Supporting primary care clinics to prioritise hepatitis C testing and treatment through the provision of a tailored package of interventions – the EC Nurse-led Model

Author: Layton C, Draper B, Chan K, Accadia L, Bryant M, Richmond J, Traeger M, Thompson A, Hellard M, Pedrana A

Theme: Models of Care Year: 2019

Background: Elimination of hepatitis C will require an increase in the number of people at risk of
hepatitis, specifically people who inject drugs (PWID), being diagnosed and linked to treatment. The
Eliminate hepatitis C (EC) Victoria Partnership aims to increase the capacity to provide hepatitis C
testing and treatment to PWID in Victoria, Australia, through a nurse-led model of care.
Argument: The model uses a health system strengthening approach whereby a clinical nursing team
support high case load services to prioritise hepatitis C testing and treatment through the provision
of tailored package of interventions. These interventions are co-designed with clinic staff and are
informed by a baseline assessment involving a clinic audit and provider interviews to identify
barriers along the care cascade. We developed a Primary Care Toolkit to support a whole of practice
approach and targeting of interventions. The Australian Collaboration for Coordinated Enhanced
Sentinel Surveillance is used to evaluate the model, assessing changes in testing and treatment
Outcomes: 14 high-caseload clinics were recruited between 2017 -2018. Baseline clinical audits
revealed an average of 164 (range 54-370) people treated at each service. Interventions included
nursing education & mentoring (n=5), phlebotomy access on site (n=7), clinical nursing support
(n=5), implementation of proactive follow up system (n=7). Preliminary analysis shows that the
proportion of antibody-positive patients receiving reflexive RNA testing after a positive test
increased from 73.8% in 2017 to 79.4% in 2018 and the proportion of patients with RNA-positive
results prescribed DAA treatment within 3 months increased from 30.8% in 2017 to 36.3% in 2018.
Conclusions: Achieving elimination targets requires localized responses at the health service level.
The EC nurse-led model assists services to identify and target interventions to improve the hepatitis
C care cascade and uses data to drive treatment uptake at these primary care clinics.
Disclosure of Interest Statement: The authors acknowledge funding support from Gilead Sciences
and National Health and Medical Research Council for this project through an investigator initiated
research grant from. The Burnet also receives funding support from Abbvie, GSK and Merck for
investigator initiated research.

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