Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Vic, Australia.
Disease Elimination Program, Burnet Institute, Melbourne, Vic, Australia.
J Viral Hepat. 2021 May;28(5):771-778. doi: 10.1111/jvh.13487. Epub 2021 Mar 3.
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.
丙型肝炎病毒（HCV）在有严重精神疾病经历的人群中的流行率高于普通人群，部分原因是注射毒品使用率较高。通过心理健康服务提供 HCV 护理可以减少护理障碍并改善结果。在澳大利亚墨尔本的一个精神健康和成瘾服务中心，建立了一个由护士领导的 HCV 项目。有注射毒品使用史的人，包括目前使用的人，由护士转介进行 HCV 检测，由全科医生在现场提供支持，并由传染病和肝脏病专家远程提供支持。护士从业者、全科医生或专家可以开 HCV 治疗药物。有 130 人被转介到由护士领导的服务中，其中 112 人（86%）参与了护理。在这 112 人中，84 人（75%）发现 HCV RNA 可检测到，70 人（83%）开始治疗；28 人（40%）的处方由护士开具，19 人（27%）由全科医生开具，20 人（29%）由医院诊所或其他地方开具。所有 SVR 结果（48/70）的人都实现了 HCV 治愈（意向治疗 SVR69%，方案 SVR100%）。在开阿片类激动剂治疗处方的人中，开始治疗的比例最高（28/29，96%），而未开阿片类激动剂治疗处方的人中，开始治疗的比例较低（18/26，69%）。总之，对于有严重精神疾病的人，包括在需要时获得专家支持的途径，由护士领导的 HCV 服务可以实现高治疗率和治愈率。需要进一步开展实施工作，以提高治疗率，特别是在未开阿片类激动剂治疗处方的人群中，并改善 SVR 检测的随访。
