October 16, 2013
Dr. Stacey Toomskin (left) with second-year medical student Katrina Castille.
A white van large enough to fill three parking spaces pulls into a southwest Philadelphia neighborhood. Several Drexel medical students and other volunteers emerge, led by Drexel Medicine’s Stacey Trooskin, M.D., Ph.D., assistant professor in the Division of Infectious Diseases and HIV Medicine. Traveling in pairs, the volunteers begin canvassing up and down the street within a two-block radius, encouraging local residents to “Do One Thing”: come out to the van – a mobile lab – for a free and easy test for hepatitis C (HCV) and HIV.
Trooskin and the College of Medicine are collaborating with Amy Nunn, Sc.D., of Brown University’s Alpert Medical School in the “Do One Thing, Change Everything” campaign, aimed at combating not only HCV, but also HIV, in medically underserved communities.
One of the first of its kind nationwide, the campaign aims to dramatically stimulate HCV and HIV testing in communities with high rates of infection. The approach focuses on the neighborhood as the unit of intervention, rather than the individual. Philadelphia is serving as the campaign’s model city, with plans to offer it in other cities in the future. The program’s unique mobile lab offers free, rapid testing for both diseases.
“Hepatitis C is a hidden disease in many urban communities because of misconceptions about the disease and lack of access to testing and care,” Trooskin said. “So, many people may be infected and simply don’t know it. This campaign is aimed at tackling these issues through the rapid, mobile testing lab and through community education.”
Every week, the mobile lab goes out in the community, methodically visiting every block in a ZIP code identified as having high rates of infection. Trooskin and her colleagues use geographic information systems software to track their progression through the neighborhoods, making sure no street is missed. Among the methods they use to publicize their location is a constant Twitter feed.
Before bringing the mobile lab into a neighborhood, the “Do One Thing” team mobilizes the community by meeting with block captains, local clergy, and local businesses, asking them to support and encourage HCV testing among their neighbors, congregations, or customers.
Drexel medical students learn important lessons about community medicine by participating in the campaign as part of their community experience requirement or as volunteers in a program called Bridging the Gaps. During the spring 2013 semester, 10 students participated; currently, two are volunteering. Students from the School of Public Health also volunteer. After walking the area with flyers to encourage testing, students doing outreach go door to door in pairs.
The campaign’s goal for individuals who test positive for HCV is follow-up RNA testing to confirm a chronic infection. According to a study by the Centers for Disease Control and Prevention, about half of reported hepatitis C cases in the United States had only an HCV antibody test and did not follow up with confirmatory testing.
“To improve the identification of chronic infections and link more chronically infected people into care, confirmatory RNA testing is crucial,” Trooskin said, noting that CDC guidelines have recently been changed to reflect this. During the campaign, if the rapid test is positive, a trained phlebotomist in the van can draw blood for RNA testing. Through an agreement with Hahnemann University Hospital, the mobile testing unit can deliver HCV blood tests to the hospital’s labs at any time of day or night for processing within the required six-hour window.
“We encourage individuals who test positive to engage in care and learn about secondary prevention and treatment options so HCV doesn’t progress further and cause advanced liver disease,” says Trooskin.
The campaign has experienced HCV test technicians who also act as patient navigators to help engage patients in care. These patient navigators will meet individuals at predetermined locations such as the person’s home, a subway stop or another spot selected by the patient, where they share the follow-up test results and offer to escort them to Drexel Medicine’s Partnership Comprehensive Care Practice for treatment, if indicated.
“Our patient navigators have even tracked people down who are living in abandoned houses to ensure they get care,” relates Trooskin. “Many people who test positive have never had a primary care provider before, so we go through a process of building trust before they will agree to confirmatory testing and treatment.”
Since the College of Medicine began the collaboration in December 2012, 780 individuals have been tested, and 31 had a reactive HCV antibody test. Of those, 25 have already been seen by Trooskin at the Partnership, have an appointment scheduled, or are working with the practice social worker to get insurance coverage for treatment. Of the other six, four had cleared the virus on their own, and two were already linked to care at another clinic.
Many individuals may have had HCV for a while but don’t understand the importance of getting care, or they have the misconception that there is no treatment for HCV, according to Trooskin. However, current treatment regimens for those with HCV can cure more than half of those infected, and even more effective therapies are in the drug development pipeline.
“We are excited about our campaign results so far,” says Trooskin. “This innovative effort could put Philadelphia on the map in terms of increasing access to HCV care.”
For more campaign information, visit 1nething.com.
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