Blood borne viruses (BBV) screening for rough sleepers during Covid-19 pandemic

On Monday 22nd June 2020 a partnership between the Brighton-based HIV charity, The Martin Fisher Foundation and not for profit organisation EmERGE M-Health Ltd, saw the launch of a Hepatitis and HIV screening programme for all temporarily housed rough sleepers (about 200 of them) in Brighton & Hove. Outreach workers from Brighton & Sussex University Hospitals NHS Trust and the Terrence Higgins Trust, aided by St Mungo’s support workers, are going into the hotels and offering screening using a simple finger-prick test. Personal protective equipment (PPE) will be used for face-to-face interactions and clients will be offered a £5 food voucher for their time and engagement. This project has been generously funded by Gilead Sciences.

Dr Gillian Dean, Trustee of the Martin Fisher Foundation and Consultant HIV Physician, said “the Covid-19 response has given us a once in a lifetime chance to reach out to this traditionally ‘hard-to-find’ group and offer them screening. By offering finger-prick tests we’re expecting a higher uptake, and knowing where clients are living will improve our chances of linking those testing positive into appropriate care. The project supports the Brighton & Hove Towards Zero HIV initiative, whilst also working towards the national target eliminating hepatitis C”.

Marc Tweed, Centre Manager at Brighton Terrence Higgins Trust said “At the heart of the project is working in partnership with a network of professionals in the city, drawing on their specialist knowledge and skills to ensure that what we are offering meets the complex and diverse needs of the people we want to engage with. In the light of recent medical advances, as we look towards ending new HIV transmissions in Brighton & Hove and encourage more people to test for HIV and Hepatitis C, it is vital we don’t take our eye off the ball in continuing our testing, treatment and prevention efforts. That’s why Terrence Higgins Trust wholeheartedly supports this project and is proud to be a part of it.”

The need for social isolation in England due to Covid-19 has resulted in the movement of vulnerable people off the streets and into individual hotel rooms. A range of people are being accommodated from the entrenched homeless to people with no history of rough sleeping who were previously sofa-surfing.

A unique multidisciplinary team has been established including: St Mungo’s support workers, specialist homeless GPs (Arch Health CIC), Hepatitis C (HCV) specialist outreach nurses, substance misuse specialists (Change Grow Live [CGL]), HIV prevention experts (Terrence Higgins Trust), and Brighton & Sussex University Hospitals NHS Trust.

We are offering HIV, Hepatitis B and Hepatitis C tests by using dried blood spot sampling (DBS). The successful processing rate for  DBS has been shown to be 98.8% and gives highly accurate results. This method is the preferred testing medium for this traditionally ‘hard-to-bleed’ group and will reduce ‘contact sampling time’ compared to traditional venous bloods during the Covid-19 pandemic.

For those diagnosed with BBVs we will support treatment in the community if necessary. For HIV, by taking as few as one tablet a day, the virus is completely controlled and cannot be passed on. Hepatitis C is now completely curable by taking just one tablet a day, with few side effects, for only a 8-12 weeks. People often report feeling much healthier once they have cleared Hepatitis C.

We estimate the ‘number needed to test’ to identify one case of current Hepatitis C infection will be 4. The ‘number needed to test’ to diagnose one case of HIV will be between 50-200.