Integrating peer support within NHS clinics: a London Fast-Track Cities Initiative (FTCI) project

ABSTRACT

Background: BHIVA Standards of Care for people living with HIV (PLWH) include quality statements and auditable outcomes for peer-support pathways to improve selfmanagement and engagement in care. FTCI London convened 3-year 'improvement collaborative' projects between HIV charities and NHS clinics. Chelsea and Westminster Hospital (CWHFT) supported the implementation of this initiative to 4 London HIV clinics with a cohort of >10,000 PLWH. We here illustrate the results of this initiative to date. Method(s) Positively UK, NAZ Project, Plus Health and CWHFT trialled approaches to integrating in-clinic peersupport pathways, with the aim of having >90% of those accessing peer-support retained in care, with a VL<50. 3 peer-supporters (2 FTE posts) received NHS honorary contracts, emails and the ability to log interventions within the Trust's EPR. Data on peer-support attendance and outcomes were collected from the EPR into an encrypted NHS database. Result(s) Although planned as an in-person initiative, the COVID-19 pandemic led to a shift to fully remote support and delayed project initiation to 7/2020, when email referrals commenced for newly diagnosed and those identified as being at risk of lost to follow up (LTFU). Referrals reached 4.4/month within the first 3 months. Initiatives such as MDT, focus group participation, staff teaching, and physical presence in clinics increased referrals to 7/month by 4/2021 and 12/month by 11/2021. Median patient age was 45 years (range 16-74), 13% were female, and 47% from BAME background (vs 34.5% in the CWHFT HIV cohort). Median diagnosis length was 2 years (<1-31). Moving from opt-in to opt-out support for newly diagnosed increased uptake of support from 33% in 4/2021 to 67% by 12/2021. Overall, 287 people (66% of referrals) engaged with peersupport between 7/2020 and 11/2022, with 164 (57%) receiving ongoing support. Virtual appointments moved from 100% to 54% over time. Rates of having a VL<50 increased from 71% at referral to 90% following peer-support, including new diagnoses. Conclusion(s) Implementing in-clinic peer-support pathways significantly increased referrals and uptake of support for new HIV diagnosis and those at risk of LTFU, showing the potential of improving clinical outcomes and quality of life of PLWH.