HCV Testing Starter Kit

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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.

What is Community Testing?

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.

 

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.

    Preliminary needs assessment ↓

    Community assessment ↓

    Testing protocols ↓

    Peer-testing worker support ↓

    HCV tests ↓

    Testing Manual ↓

    Examples ↓

    Template Documents ↓

    Starting Steps

    1. Preliminary needs assessment

    Even if it is widely acknowledged that testing in the community by the community is effective, it is important to determine the added value of that service to the community; the question is – why your testing service?

    Action(s) needed:

    Required task(s):

    Recommendations:

    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.

    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.

    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: 

    1. Is community testing allowed?

    2. Is peer-delivered community testing allowed?

    3. If yes, what are the legal requirements to provide peer-delivered community testing?

    4. Who is your target group?

    5. What are the gaps in access to testing that your service will fill?

    6. What is the added value, or difference, that your testing service will bring? 7. Where will you be testing? and, 

    8. 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.

    2. Prepare a community testing project plan

    The community testing project plan.
    Action(s) needed:

    Required task(s):

    Recommendations:

    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 avialble.

    Action(s) needed:

    Write a description of the testing project.

    Required task(s):

    Collect information to describe the testing project that includes:

    1. The name and mission of your organisation and what you are proposing;
    2. The reason why you want to provide testing;
    3. Local data for infections and proven benefits of community testing;
    4. Days and times you are proposing to conduct tests;
    5. The specific locations where testing will be available;
    6. What type of tests you will be providing;
    7. The estimated number of people you will reach with tests; and,
    8. 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: (link)

    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.

    3. Testing protocol

    Testing protocols include guidelines and standards for establishing and providing testing services and connecting to care.

    Action(s) needed:

    Required task(s):

    Recommendations:

    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:

      1. Name of the healthcare facility or healthcare provider;
      2. The dates for which the linkage agreement will be valid;
      3. The name of a designated person to deal with referrals and to make appointments at the local hospital or other healthcare facility;
      4. What is required to obtain medical care from the medical provider/facility (identification, insurance, etc.);
      5. Days/times of operation; and,
      6. 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.

      (template linkage agreement form)

       

      Action(s) needed:

      Ensure testing and treatment protocols are in place with each referral site / testing and treatment provider.

      Required task(s):

      Ensure written protocols are in place for confirmatory tests and treatment at each designated site.

        Recommendations:

        Each referral site should have a written protocol for individuals to receive a specific type of service.

        Action(s) needed:

        Obtain written permits and authorisation for mobile testing.

        Required task(s):

        Meet with the relevant local authority / municipality to acquire all permits and authorisation required for mobile testing.

        Recommendations:

        Each location / city has their own guidelines, requirements and fees to issue a permit for parking mobile testing units. It is recommended to check the website of your local authority / municipality for this information, or meet with relevant officials.

        Action(s) needed:

        Establish testing policy and guidelines.

        Required task(s):

        Prepare guidance and a manual outlining testing procedures and protocols for training peer workers.

        Recommendations:

        Each testing site should have protocols that include administering a screening tool to determine who is eligible to be tested. The screening tool will be based upon specific risk behaviours over a period of 3 months. If the person has participated, or engaged, in risk behaviours likely to cause infection, they should be tested. Legal age requirements of each location / city / country will also need to be adhered to.

        4. Peer-testing worker recommendations

        Peer-testing protocol: This describes specific support and training required to effectively provide testing by peer-workers.

        Action(s) needed:

        Required task(s):

        Recommendations:

        Action(s) needed:

        Establish a protocol for identifying peer-workers.

        Required task(s):

        A standardised screening tool can be developed to identify peers who use drugs to be hired as testing workers. This ensures a fair system for all those applying for such work.

          Recommendations:

          Based on information provided, all potential peer-workers should be able to manage their personal drug use, participate in OST services (where relevant), and demonstrate good communication skills.

           

          Action(s) needed:

          Hire peer-workers (peer-worker contract template).

          Required task(s):

          All peer-workers must have a contract that clearly describes their work, training, support provided, payment and unacceptable behaviours.te.

