A multi‐site, nurse‐coordinated hepatitis C model of care in primary care and community services in Melbourne, Australia

Abstract

Background: Hepatitis C virus (HCV) treatment through primary care and communitybased services will be a critical component of HCV elimination. We evaluated a nursecoordinated programme providing care across eight sites and analysed progression through the HCV care cascade.Methods: People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. Results:Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive.Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed

Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: findings from a multinational cohort between 2010 and 2019

“…35 Decentralization of health care, peerbased or nurse-led models of care, increased testing frequency or home-based testing, incentives and simplifying the HCV cascade of care all facilitate diagnosis and treatment. [36][37][38] Crucially, we show that HCV incidence remains 10 times higher in 2019, at 50 per 100,000 PY, than the absolute incidence target of ≤5 per 100,000 PY that WHO defines as "elimination" in the general population. 4 Given that PLHIV have higher rates of HCV infection than the general population, we suggest that a PLHIV-specific absolute incidence elimination target should be considered, similar to separate targets established for PWID.…”

Decentralisation of hepatitis C virus care into community settings: A key approach on the path to elimination

“…To this end, we read with interest the paper presented by Harney et al, 7 who present the findings of a community‐embedded nurse‐led model of HCV care (MoC) for those attending alcohol and other drug (AOD) services in Melbourne, Australia. The study pathway embedded routine nurse visits to AOD services in greater metropolitan Melbourne to provide testing and conduct pre‐treatment assessments for HCV RNA‐positive individuals.…”

“No, my name’s not on the lease at all”: an interpretive phenomenological analysis of unstable housing and hepatitis C among people who inject drugs

“…More recent research continues to highlight unstable housing and homelessness as a risk environment for hepatitis C among people who inject drugs (Aung et al , 2021; Arum et al , 2021). Similarly, even in an era of “easy” treatment for hepatitis C, evidence indicates that people who are homeless or unstably housed are less likely to commence treatment compared to those who are housed (Alavi et al , 2019; Beiser et al , 2019; Harney et al , 2022). There is a growing body of qualitative literature focused on homelessness, or housing more generally and hepatitis C treatment.…”