Turning a Negative into a Positive

1. Turning a Negative into a Positive Janet Keauffling Nurse for Homeless & Vulnerable Adults

2. Harm Minimisation Advice • How BBVs can be contracted • No “sharing” • Needle Exchange • Immunisation against HAV & HBV • Safe sex • Safer drug use

3. How to deliver Harm Minimisation Advice • Tell ‘em • Written info to take away • Leaflets • Computer screen savers • DVDs • Keep telling ‘em • Pre & Post test discussions

7. How BBVs can be contracted • Transmission is through blood to blood contact • Sharing of any drug paraphernalia, razors & toothbrushes • 1 in 3 risk of contracting HBV • 1 in 30 risk of contracting HCV • 1 in 300 risk of contracting HIV • Low risk of transmission with sex • Can’t be contracted through sharing cups, cutlery, toilets and other household items

8. Pipes Flutes Straws Bongs Filters Cookers Spoons Swabs Needles Syringes water for injection Razors Toothbrushes No “sharing”

9. Immunisation against HAV & HBV • There is no vaccine to protect people from Hepatitis C or HIV • There is an injection that can prevent both HAV & HBV • Immunisation against HAV & HBV is simple and can be provided by GPs, Practice Nurses, CDATs, GUM (ISH) etc.

11. Needle Exchange • Direct to nearest needle exchange • Never share any drug paraphernalia • Use clean works for every injection • Never toss used needles in the street, in rubbish, down the drain or down the toilet • Dispose of all used equipment at the NEX

12. Safe Sex • Use condoms • Use condoms or clean all sex toys after every use • MSM sex is higher risk for BBVs • Menstrual loss

13. Safer Drug Use • Move away from injecting • Reduce the frequency of injecting • Reduce the risks associated with injecting drug use through NEX, no “sharing” etc. • Refer for support, advice and help to stop if they want it

14. Other Advice • Always use gloves to clean up any blood or body fluid spills • Cover cuts with a plaster • Clean up spills properly • Hepatitis C can survive outside the body for up to 7 days • Always use a local authority registered tattooist, acupuncturist, piercing shop – i.e. no “jail-house” tattoos etc.

15. Pre-test Discussion • It provides an excellent opportunity to give harm minimisation advice as part of the pre-test “counselling” • You can give information whilst doing immunisations and blood tests

16. Downside • Too much detailed information to give • Too little time • Test is just a “passport” to dealing with their lifestyle issues

17. Post test advice Guidance says: • Re-test if any at risk behaviour in the past 3 - 6 months • Give prevention advice if lifestyle persists

18. Positives • They may have had a scare and be prepared to listen • Their fears have been realised & they want help

19. Negatives • They may be in a “rush to see someone” • Their fears have not been realised • Their fears have been realised but they can’t cope with the reality when they are faced with it

20. Hepatitis C Positive Results • Immunisation • Safe sex • NEX • Strategies to move away from injecting • Reduce / stop alcohol • Stop smoking

21. But… • They’ve just had a positive result and they can’t take any of it in

22. 2 Types of Negative Results • HCV antibody negative • HCV antibody positive – viral load negative (HCV antibody positive – PCR negative HCV antibody positive – PCR not detected)

23. HCV antibody negative

24. Beware the Negative Result! • May provide false reassurance • May use result as evidence to others • Badge of Honour • May think that if they’ve got away with it so far that their practises are safe

25. HCV antibody positive – viral load negative

26. HCV antibody positive – viral load negative • The patient has previously had HCV infection but has cleared the virus • The person will remain HCV antibody positive for the rest of their life even though they no longer have the infection • The person can still contract other HCV genotypes

27. HCV antibody positive – viral load negative • If they have been treated for one HCV genotype with interferon & ribavirin they have no protection against that genotype and can still be re-infected • The viral load / PCR can become transiently negative during the acute phase so must be re-checked at 6 months

30. Window Period • HCV antibodies can take up to 3 months to show themselves (DOH 2004; BBV Action Plan 2010) • (NB: RCGP says that the window period is 6 months)

35. Reality Check • IDUs are busy people… • Try to assess what the patient / client already knows & build on that • If the patient / client has only got 5 minutes then testing can’t be done safely • But…don’t over-complicate things • Use time wisely to get the vital info over • Use leaflets, posters, other resources & your local NEX to inform

36. Thank you for listening • Any questions?

37. References • Hepatitis C - Essential information for professionals and guidance on testing, DOH 2004 • RCGP Guidance for the prevention, testing & management of hepatitis C in primary care, RCGP 2007 • Blood Borne Viral Hepatitis Action Plan for Wales 2010-2015 • http://www.library.nhs.uk/integratedSearch/viewResource.aspx?resID=394438