Programming Connection

Ontario Hepatitis C Team: Elevate NWO 

Elevate NWO
Ontario
2014

How Does the Program Work?

Elevate NWO has a regional identity with a catchment area about the size of France. Although efforts are underway to increase direct client services in other communities, most in-person services are only available in Thunder Bay.

The agency’s roots are in HIV prevention and support; however, since 2012, hepatitis C and HIV client services have been integrated. Practically, this means that direct client services, which include information services, the distribution of harm reduction supplies, and support programs, such as social outings, the food bank, and some support groups, are integrated.

An integrated, multidisciplinary hepatitis C team is a natural fit at Elevate NWO, where clients are already accustomed to receiving a number of services at one time in one place. This team coordinates Thunder Bay’s hepatitis C prevention, treatment and support work, including the distribution of harm reduction supplies and information, hepatitis C treatment, case management and other psychosocial support for clients who are at risk for hepatitis C or who live with hepatitis C. Referrals for hepatitis C testing are made to the public health unit.

Community development

Community coalitions

Part of the hepatitis C team’s mandate is to engage other service providers in discussions about hepatitis C. The goals of this community engagement are to reduce hepatitis C transmission through greater access to harm reduction supplies and accurate risk-reduction information and to increase rates of engagement in treatment and support for people living with hepatitis C.

A community developer engages the community by participating in coalitions of service providers, such as the local poverty reduction coalition and the local homelessness coalition. By working in this way, Elevate NWO is increasing awareness of hepatitis C among service providers across the city of Thunder Bay who may work with people at risk for or living with hepatitis C.

In 2012, the community developer also convened a hepatitis C network to further strengthen linkages among service providers who may work with clients at risk for or living with hepatitis C. Despite the strong relationships being built, it has been challenging for Elevate NWO to increase the profile of hepatitis C in the community because a variety of priorities compete for the attention of service providers.

One strategy that the community developer has used to improve engagement around the issue is to make sure that every person on the network’s committee is invested in the network’s activities. This is done by ensuring that the campaigns the network launches and the concrete actions it takes are relevant to the work of each of the members.

Road shows

Twice a year, the hepatitis C team tours smaller communities in the district to deliver presentations about hepatitis C, HIV and Elevate NWO to service providers. This is one way that the team promotes its services and connects with nurses and social workers across northwestern Ontario. Although this has been a good way to improve the team’s profile in its catchment area outside of Thunder Bay, the distances across the district continue to make it difficult for staff to maintain strong relationships with service providers year-round.

Prevention

Prevention services at Elevate NWO, like the rest of its programs, are integrated. This means that presentations, information sharing, risk-reduction counselling and the distribution of harm reduction supplies raise awareness of both hepatitis C and HIV. Outreach workers from Elevate NWO work through strategic partnerships with other organizations around Thunder Bay, including local shelters, soup kitchens and the local Boys and Girls Club. A few times a week, outreach workers and peers distribute harm reduction supplies and provide client support on the street, following a set route around town.

Treatment

Elevate NWO’s hepatitis C team includes two treatment nurses who work with Thunder Bay’s infectious diseases specialist to assess, monitor and treat clients with hepatitis C. The nurses work in the Elevate NWO office and at the infectious diseases specialist’s clinic. Nurses provide information and assess whether clients are ready for treatment. They make sure that clients have a primary care provider and that all of the necessary blood work and other baseline tests have been done before treatment is initiated.

Nurses also play a key role in identifying barriers clients may have to treatment, including mental health challenges, lack of adequate financial support, lack of adequate food and other issues.

Finally, nurses are responsible for monitoring clients during and after treatment. Clients are given the flexibility of choosing where to get their care: they can attend nursing appointments at Elevate NWO or at the infectious diseases specialist’s clinic. Having staff always available to see clients at Elevate NWO, which is a community-based site that has strong support services, is very important for many clients. They can come in for treatment, use the food bank and talk to a case manager all in the same visit. This one-stop shop approach is key to ensuring treatment adherence, especially for clients who may be challenged to keep appointments and who may not be feeling well.

Support

The case manager provides support services for clients by offering harm reduction supplies and counselling, accompanying them to appointments, advocating on their behalf for other services when needed, and facilitating referrals for specialized counselling for mental health and addictions.

Although the case manager works with any client in need, they work particularly closely with clients who are preparing to go on treatment and who are currently on treatment. They provide help to reduce systemic barriers to treatment such as inadequate housing, food insecurity and financial instability and provide counselling to clients who may need it as they initiate and continue treatment. Counselling may be for pre-existing concerns such as depression or substance use or to provide support in dealing with the side effects that clients may experience as a result of treatment.

Biweekly support groups offer people living with hepatitis C peer support, education on treatment and living well with hepatitis, and an opportunity to socialize with people who have similar experiences.

Peers

As a community-based organization, Elevate NWO has always relied on the work of peers to provide services. The organization and its services are integrated, so peers may be living with HIV or hepatitis C or they may be co-infected.

Peers are hired annually, through a hiring process that includes an application and an interview. When hiring peers, staff look for people who are already engaged at Elevate NWO, who are friendly and approachable, who demonstrate commitment and who have a personal understanding that harm reduction works to help people who use substances remain healthy.

Peers are hired every March and receive an honorarium for their work. Peers must complete five workshops (HIV 101, HCV 101, Sexually Transmitted Infections 101, Harm Reduction 101 and Getting to Know Your Community, a workshop about community resources) before starting to work with clients. Peer team meetings are used to refresh and reassess peer knowledge, and peers are expected to attend other agency-wide training.

Peers are involved in direct client services, by distributing harm reduction supplies and providing peer support to clients through support groups and during social events. Since 2014, Elevate NWO has had a peer leader who is responsible for coordinating the peers and managing the harm reduction supplies room.

The current outreach worker on the hepatitis C team is a former client and peer worker of the organization, a testament to the agency’s commitment to building the capacity of people with lived experience to be meaningfully involved in providing services to the community.

Telehealth

Access to the Ontario Telemedicine Network (OTN) has made connecting with clients across northwestern Ontario easier for the hepatitis C team at Elevate NWO. Clients can receive care from treatment nurses in Thunder Bay via video and telephone links set up in healthcare centres in their communities.

Through telehealth, clients on treatment can access specialized hepatitis C care without having to travel to Thunder Bay. Given that the currently available treatments for hepatitis C can take as long as a year to complete and may have significant side effects, this support is crucial for clients. Knowing they can access a healthcare provider with expertise in hepatitis C from their home communities encourages clients to seek care and support rather than stop treatment. Although nurses prefer to see clients in person, the OTN has improved healthcare access for people living with hepatitis C in remote communities.

Elevate NWO has also piloted telephone-based case management for clients. This service, which has been successful, keeps people in communities outside of Thunder Bay who live with HIV or hepatitis C connected to service providers. This is key for clients in smaller communities who may feel socially isolated.

Telehealth and telephone-based case management have also strengthened the hepatitis C team’s network of service providers outside Thunder Bay. The team has had to connect with service providers (physicians, nurses, counsellors, community health workers) in communities nearer to clients so that clients have access to in-person services when needed.

Next steps

Elevate NWO has a regional mandate and is working to foster strategic relationships with service providers outside of Thunder Bay. As of August 2014, Elevate NWO is working with a physician in Sioux Lookout, a community five hours north of Thunder Bay, to provide harm reduction supplies in the community. Local peer educators are being trained to provide information about safer drug use and to distribute harm reduction supplies in the community.