            Recommendations:

            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. (Peer-work contract sample)

             

            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;

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

             

            5. HCV Tests

            HCV Tests

            Action(s) needed:

            Required task(s):

            Recommendations:

            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).

               

              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.

                 

                 

                Service Delivery

                1. Testing Manual

                Testing manual: Testing operations and policy manuals clearly outline and describe testing procedures and protocols.

                Action(s) needed:

                Required task(s):

                Recommendations:

                Action(s) needed:

                Review existing community HCV testing manuals, where available.

                Required task(s):

                Review the HCV community testing manuals of other organisations to identify areas that you may need to replicate or include.

                Recommendations:

                When starting an HCV community testing service, there is no need to create your own testing manuals as they already exist. Most community testing services operate and conduct testing services in similar ways. We suggest reviewing as many operational testing manuals as possible to create your own. ECDC, WHO and CEHRN all have material to help you. We have a selection of sample manuals for you to look at (link).

                Action(s) needed:

                Replicate all required information from other sources to create your own testing manual.

                Required task(s):

                All required information can be replicated from other sources in your HCV Community Testing Operational Manual.

                Recommendations:

                After reviewing operational testing manuals, you can replicate the information that is required according to ECDC and WHO guidelines.

                Action(s) needed:

                Include content identified for testing services for people who use drugs.

                Required task(s):

                Information collected from organisations of people who use drugs can be included in your HCV Community Testing Operational Manual.

                Recommendations:

                What has not been included in standard operational testing manuals is how to identify, train and supervise peer workers who do testing. This information has been provided by organisations of people who use drugs who have helped to develop this guidance. Here we offer you additional information that you may want to include based upon the experience of such organisations (link).

                 

                Action(s) needed:

                Equipment for safe testing.

                Required task(s):

                • Sharps / needle containers;
                • Disposable gloves;
                • Plasters;
                • Universal wipes (special) to clean surfaces;
                • Pens/alcohol markers to write on screening tools (to ensure different tests do not get mixed up);

                Sterile injecting equipment to give to PWID, if needed.

                Recommendations:

                When providing testing services universal precautions must be followed and testing guidelines according to WHO, ECDC and your local ministry of health. (link)

                 

                2. Manuals for Community Testing

                Examples of existing manuals for community testing.

                Action(s) needed:

                Required task(s):

                Recommendations:

                Action(s) needed:

                Prolar

                Required task(s):

                Community Testing Manuals and other services delivery support information.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                User Academy

                Required task(s):

                Community Testing Manuals and other services delivery support information.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Free Clinic

                 

                Required task(s):

                Community Testing Manuals and other services delivery support information.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Fixpunkt

                Required task(s):

                Community Testing Manuals and other services delivery support information.

                Recommendations:

                Community testing information samples (link)

                3. Template Documents

                Template Documents

                Action(s) needed:

                Required task(s):

                Recommendations:

                Action(s) needed:

                Linkage to care.

                Required task(s):

                The linkage to care agreement form will indicate:

                1. The name, address and contact details of the referral facility;
                2. The name and phone number of the contact person from your organisation and that of the referral facility;
                3. The agreed terms of collaboration; and,

                The time period for which the linkage to care agreement is valid / operational.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Peer-worker screening tool.

                Required task(s):

                Standardised screening to determine eligibility to become a peer-test worker. The screening tool will assess cognitive skills, drug use stability, ability to keep to a schedule, communication skills, etc.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Free Clinic

                 

                Required task(s):

                A peer-worker contract indicates payment, days, hours, required tasks, required conduct and terms of dismissal.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Fixpunkt

                Required task(s):

                A standardised consultation form required by ECDC and the relevant local authority / Ministry of Health.

                Recommendations:

                Community testing information samples (link)

                Action(s) needed:

                Replicate all required information from other sources to create your own testing manual.

                Required task(s):

                A referral form is a standard form that verifies that the person is being referred by your organisation to another facility for a confirmatory test and then treatment.

                Recommendations:

                After reviewing operational testing manuals, you can replicate the information that is required according to ECDC and WHO guidelines.