reluctant, to access such services at public health facilities, such as at major hospitals. Community settings can include one or more of the following: fixed venues; mobile testing units; outreach sites; through home visits; and also through community-based organisations such as buildings used for religious practices, such as churches and mosques; parks; homeless shelters; needle and syringe programmes; educational environments; and workplaces, amongst others.

Community testing may be provided by health workers, such as community health staff, lay providers, nurses, and non-physician clinicians who have received appropriate training.

This HCV Community Testing Starter Kit is designed to assist services for, and by people who use drugs and their peers to implement quality HCV testing services.

It was developed with support of experts from cummunity based organisations of people who use drugs: Brugernes Akademi, Copenhagen, Caso (Consumers Associated Survive Organized) Porto, the Stockholm Drug User Union and ProLAR Nett, Oslo. The harmreduction organisations Fixpunkt e.V., Berlin and Free Clinic, Antwerp and the EuroNPUD (European Network of People Who Use Drugs) provided critical feedback.

Testing services, including community-based testing, is governed by five principles:

- - - Consent written or verbal – to voluntary testing, including the right to refuse a test;
    - Confidentiality around the sharing of information with others;
    - Pre- and post-test counselling (increasingly referred to as pre- and post-test discussion);
    - Correct results derived from high quality testing services; and,
    - Connection, or linkage to prevention and treatment services is critical and should be emphasised in all community-based testing services, including follow-up.

Starting HCV Community Testing

We have divided the HCV Community Testing Starter Kit into four sections.

Each section provides suggested tasks, actions needed and recommendations, with links to relevant documents and to sites with additional information.

1. What do you need, where are the gaps?

2. Prepare a community testing project plan

3. Testing protocol

4. Peer-testing worker recommendations

5. HCV tests

Starting Steps

What do you need, where are the gaps?

Action(s) needed:

Identify what your community needs but cannot access, and why.

Required task(s):

Organise meetings and focus group discussions with members of your community to determine days, times, locations for testing services, and preferred types of tests.

Recommendations:

If a focus group cannot be organised, distributing questionnaires or surveys may also work.

h Focus Group Planning Checklist (pdf)

h Increasing Access to Hep C Testing and Care for PWID (pdf)

Action(s) needed:

Identify gaps in the availability of testing, including best days, times, types of tests to use, target groups, etc.

Required task(s):

Meet with the local health department, NGOs, harm reduction programmes and organisations that provide.

Recommendations:

See attached community assessment checklist.

h Vaccination Community Assessment Tool (pdf)

Action(s) needed:

Investigate what testing site locations will need approval from local authorities / municipality. Each testing location may have different requirements (on the street or in a community centre/location).

Required task(s):

Meet with local authorities / municipality, local businesses and organisations where testing will be provided during outreach activities.

Recommendations:

When meeting with local authority / municipality workers or elected officials it is always a good idea to bring documentation of why you want to test at these locations and when you want to test. Infection rates are always good but information from the target groups and other organisations that show you have support directly from the community is very useful.

Action(s) needed:

Prepare a needs assessment report by documenting key information from meeting with local key stakeholders, local testing organisation, supportive hepatologists or general practitioners, and members of your target group that you want to test.

Required task(s):

Collect needed information by asking the following questions:

Is community testing allowed?
Is peer-delivered community testing allowed?
If yes, what are the legal requirements to provide peer-delivered community testing?
Who is your target group?
What are the gaps in access to testing that your service will fill?
What is the added value, or difference, that your testing service will bring?
Where will you be testing?
What is the basis / justification for offering specific tests?

Recommendations:

This is where you can obtain the required information, such as all legal and regulatory issues and requirements and determine if a testing service can be established.

Once you answer the need assessment questions, you can use it to prepare your testing project plan.

Prepare a community testing project plan

Action(s) needed:

Prepare a community testing project plan.

Required task(s):

Obtain the following information for your project plan:

- Who will be tested?
- What type of tests?
- When will testing occur?
- Where will testing occur?

Recommendations:

This information can be collected during a team meeting and speaking with members of the DU community you want to test. Most testing sites have hours and locations based upon when and where the people they want to test will be available.

