A nurse-led model for hepatitis C testing and treatment at a community-based mental health service
Melbourne, Australia
2021
In 2017, a program using a nurse-led model for hepatitis C testing and treatment opened in a community-based mental health service co-located with alcohol and drug treatment services. The aim of the program was to improve hepatitis C care among people with mental health issues. Nurses were supported in program delivery by a general practitioner and infectious disease and hepatology specialists. Of the 84 people diagnosed with chronic hepatitis C through the program, 83% started treatment. Of those who started treatment, 69% were known to be cured of hepatitis C (cure information was unavailable for 22 clients).
Program description
This nurse-led model provided hepatitis C testing and treatment to people with mental health issues in a community-based mental health service. The program was co-located with alcohol and drug treatment services. The program held biweekly clinics staffed by a nurse practitioner and a hepatitis C clinical nurse consultant. To start, people with current or past drug use could be referred to the program by their mental health team to be tested for hepatitis C and start treatment. Later, access to a drop-in service that was self-initiated by clients was available. Although the program targeted people with mental health issues, people with no mental health issues who were clients of the alcohol and drug treatment service were also treated through this model to streamline services. Support was provided onsite by a general practitioner and remotely by infectious disease and hepatology specialists.
At the biweekly clinics, blood tests for hepatitis C antibody and other blood-borne viruses were completed by nurses. As part of the program, nurses also collected a clinical history and assessed liver fibrosis, including FibroScan imaging. Everyone who was RNA positive was eligible for treatment. Treatment for hepatitis C could be prescribed by the nurse practitioner or general practitioner onsite. Individuals with cirrhosis, HIV or hepatitis C were referred to specialists for treatment management.
Mental health staff (clinical and non-clinical) provided tailored medication support to individuals, including dispensing medications to improve treatment adherence and transporting clients to treatment appointments.
Results
The program was established in 2017 and ran until February 2020. There were 130 clients referred to the program. Most of the clients were male (62%), and 82% of those referred were diagnosed with a mental health issue. Of the clients diagnosed with a mental health issue, schizophrenia (88%) was the most common. About half of those referred (53%) lived in social housing and 11% were homeless. All of clients referred to the program had a history of injection drug use, 39% reported injection drug use in the last six months and 25% were on opioid agonist therapy (OAT).
Among the 130 people referred to the program, 110 underwent hepatitis C testing and 84 had a confirmed chronic hepatitis C infection. Among those with chronic hepatitis C, 12% were found to have liver cirrhosis and were referred to a specialist.
Among the 84 people with chronic hepatitis C infection, 70 (83%) started treatment. Those who were on OAT were more likely to start hepatitis C treatment than those who were not. Treatment was prescribed onsite for 47/70 (67%) people, with 28/70 (40%) of these prescriptions prescribed by the nurse practitioner and 19/70 (27%) by a general practitioner. Clients who did not receive their prescriptions onsite (33%) had their treatment prescribed by an infectious disease or another specialist.
Overall, 48 clients of the 70 prescribed hepatitis C treatment (69%) were cured of hepatitis C. Hepatitis C cure status was unknown for the other 22 clients.
What does this mean for service providers?
This nurse-led model of care helps to expand access to hepatitis C treatment prescribers and makes treatment accessible in a community-based mental health service to people with mental health issues, who may have barriers to traditional healthcare. This program demonstrates that a nurse-led model in a co-located mental health clinic can help to treat people with mental health issues (e.g., schizophrenia) for hepatitis C. Furthermore, integrating hepatitis C assessment and treatment services into locations where people are already receiving services and support from clinical and non-clinical professionals can help to increase accessibility and care engagement.
This study showed that people who are taking OAT had the highest levels of treatment uptake and that OAT use in this nurse-led model could help with medication dispensing and adherence. This could be because OAT has the potential to provide additional supports for medication dispensing and engagement in clinical healthcare.
Related resources
Project HEAL Hepatitis C screening and linkage to care program – evidence brief
Linkage to hepatitis C care using a nurse navigator at the University of Virginia Infectious Diseases Hepatitis C Clinic – evidence brief
Nurse-led treatment model for hepatitis C in state prisons – evidence brief
Reference
Harney BL, Brereton R, Whitton B et al. Hepatitis C treatment in a co-located mental health and alcohol and drug service using a nurse-led model of care. Journal of Viral Hepatitis. 2021 Feb 17. [Online ahead of print]