Integrating hepatitis C care with mental health and alcohol and other drug services

Author: Whitton B, Brereton R, Harney B, Read J, Pietrzak D, Paige E, Roberts SK, Price B, Birks S, Saraf S, Hellard M, Doyle J

Theme: Models of Care Year: 2019

Among many people with a lived experience of mental health illness, there is a complex overlap with
alcohol and other drug (AOD) use, including injecting drug use. As a result, some people with mental
health illnesses are at increased risk of blood borne infections, including hepatitis C virus (HCV).
Despite this, engagement in HCV care among these people has been historically low due to a range
of personal, service and system level barriers.
A nurse-led hepatitis C clinic was established within a mental health and AOD service in
collaboration with infectious disease and gastroenterology departments. Clinics were held on a
fortnightly basis with a hepatitis clinical nurse consultant working alongside a nurse practitioner
specialising in mental health and addiction. Treatment workup was undertaken by the nurses with
treatment for those who were HCV positive prescribed by either the nurse practitioner or
collaborating physicians.
Of 116 people referred to the clinic, 95 (82%) had a HCV test of whom 81(85%) were currently HCV
RNA positive with 8 (9%) identified as cirrhotic. All reported a history of injecting drug use, including
68% recently. The majority, 79%, had a major psychiatric Illness.
To date, 58/81 (72%) have commenced treatment of whom 43 (74%) were treated at the clinic with
22 (51%) prescribed treatment by the nurse practitioner. Among 43 people who were due for
sustained virological response (SVR) testing as of end February 2019, 31 people have had a test and
all have been cured.
Through this nurse-led model of care, the majority of people living with HCV started treatment. Of
those who underwent SVR testing, all were cured. While specialist referral is important for people
with cirrhosis, the majority did not require it, indicating replication of this model may be viable in
other mental health settings.
Disclosure of interest: none

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