Table 2 Lessons learned during implementation of efforts focusing on testing and treatment of hepatitis C virus (HCV)
Periods with difficulties in accessing HCV treatment | Initial difficulties in reaching people who inject drugs | Rotation in clinical staff | |
|---|---|---|---|
Description of situation | Until February 2018, Norwegian guidelines for HCV made treatment available for only approximately half of the people with chronic HCV. The other half were required to wait during monitoring until liver fibrosis had developed. Both user groups, clinicians and researchers working with HCV worked hard to change this policy | Initially, several patients were less open for testing of HCV. This might partly have been related to some initial tension in the patient-clinician relationship, as many patients were not satisfied with the choice of opioid agonist therapy they received and the follow-up requirements for the opioid | Some of the clinical staff groups such as physicians rotated frequently between different clinical sections. This made it more difficult to plan clinical patient contact and meetings with these groups |
Impact of challenges | The guidelines caused substantial frustration for people living with HCV as they were impatient to initiate treatment. It threatened a good patient-clinician relationship as clinicians were not able to provide HCV treatment to people who wanted this | The situation contributed to an initial slower start in testing of HCV, particularly during the first few months | This situation also made implementation of new routines more challenging as there was often a need for frequent training and provision of information |
Efforts to overcome the challenges | The user group involvement helped patients living with HCV understand that the delay in making treatment available was due to policy that the clinicians were required to adhere to. This reduced tension | Efforts from highly motivated and patient-centred nurses together with user group involvement contributed to an improved patient-clinician relationship making testing and treatment of HCV more feasible and efficient | Through a combination of shifting of some tasks from clinicians with frequent rotation to clinicians with higher degree of stability in addition to frequent provision of information and training, we managed to achieve good continuity and quality of care |