Action(s) needed:

Write a description of the testing project.

Required task(s):

Collect information to describe the testing project that includes:

- The name and mission of your organisation and what you are proposing;
- The reason why you want to provide testing;
  Local data for infections and proven benefits of community testing;
- Days and times you are proposing to conduct tests;
- The specific locations where testing will be available;
- What type of tests you will be providing;
  The estimated number of people you will reach with tests; and,
- A list of partner organisations you will collaborate with, such as medical providers.

Recommendations:

Before meeting with collaborating organisations, health departments and donors, it is helpful to have a short description of the project that is easy to understand. Here is a sample description:

h ProLar Hepatitis C Bus Info (pdf)

Action(s) needed:

Introduce the testing service proposal to the local health department, elected officials and other community groups.

Required task(s):

Organise meetings with municipality and local stakeholders to brief them about your proposal.

Recommendations:

When the testing project description is ready, it is then recommended to meet organisations you want to collaborate with, gain funding from, and officials whom you want to gain support for your initiative.

Testing protocol

Action(s) needed:

Establish linkage agreements to medical care and hepatitis specialists.

Required task(s):

Meet with local hospitals and individual health care workers to establish linkage to care; determine protocols to be followed in writing (a ‘linkage agreement’).

Recommendations:

Linkage agreements with medical providers are the foundation of all testing services. Your linkage agreement to treatment will need to be signed by both organisations and have the following information:

- Name of the healthcare facility or healthcare provider;
- The dates for which the linkage agreement will be valid;
- The name of a designated person to deal with referrals and to make appointments at the local hospital or other healthcare facility;
- What is required to obtain medical care from the medical provider/facility (identification, insurance, etc.);
- Days/times of operation; and,
- Estimated waiting time upon arrival at designated facilities; this is extremely helpful for people who use drugs to prevent possible withdrawal symptoms during long waiting periods.

h Memorandum of Understanding (pdf)

Action(s) needed:

When hiring peer-workers, it is best when contracts are be prepared. This establishes clear understanding of what is expected from both the peer and organisation. The Peer Worker contract should clearly outline the responsibilities of the position, each task, training, and confidentiality requirements.

h Peer Work Contract Sample (pdf)

Action(s) needed:

Train peer-workers and provide support.

Required task(s):

All peer-workers will be trained to become test counsellors and to document their work in accordance with prescribed guidelines, standard operating procedures and protocols.

Recommendations:

Peer-worker training, or training peers to provide testing, can last one- or two-days. The training should include:

pre/post-test counselling skill building;

- How to conduct a test;
- How to document testing activities;
- Information about risks of infections, safer injection techniques and safer sex techniques;
- How to make referrals to medical providers; and,
- Other specific needs determined by the organisation.

 Two-day HCV Capacity Building Training

h Peer Worker Basic Knowledge (pdf)

HCV tests

Action(s) needed:

Determine the test or tests allowed by relevant local or national authorities for use by peer-workers.

Required task(s):

Meet with the local authority / municipality / Ministry of Health to determine which tests are authorised for use by peer-workers; ascertain whether such tests are by way of finger stick or oral.

Recommendations:

Before purchasing HCV tests, it is recommended to learn what tests the organisation is allowed to use according to local or national laws. Also, the target group may prefer a specific type of test: oral fluid; finger stick; or dry blood spot (DBS).

 Screening Technologies

Action(s) needed:

Identify the most cost-effective and reliable source of approved peer-worker HCV test kits.

Required task(s):

Once the authorised type of test(s) is/are confirmed, liaise with other organisations, local authorities and test facilities to identify a suitable supplier based on quality, cost, and reliability. A meeting with one or more HCV test manufacturer – possibly virtually if the manufacturer is located outside of your country – could help secure test kits, possibly at a price below their retail cost. test manufacturers.

Recommendations:

Contact each diagnostic testing manufacture and request samples or check with each website. Many organisations have received discounted prices for tests or donated tests and have partnered with other organisations to get better prices. It is always a good idea to contact the test manufacture to see if any discounts or donations are available.

 OraSure Technologies

 Cepheid Molecular Diagnostics

 bioLytical Laboratories

 WHO Dry Blood Spot Screening