Increasing Blood-Borne Virus Screening in the Community Setting

St George Drug and Alcohol Service established a clear process for blood-borne virus (BBV) screening, by delivering training to staff and embedding the test into the initial assessment of new clients.

Aim

To increase BBV screening of drug and alcohol clients at the St George Drug and Alcohol Service, by 60 percent by 31 December 2017.

Benefits

• Increases BBV screening rates among new and existing clients.
• Detects BBVs earlier, resulting in earlier treatment and a reduced risk of transmission.
• Reduces the risk of illnesses associated with BBVs, such as liver disease.
• Improves clinical skills among staff, such as risk assessments, venepuncture and treatments for BBVs.
• Provides an opportunity for staff to discuss risk-taking behaviours with clients.
• Provides an easy-to-use screening guide and referral pathways for BBVs, to maintain client engagement.

Background

St George Drug and Alcohol Service provides care to more than 500 clients who experience issues related to drug and alcohol use. It offers counselling, support groups, opioid pharmacotherapy and withdrawal management services, in both a community and hospital setting. Clients with substance use disorders are at a higher risk of hepatitis C, hepatitis B and HIV, due to risk-taking behaviours such as injecting substances.

In recent years, increased access to new treatments for hepatitis C has improved healthcare outcomes for clients, while reducing the adverse effects and effort associated with treatments. Despite the slight increase in BBV screening as a result of these new treatments and the Service’s access to a FibroScan device, screening rates remained low (62 clients between 2013 and 2017) due to a lack of staff skills and capacity. In addition, there was no clear BBV screening process, which meant tests were conducted on an ad hoc basis.

The referral process for clients with positive results for hepatitis B and HIV was also unclear, and there was a lack of understanding on where to document consent and results in the client’s clinical notes. BBV screening is an important tool to detect BBVs early, resulting in faster treatment and a reduced risk of transmission and associated illnesses. As such, it was determined that a new process was required to increase BBV screening among new and existing St George Drug and Alcohol clients.

Implementation

• In-service education and resources were provided to staff on the topics of BBVs, HIV, hepatitis B and hepatitis C testing and treatments.
• A new BBV screening pathway was developed, where clients receive BBV screening at their initial assessment or within seven days. In-service education was provided to staff on this new pathway and a flowchart developed to standardise the screening and retesting process.
• Existing clients had BBV screening added to their global treatment care plan, which was updated by their case manager, with time scheduled for discussion and education on risk-taking behaviours.
• South Eastern Area Laboratory Services Pathology provided education to staff on screening processes, documentation and blood collection.
• A flowchart was developed, outlining the standard referral process for the St George Infectious Diseases Team and Liver Clinic.
• A fast-tracked referral process was developed in collaboration with the St George Pathology Unit, for situations where Drug and Alcohol staff are unable to collect bloods.
• Resources were developed for clients to educate them on the myths associated with BBVs, the importance of screening and available treatments.
• Additional nurses were enrolled in venepuncture courses, and venepuncture was added to the orientation package for new nursing staff at the Service.
• A poster was developed to advertise the BBV screening service to St George Drug and Alcohol clients.

Status

Sustained – The project has been implemented and is sustained in standard business.

Dates

May 2017 – December 2017

Implementation sites

St George Drug and Alcohol Service, SESLHD

Partnerships

Clinical Excellence Commission. Clinical Leadership Program

Results

• A total of 62 clients received BBV screening between 23 December 2016 and 10 November 2017. Prior to implementation of the project (24 December 2016 - 23 May 2017), the number of clients screened was 22, or 35 per cent. Following implementation (24 May 2017 - 10 November 2017), this increased to 42 clients, or 67 per cent.
• A staff survey conducted in November 2017, showed a self-reported increase in knowledge and understanding of BBVs, screening, referral processes and engagement of clients following in-service education.
• A survey conducted in November showed that 76.5 per cent of clients were aware that BBV screening was available at the St George Drug and Alcohol Service, with 35.3 per cent reporting it was the last place they were tested.
• Weekly audits during the project showed that 32 clients who did not wish to be screened for BBVs were provided with education on reducing the risk of BBV transmission and related illnesses.
• All permanent nursing staff in the Service were trained in the theoretical elements of venepuncture.

Lessons learnt

• Collecting bloods can be a challenge, due to staff capacity and availability, sick leave, the availability of clinical rooms and client anxiety.
• It is often difficult to access the veins of drug and alcohol clients, due to long-term intravenous substance use.

Further Reading

• Bajis S, Dore GJ, Hajarizadeh B et al. Interventions to enhance testing, linkage to care and treatment uptake of hepatitis C virus infection among people who inject drugs: a systematic review. International Journal of Drug Policy 2017;47:34-46.
• Department of Health. National Drug Strategy 2017-2026. North Sydney NSW; Ministerial Drug and Alcohol Forum; 2017.
• Keats J, Micallef M, Grebely J et al. Assessment and delivery of treatment for hepatitis C virus infection in an opioid substitution treatment clinic with integrated peer-based support in Newcastle, Australia. International Journal of Drug Policy 2015;26(10):999-1006.
• NSW Ministry of Health. NSW Hepatitis B Strategy 2014-2020. North Sydney NSW; NSW Health; 2014.
• NSW Ministry of Health. NSW Hepatitis C Strategy 2014-2020. North Sydney NSW; NSW Health; 2014.
• NSW Ministry of Health. NSW HIV Strategy 2016-2020. North Sydney NSW; NSW Health; 2015.

Contact(s)

Matthew Burdess
Clinical Nurse Consultant
Drug and Alcohol Service
South Eastern Sydney Local Health District
matthew.burdess@health.nsw.gov.au