Integrated Hepatitis C Services in Drug and Alcohol Settings Enable Engagement and Access to Care – A Cascade of Care

Author: Watkinson, Victorian Infectious Diseases Service, The Peter Doherty Institute, Melbourne Health

Theme: Clinical Research Year: 2015

Evidence suggests marginalized populations respond to client centered models of service provision. Outlined is the implementation of integrated hepatitis C services (IHCS) to improve treatment access outside tertiary settings, to groups historically not engaging with traditional models. Examined is the model applied to Drug and Alcohol AOD partners, service outcomes and client engagement.

In April 2015 the Pharmaceutical Benefits Advisory Committee (PBAC), recommended treatments that will benefit priority groups that have previously avoided engagement in care and management of their hepatitis C. These included those that access services for Drug and Alcohol (AOD) support and Needle Syringe Programs (NSP). Melbourne Health implemented models of care targeted at addressing care access barriers identified by the strategy.
AOD primary care partners established community viral hepatitis clinics attended by a Hepatology Clinical Research Nurse Consultant (CNC) and supported by General Practioners S100 Hepatitis C treatment prescribers, AOD Clinicians and Outreach Specialists, delivered through outreach consultations with CNC, associated Health Care Teams. Flexible referral pathways, community Fibroscan assessment of liver fibrosis CNC care coordination enabled minimal scheduled appointment and maximum client involvement, participation etc.

Clients attending AOD and NSP services engaged in liver assessment, management and surveillance whilst awaiting new therapies and demonstrated commitment to remaining in a program of care.

It is demonstrated that clients engage in care if provided within services that they already engage and feel safe. Clients are interested in their liver health and demonstrate that with a high attendance in screening that offers readily accessible feedback such as community based Fibroscan and specific Hepatology CNC advice and support from a Hepatology CNC. Specialist Hepatology Nursing assessment and support including community fibroscan is a significant enhancement to engagement to care and hepatitis C management and assessment.

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