Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Pourmarzi, Davoud; Smirnov, Andrew; Hepworth, Julie; Rahman, Tony; FitzGerald, Gerrard; Hall, Lisa

doi:10.1002/hpm.2770

Cited by 11 publications

(22 citation statements)

References 22 publications

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“…This was also reported in other studies as a barrier to HCV treatment . Enabling PCPs to assess patients’ psychosocial status and empowering them to provide support for patients through collaboration or linkage with other related services are essential to successfully engage PCPs in HCV treatment …”

Section: Discussionsupporting

confidence: 55%

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Pourmarzi

Smirnov

Hall

et al. 2020

Journal of Viral Hepatitis

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Background Although the availability of fully funded direct‐acting antivirals (DAAs) and the eligibility of primary care providers (PCPs) to provide hepatitis C virus (HCV) have removed barriers related to access to hospital‐based HCV treatment in Australia, there are still many barriers to the provision of HCV treatment in community settings. There is a lack of knowledge regarding the barriers to, and enablers of HCV treatment in community settings in Australia. This study aimed to identify barriers and enablers for the provision of community‐based HCV treatment. Methods This study was a part of a mixed‐method case study of the Cure‐It programme. The programme was studied to better understand barriers and enablers experienced by stakeholders of such programmes. The programme is delivered through the Prince Charles Hospital in Brisbane, Australia, and aimed to improve access to HCV treatment in community settings. Data were collected using semi‐structured interviews with 12 healthcare providers and nine patients between July and December 2018. Purposive sampling was used to ensure diverse views were captured. The interview transcripts were analysed using inductive thematic analysis. Results Ease of access to specialist support, easy and high value treatment, co‐location with or providing other services and motivated patients enabled PCPs to be engaged with the Cure‐It programme. Several interconnected factors related to patients’ characteristics and health system acted synergistically to enable patients to initiate and complete treatment. These included a desire to remove HCV as a source of shame, having children, awareness of HCV consequences, access to DAAs for free, ease of access to general practices and drug and alcohol services, and access to a safe and enabling environment. The identified barriers were interconnected at the levels of patients, PCPs and primary care systems and acted synergistically to prevent patients and PCPs from becoming engaged with HCV treatment. PCPs’ related barriers included a lack of knowledge, their perception of HCV as a specialist area and of patients with HCV as ‘hard to manage’ patients along with the practice preferences and priorities. Patients’ related barriers included their socioeconomic characteristics, internalized stigma, perception of not being sick and lack of knowledge. Additionally, the unavailability of support for patients and existence of stigma in primary health care, along with poor communication between the hospital and primary care system, and the unavailability of FibroScan® in primary care discouraged PCPs and patients engagement specifically with the provision of community‐based HCV treatment. Conclusion Various strategies are needed to improve PCPs and patients’ knowledge and awareness of HCV treatment. Training and support for PCPs need to be easy to access and should cover both clinical and social aspect of HCV. Connecting PCPs to other related services may improve PCPs’ and patients’ engagement with HCV treatment.

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Section: Discussionsupporting

confidence: 55%

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Pourmarzi

Smirnov

Hall

et al. 2020

Journal of Viral Hepatitis

Self Cite

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“…This nurse-led model of care incorporates all eight elements identified by consensus as being important for community-based hepatitis C treatment. 19 These elements include; a safe and enabling environment, training and support for health care providers, an open referral policy, linkage with or providing outreach services, a person-centred approach, on-site screening and assessment, linkage or co-location with harm reduction services and linkage or co-location with drug and alcohol services. These elements are important in expanding access to HCV treatment with prescribing limited to specialist clinicians in other settings globally.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

Harney

Brereton

Whitton

et al. 2021

Journal of Viral Hepatitis

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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.

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“…Third, barriers to being referred to a hospital included a high percentage of patients who were unable to be contacted, the patients' self-perception of being healthy, mistrust of treatment/ healthcare, transportation issues, and work conflict. Recently, in Australia, Pourmarzi et al [18] demonstrated that a key to achieving the HCV elimination goal is the provision of its treatment in community settings, and that the integration and coordination of care and support provided for both patients and healthcare providers are important processes. The present study lends support to Pourmarzi et al [18], who reported that successful elements of treatment in community settings include "training and support for healthcare providers, an open referral policy, linkage with or providing outreach services, a person-centered approach, and on-site screening and assessment."…”

Section: Discussionmentioning

confidence: 99%

“…Recently, in Australia, Pourmarzi et al [18] demonstrated that a key to achieving the HCV elimination goal is the provision of its treatment in community settings, and that the integration and coordination of care and support provided for both patients and healthcare providers are important processes. The present study lends support to Pourmarzi et al [18], who reported that successful elements of treatment in community settings include "training and support for healthcare providers, an open referral policy, linkage with or providing outreach services, a person-centered approach, and on-site screening and assessment." Further, to increase access to treatment for HCV in Australia, White et al [19] developed a community-based FibroScan and a nurse-led service to assess patients.…”

Section: Discussionmentioning

confidence: 99%

Challenges of transferring rural adults with chronic HCV infection for further HCV RNA confirmation and free DAAs treatment: a success story of the interdisciplinary collaboration approach

Chang

et al. 2020

BMC Infect Dis

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Background Chronic hepatitis C virus (HCV), which is a concern in many countries, is the leading cause of liver cancer around the world. Since Taiwan launched its national health insurance system in 1995, it has managed to extend health coverage to 99% of the Taiwanese population, providing free but limited antiviral treatment each year since 2017. However, many people in rural areas are unaware that they have chronic HCV; nor do they realize that new drugs with high cure rates could drastically reduce their health burden. The aim of this study is to explore the implementation facilitators of and barriers to inviting potentially infected patients in rural areas to be transferred for HCV ribonucleic acid (RNA) confirmation and new drug treatment. Methods A descriptive and prospective study design with an interdisciplinary collaboration approach was implemented. After five elements of referral were developed, telephone counseling was conducted between August 2018 and May 2019 in Yunlin, Taiwan. The elements of referral developed by the research team were: (1) forming and coordinating physicians’ schedules, (2) recruiting and training volunteers, (3) training the nursing staff, (4) raising funds or resources, and (5) connecting with village leaders. Thereafter, we collaborated with two district health centers, a private local hospital, and health clinics. Based on the medical records provided by these agencies, community adults that were HCV antibody (anti-HCV) positive were invited to join the program. Results Of the 1795 adults who were serum anti-HCV positive, 1149 (64%) accepted transfer to a qualified hospital; of these, 623 (54.2%) had an HCV infection. 552 (88.6%) of those infected started receiving direct-acting antivirals (DAAs) treatment. The top four barriers to accepting transfer were: (1) they perceived themselves to be healthy (n = 98, 32.3%); (2) mistrust of treatment/healthcare (n = 60, 20.2%); (3) limited transportation to the hospital (n = 52, 17.5%); and (4) work conflict (n = 30, 10.1%). Conclusion An interdisciplinary collaboration approach significantly contributed to the invitation of CHC patients, as well as their acceptance of HCV RNA confirmation and free DAAs treatment. Using anti-HCV data from previous medical records for case-finding and collaborating with a hospital and health clinics proved to be an efficient strategy.

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Elements of community‐based models for treating hepatitis C virus in supporting HCV elimination in Australia: A Delphi study

Cited by 11 publications

References 22 publications

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Enablers and barriers for the provision of community‐based HCV treatment: A case study of a real‐world practice

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

Challenges of transferring rural adults with chronic HCV infection for further HCV RNA confirmation and free DAAs treatment: a success story of the interdisciplinary collaboration approach

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