Peer-led community based infectious disease integrated testing and linkage to care in inclusion health populations in London, UK

Background: Peer support workers (PSWs) are vital in the drive to reduce inequalities in inclusion health populations. The COVID-19 pandemic presented severe challenges to services providing care to the most vulnerable in society such as people experiencing homelessness. We describe the collaborative response of an integrated infectious disease inclusion health outreach team, led by PSWs, nurses and community partners during the ongoing pandemic.

Methods: Find&Treat are a multi-disciplinary team collaborating with community-based partners and providing outreach testing with highly trained PSWs. They utilise point-of-care testing technology (POCT), digital mobile radiology and video supported care (VSC) with two mobile health units (MHU) serving homeless, migrant and other inclusion health populations. Ongoing interventions include Peer-led blood borne virus (BBV) and sexually transmitted infection (STI) testing and linkage to care; COVID-19 PCR testing of symptomatic individuals and outbreak response mass testing; COVID-19 vaccination service; Influenza, pneumococcal and hepatitis B vaccinations; Street based sex worker (SBSW) BBVs testing.

Results: Since May 2020 3,676 BBV tests were performed. In the homeless setting there was a high proportion of people who inject drugs (16.9%) and problematic alcohol use (31.9%). The prevalence of BBVs was high for chronic HCV infection (8.1%), HIV (1.6%) and syphilis (1.4%). In the migrant population a high prevalence of HBV (3.7%) was found. In total, 13,122 COVID-19 PCR tests were done with 830 (6.3%) testing positive as well as 6,758 COVID-19 vaccinations. In the SBSW population, of the 68 tested, 21 (30.1%) were positive for at least one STI. All individuals were supported into care by PSWs and some received VSC through treatment.

Conclusion: The COVID-19 pandemic provided the opportunity to further integrate infectious disease testing, linkage to care and treatment support. The use of peer support is a powerful tool that can improve uptake and delivery of these services.