Micro‐elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial

Abstract

IntroductionHepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations.MethodsFrom January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse).Results75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody‐positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR.Discussion and ConclusionsUniversal screening of HCV using a nurse‐led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.

Missed Opportunities: A Retrospective Study of Hepatitis C Testing in Hospital Inpatients

“…Mental health services are increasingly being identified as an opportunity to provide hepatitis C care [ 6 , 7 , 41 ]. A recent study in Australia showed a DAA treatment uptake of 46% in mental health inpatients with hepatitis C [ 42 ]. Antenatal inpatients, in whom there is a relatively high rate of hepatitis C testing due to inclusion in standard antenatal serology, would benefit from a collaborative care model that coordinates hepatitis C treatment and care post pregnancy, inclusive of infant testing, similar to those in place for hepatitis B [ 43 ].…”