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Abstract Details
Hepatitis C treatment in a co-located mental health and alcohol and drug service using a nurse-led model of care
J Viral Hepat. 2021 Feb 17. doi: 10.1111/jvh.13487. Online ahead of print.
Brendan L Harney12, Rebecca Brereton3, Bradley Whitton1, Danusia Pietrzak3, Emma Paige1, Stuart K Roberts45, Susanne Birks3, Sudeep Saraf3, Margaret E Hellard12, Joseph S Doyle12
Author information
1Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia.
2Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia.
3St Kilda Road & Southcity Clinic, Alfred Community Mental & Addiction Health, Melbourne, Vic, Australia.
4Department of Gastroenterology, Alfred Health, Melbourne, Vic, Australia.
5Department of Medicine, Monash University, Melbourne, Vic, Australia.
Abstract
Hepatitis C virus (HCV) is more prevalent among people with experience of severe mental illness compared to the general population, due in part to higher levels of injecting drug use. Delivering HCV care through mental health services may reduce barriers to care and improve outcomes. A nurse-led HCV program was established in a co-located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses, with support provided on-site from a general practitioner and remotely from infectious disease and hepatology specialists. A nurse practitioner, general practitioner or specialists were able to prescribe HCV treatment. One-hundred and thirty people were referred to the nurse-led service, among whom 112 (86%) were engaged in care. Of those 112, 84 (75%) were found to have detectable HCV RNA, 70 (83%) commenced treatment; 28 (40%) prescriptions were nurse initiated, 19 (27%) were general practitioner initiated and 20 (29%) were prescribed from hospital clinics or elsewhere. All people with an SVR result (48/70) achieved HCV cure (intention to treat SVR 69%, per-protocol SVR 100%). Treatment commencement was highest among people prescribed opioid agonist therapy (28/29, 96%) compared to those who were not (18/26, 69%). In conclusion, a nurse-led, HCV service for people with severe mental illness including pathways to specialist support when needed can achieve high treatment uptake and cure. Further implementation work is required to improve treatment uptake, particularly among people not prescribed opioid agonist therapy, and to improve follow-up for SVR testing.