Author: Cheung C, Lothian R, Gilliver R, Read P

Theme: Models of Care Year: 2019

Background: A community-based public health facility in Sydney, Australia, the Kirketon Road Centre
(KRC) provides healthcare to people who inject drugs (PWID), homeless and other marginalised
people. Data from March 2016 to March 2018 revealed of 242 individuals commenced on direct
acting anti-virals (DAAs), 29% did not attend for sustained virological response testing 12 weeks after
treatment completion (SVR12).
Description of Model of Care: We aimed to improve our SVR12 testing rate to >85% (by 6 months
post implementation) through modifying an existing hepatitis C virus (HCV) assessment tool used by
clinicians at the initial clinical encounter to reduce loss to follow-up (LFTU). A driver diagram was
chosen as our model for improvement framework to be implemented in Plan-Do-Study-Act (PDSA)
Effectiveness: Reasons for LTFU by SVR12 and barriers to access were identified as primary drivers in
the driver diagram. This included substance use, mental health issues, homelessness, incarceration
and attrition due to mortality. Patient motivation and patient understanding were also identified as
universal primary drivers in all patient groups. The common secondary driver to all primary drivers
was to have a reliable tool at baseline assessment. This tool ensures accurate knowledge, empowers
clients to self-select optimal SVR12 testing options, captures up-to-date client contact details and
explores other means of client contact in the event that the former is unsuccessful. This includes
documentation of external services accessed by clients across the various primary driver domains.
Conclusions: We developed a novel HCV assessment tool to be used by clinicians at the baseline
clinical visit with the aim of reducing LTFU and increasing SVR12 collection. Despite high observed
efficacy of DAAs, determining virological cure has individual health implications, informs elimination
goals, and is clinically important in a population at higher risk of reinfection.
Disclosure of Interest Statement: The Kirketon Road Centre is funded by NSW Health. No
pharmaceutical grants were received in the development of this project.

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