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Working with SEPs: Working with SEPs: How do we expand How do we expand Hepatitis ServicesHepatitis Services ??
Narelle Ellendon, RNNarelle Ellendon, RNHCV DirectorHCV DirectorHarm Reduction Coalition, NYC Harm Reduction Coalition, NYC [email protected]@harmreduction.orgwww.harmreduction.orgwww.harmreduction.org
Why work with SEPs?Why work with SEPs?
Prevent the spread of any blood-borne Prevent the spread of any blood-borne infections, including HIV and Hep Cinfections, including HIV and Hep C
Make and maintain contact with active Make and maintain contact with active injectors outside of the health care injectors outside of the health care systemsystem
Varied delivery, size, nature, populations, Varied delivery, size, nature, populations, etc, etc, etc…etc, etc, etc…
Why SEPs ???Why SEPs ???
It’s not just the Syringes, it’s not just the SEP.It’s not just the Syringes, it’s not just the SEP. Bridge to treatment and other servicesBridge to treatment and other services
- HIV testing & counseling- HIV testing & counseling
- Medical & Mental health services- Medical & Mental health services
- Case Management- Case Management
- Housing- Housing
- Food programs- Food programs
- Support groups- Support groups
SEP ParticipantsSEP Participants Many IDUs not using SEPsMany IDUs not using SEPs More then half acquire syringes from More then half acquire syringes from
potential unsterile sourcepotential unsterile source Nearly half report “sharing” syringes and Nearly half report “sharing” syringes and
other equipmentother equipment Generally participants of SEPs have been Generally participants of SEPs have been
injecting for some timeinjecting for some time Large number of IDUs already infected with Large number of IDUs already infected with
HCVHCV
HCV Prevention HCV Prevention AttitudesAttitudes
HCV infection is INEVITABLEHCV infection is INEVITABLE
HCV infection is HCV infection is INCONSEQUENTIALINCONSEQUENTIAL
HCV infection is HCV infection is INDETERMINATEINDETERMINATE
Limitations of SEPs to Limitations of SEPs to address HCV?address HCV?
Lack of expertise & trainingLack of expertise & training Competing PrioritiesCompeting Priorities Lack of referral options for DU’sLack of referral options for DU’s Funding LimitationsFunding Limitations Regulations on syringe provisionRegulations on syringe provision Police HarassmentPolice Harassment Federal banFederal ban
Where to begin……Where to begin……
Assessment:Assessment:- Participant- Participant- Staff- Staff- Program- Program
Evaluation not just for Data.Evaluation not just for Data.Process of assessment needs to provide Process of assessment needs to provide
Education & Interventions.Education & Interventions.
Adding Hep C….Adding Hep C….One size does NOT fit One size does NOT fit all…all…
Tailoring Program Strategic Plan to the Tailoring Program Strategic Plan to the SEP.SEP.
HCV Networking, (Motivation & Position)HCV Networking, (Motivation & Position) Tailored Training, (SEP Staff, Other Tailored Training, (SEP Staff, Other
services)services) Peer EducationPeer Education Manuals & CurriculumManuals & Curriculum MaterialsMaterials
Adding Hep C….Adding Hep C….
Build on existing assessment toolsBuild on existing assessment tools HCV Screening & Hep A/B Vaccs HCV Screening & Hep A/B Vaccs
servicesservices Linkages to care & treatmentLinkages to care & treatment
AdvocacyAdvocacy
Local & National forums to bring the Local & National forums to bring the focus on Hepatitis C & Drug focus on Hepatitis C & Drug
Coaching/Mentoring internal program Coaching/Mentoring internal program advocacyadvocacy
Community focus, African Americans & Community focus, African Americans & HCVHCV
Pharmaceutical companiesPharmaceutical companies FundingFunding
IDUs more likely to not IDUs more likely to not be infected with HIV or be infected with HIV or HCV if…..HCV if…..
Avoid situations that threaten safe Avoid situations that threaten safe injection:injection:
- withdrawal period- withdrawal period- lack of syringes- lack of syringes- high-risk contexts- high-risk contexts- institutionalization- institutionalization
Match equipment supply with drug supplyMatch equipment supply with drug supply Maintain connection with communityMaintain connection with community
Opportunities…. Validate & Share IDUs strategies to avoid HCV Infection.Validate & Share IDUs strategies to avoid HCV Infection.
Change syringe quotasChange syringe quotas
Tap into Social Networks, Peer Secondary ExchangeTap into Social Networks, Peer Secondary Exchange
Police/Community EducationPolice/Community Education
Address stigma of Drug Users Address stigma of Drug Users using other servicesusing other services
Federal Ban on $ for SEPFederal Ban on $ for SEP
Safer Injecting FacilitiesSafer Injecting Facilities