Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia

Harney, Brendan; Whitton, Bradley; Lim, Cheryl; Paige, Emma; McDonald, Belinda; Nolan, Sarah J; Pemberton, David; Hellard, Margaret; Doyle, Joseph S

doi:10.1016/j.drugpo.2019.02.012

Cited by 35 publications

(43 citation statements)

References 15 publications

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“…While initial engagement was lower among people who were experiencing homelessness, we found no association between homelessness and treatment commencement. This is encouraging given suboptimal HCV treatment reported in other treatment studies involving homeless services 26,27 . This was likely at least in part a result of pre‐existing healthcare relationships between clients and staff as well as assertive outreach and enhanced support that was available to this group of clients.…”

Section: Discussionmentioning

confidence: 72%

“…This is encouraging given suboptimal HCV treatment reported in other treatment studies involving homeless services. 26,27 This was likely at least in part a result of pre-existing healthcare relationships between clients and staff as well as assertive outreach and enhanced support that was available to this group of clients. Despite this, while not significant, SVR testing was considerably lower among people who were homeless, consistent with other reports in general practice.…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

Harney

Brereton

Whitton

et al. 2021

Journal of Viral Hepatitis

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Hepatitis C virus (HCV) is more prevalent among people with experience of severe mental illness compared to the general population, due in part to higher levels of injecting drug use. Delivering HCV care through mental health services may reduce barriers to care and improve outcomes. A nurse-led HCV program was established in a co-located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses, with support provided on-site from a general practitioner and remotely from infectious disease and hepatology specialists. A nurse practitioner, general practitioner or specialists were able to prescribe HCV treatment. One-hundred and thirty people were referred to the nurse-led service, among whom 112 (86%) were engaged in care. Of those 112, 84 (75%) were found to have detectable HCV RNA, 70 (83%) commenced treatment; 28 (40%) prescriptions were nurse initiated, 19 (27%) were general practitioner initiated and 20 (29%) were prescribed from hospital clinics or elsewhere. All people with an SVR result (48/70) achieved HCV cure (intention to treat SVR 69%, per-protocol SVR 100%). Treatment commencement was highest among people prescribed opioid agonist therapy (28/29, 96%) compared to those who were not (18/26, 69%). In conclusion, a nurse-led, HCV service for people with severe mental illness including pathways to specialist support when needed can achieve high treatment uptake and cure. Further implementation work is required to improve treatment uptake, particularly among people not prescribed opioid agonist therapy, and to improve follow-up for SVR testing.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

Harney

Brereton

Whitton

et al. 2021

Journal of Viral Hepatitis

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“…A qualitative study among homeless people in the USA has suggested that a designated HCV coordinator, an incentive for clients to continue follow-up appointments, reduced treatment periods (to a maximum 2 months), education of personnel and HCV-positive patients, and peer support for HCV patients are needed to promote linkage to care [ 27 ]. Unstable accommodation in particular is a major barrier for HCV treatment uptake [ 28 , 29 , 30 ], which could be overcome by extending shelter stays for HCV-positive clients [ 27 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care among Clients Attending Homeless Services in Amsterdam, The Netherlands

Grient¹,

Schatz²,

Santen

et al. 2021

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People who inject drugs (PWID) are disproportionately affected by hepatitis C virus (HCV) infections and are frequently homeless. To improve HCV case finding in these individuals, we examined the feasibility of rapid HCV RNA testing in homeless services in Amsterdam. In 2020, we provided a comprehensive service to homeless facilities, which included workshops on HCV for personnel, a “hepatitis ambassador” at each facility, a rapid, onsite HCV RNA fingerstick test service, and assistance with linkage to care. Risk factors for HCV RNA-positive status were examined using Bayesian logistic regression. Of the 152 participants enrolled, 150 (87% men; median age: 47 years) accepted rapid HCV testing. Seven tested HCV RNA positive (4.7%, 95%CrI = 1.31–8.09; 7/150). Of these, five (71%) were linked to care, of whom four (57%, 4/7) initiated treatment and one (14%, 1/7) delayed treatment due to a drug–drug interaction. Of these four people, two completed treatment (50%), of whom one (25%) achieved sustained virologic response after 12 weeks. HCV RNA-positive individuals were more likely to originate from Eastern Europe (posterior-odds ratio (OR) = 3.59 (95% credible interval (CrI) = 1.27–10.04)) and to inject drugs (ever: posterior-OR = 3.89 (95% CrI = 1.37–11.09); recent: posterior-OR = 3.94 (95% CrI = 1.29–11.71)). We identified HCV RNA-positive individuals and linkage to care was relatively high. Screening in homeless services with rapid testing is feasible and could improve HCV case finding for PWID who do not regularly attend primary care or other harm reduction services for people who use drugs.

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“…Despite this favorable policy setting, our work and that of others in Australia have identified suboptimal levels of hepatitis C treatment among people attending homeless services. (2,3) Fokuo and colleagues remind us that people who are homeless often have competing needs to their hepatitis C treatment. Therefore, models of care need to be tailored to the specific needs of people experiencing homelessness; simply replicating what works in primary care, including alcohol and other drug services and opioid agonist therapy programs, may not be enough to engage all people experiencing homelessness in treatment.…”

Section: To the Editormentioning

confidence: 99%

Letter to the Editor: Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

et al. 2020

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Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia

Cited by 35 publications

References 15 publications

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

Hepatitis C treatment in a co‐located mental health and alcohol and drug service using a nurse‐led model of care

A Feasibility Study to Increase Chronic Hepatitis C Virus RNA Testing and Linkage to Care among Clients Attending Homeless Services in Amsterdam, The Netherlands

Letter to the Editor: Recommendations for Implementing Hepatitis C Virus Care in Homeless Shelters: The Stakeholder Perspective

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