Peers On Wheels: the new van that is revolutionising hep C healthcare | Interview with MJ
Peers On Wheels (POW) is a new pilot project NUAA has launched. The project delivers mobile peer-led testing and treatment services for hepatitis C (hep C). POW is friendly, confidential, quick and easy. POW is visiting a bunch of places in NSW over the coming months. To help spread the word to peers, we interviewed MJ, the project’s Coordinator.
Users News (UN): We have been talking to many people who use drugs, who are hep C positive, and who live in rural areas and they’ve been calling out for help to overcome the many barriers they face to getting hep C treatment.
People say stigma and lack of services are some of the biggest barriers, and that one way to help people would be to have a portable AND peer-led ‘one-stop-shop’ van for hep C testing and treatment.
That sounds a lot like the van you’re about to launch as part of your pilot project! What has finally made this project a reality?
MJ: Hi! We couldn’t do this without the new portable hep C testing machines and new treatment medications.
These new testing machines are very sophisticated. They detect the active hep C virus in a person’s RNA — an acid all humans have that is similar to DNA and give an answer in less than an hour. Recently the machines have gotten small enough, accurate enough, quick enough, and cheap enough to put in a van. Our friends at the Kombi Clinic in Queensland have shown how using a van to take testing and treatment of hep C to people can break down the barriers.
But what makes NUAA’s project so special is that ours is peer-led — which is so important for making people who use drugs feel comfortable enough to use the service. Our project has been co-designed by people who have a lived experience of injecting drug use, and we’re training peers to operate the machine.
UN: Tell us more about how these new testing machines work
MJ: The Australian National Hepatitis C Virus (HCV) Point-of-care Testing Program is run by the Kirby Institute and Flinders University. The program is making hep C testing more available by rolling out these ‘point-of-care testing’ (POCT) machines at many sites across the country. Some of them are at fixed sites like NUAA’s NSP and some are mobile, like NUAA’s van.
As part of the national program, NUAA got funding to run a pilot study to see how effective it is to get peer workers to provide mobile testing to people who have trouble getting access to testing or don’t want to go to mainstream services.
We can test if you have an active hep C infection by taking a small amount of blood from a fingertip and putting it in the machine to find out the level of virus in your blood.
It gives us the same information as the new Dried Blood Spot (DBS) tests but in a much shorter timeframe. You find out within roughly 60 minutes, instead of having to wait up to 2 weeks. That’s why we call them ‘Point-of-Care’ tests — because you get your results at the same point you get tested. If we find hep C in your blood sample, we can start treatment during that same visit.
In 2016, new hep C treatments called direct-acting antivirals (DAAs) became available. They are much easier to prescribe and use compared to the old Interferon treatments. DAAs are as simple as one pill a day for 8 to 12 weeks, and they have a 95% cure rate and very few side effects.
UN: How did you get involved in this project?
MJ: I’m an activist and junior academic. As a peer, I get to occupy a unique space in research. I’ve spent most of my life in South Africa before moving to Australia earlier this year to start a new journey. In South Africa,
I worked for the South African Network of People Who Use Drugs (SANPUD) and held a research position at the University of Pretoria’s Community Orientated Substance Use Programme. These positions helped me develop unique skills and gain experience in working with peers and people who use drugs.
I’m now at The University of New South Wales’ (UNSW) Kirby Institute, where I’ve been given the opportunity to be involved in lots of projects, including this one.
UN: Who works in the van?
MJ: There’s always 2 other people with me in the van, all peers. Rodd Hinton and Brie Lloyd both work at NUAA as hep C engagement specialists and I’ll always have one of them with me in the van. As well, we will include a NUAA Peer Worker from each Local Health District (LHD) we visit. They work with us in their community to help us reduce as many barriers as possible for their peers, and link people with further healthcare.
Flinders University’s International Centre for Point-of-Care Testing has trained our team to operate the POCT machine. We will also tell you your result and connect you with a GP or nurse who can prescribe you the treatment medication.
The research part of the project is supported by NUAA’s Deputy CEO, Charles Henderson, who is the project’s Principal Investigator, and UNSW’s Kirby Insititute.
UN: Where and when is the van visiting?
MJ: The pilot project is running until the middle of 2023. We’ll be visiting a bunch of different areas of NSW and partnering with local organisations to reach as many people as possible. We will be putting location updates on NUAA’s website or you can call NUAA on 1800 644 413 to ask when we will be in your area.
UN: Can you run us through what the experience will be like for someone?
MJ: Anyone who is at risk of getting hep C is eligible and we encourage you to visit us. When we’re with you, we want you to feel safe, comfortable and like you don’t have to hide anything. Our specialty is helping people who inject drugs. To help incentivise people to get tested, we will be reimbursing people for their time.
Prior to our van arriving in your area, we’ll be promoting when and where we’ll be parked.
You can just rock up on the day. All you need to bring is your Medicare card. If you don’t have one, call us on 1800 644 413 and we’ll try and sort something out.
If that time/place doesn’t suit you, you can also call 1800 644 413 to arrange something else. We can visit you discreetly. Our van does not have any branding on it and we can go to a location you are comfortable with.
When you get to the van, we have a quick chat with you to make sure you feel comfortable and understand the process and your options. We will answer any questions you have.
With your permission, we’ll prick your finger to get a single drop of blood for testing. About an hour later, we’ll be able to tell you if you’re currently hep C positive. This news can be tricky to process on your own, which is why it’s so good to have us peers there to support you and just chat about it all.
We can then assist you to get prescribed DAA medication as soon as possible. Unfortunately, our peers aren’t qualified to prescribe the medication. At each site, we will try and have a doctor with us so they can give you the prescription on the spot. Some might also be able to prescribe you via a phone call and mail you the meds. The length of time it takes for us to get the medication in your hands will depend on the location and each individual case. Some may take a couple of weeks.
We also hook you up with a liver health specialist who can help you know more about what’s going on in your liver. We recommend you get a fibroscan and liver function test, but you don’t need to have one to get started on the meds. (We won’t have a fibroscan with us in the van).
While you’re on your treatment journey, if there’s any help you need, you can contact our local peer.
We also have a "mobile" NSP with a variety of equipment for people to grab.
UN: What are you hoping the pilot study achieves?
MJ: We want to show that a peer-led approach can help make testing and treatment more accessible. I want to make healthcare fun. We want to show that peer workers have expertise and knowledge and can provide a unique skillset. Peers trust each other when it comes to this stuff. People with lived experience of drug use and hep C are stigmatised and discriminated against, but we are very capable and we care about our community. This project is yet another example of peers stepping up to be harm reduction heroes.
Each person we test is asked to participate in a short survey that will help us improve the service, and hopefully get the pilot extended and expanded.
UN wants to hear people’s stories of hep C and what it’s like to use the POW van — so we’re offering $50 per interview. To participate, chat to MJ or contact Users News / PeerLine at 1800 644 413 or usersnews@nuaa.org.au
Find out when Peers on Wheels will be doing hep C tests in your local area by checking out the website nuaa.org.au/peers-on-wheels-pow or calling PeerLine on 1800 644 413
