Disease Elimination, Burnet Institute, Melbourne, Australia.
Sexual Health Service Tasmania, Hobart, Australia.
BMC Public Health. 2023 Nov 20;23(1):2289. doi: 10.1186/s12889-023-17066-9.
Australia has experienced sustained reductions in hepatitis C testing and treatment and may miss its 2030 elimination targets. Addressing gaps in community-based hepatitis C prescribing in priority settings that did not have, or did not prioritise, hepatitis C testing and treatment care pathways is critical.
The Tasmanian Eliminate Hepatitis C Australia Outreach Project delivered a nurse-led outreach model of care servicing hepatitis C priority populations in the community through the Tasmanian Statewide Sexual Health Service, supported by the Eliminating Hepatitis C Australia partnership. Settings included alcohol and other drug services, needle and syringe programs and mental health services. The project provided clients with clinical care across the hepatitis C cascade of care, including testing, treatment, and post-treatment support and hepatitis C education for staff.
Between July 2020 and July 2022, a total of 43 sites were visited by one Clinical Nurse Consultant. There was a total of 695 interactions with clients across 219 days of service delivery by the Clinical Nurse Consultant. A total of 383 clients were tested for hepatitis C (antibody, RNA, or both). A total of 75 clients were diagnosed with hepatitis C RNA, of which 95% (71/75) commenced treatment, 83% (62/75) completed treatment and 52% (39/75) received a negative hepatitis C RNA test at least 12 weeks after treatment completion.
Providing outreach hepatitis C services in community-based services was effective in engaging people living with and at-risk of hepatitis C, in education, testing, and care. Nurse-led, person-centred care was critical to the success of the project. Our evaluation underscores the importance of employing a partnership approach when delivering hepatitis C models of care in community settings, and incorporating workforce education and capacity-building activities when working with non-specialist healthcare professionals.
澳大利亚的丙型肝炎检测和治疗一直在持续减少，可能无法实现 2030 年消除目标。在没有或没有优先考虑丙型肝炎检测和治疗护理途径的重点领域，解决社区为基础的丙型肝炎处方方面的差距至关重要。
塔斯马尼亚消除丙型肝炎澳大利亚外展项目通过塔斯马尼亚州性健康服务向社区中的丙型肝炎重点人群提供了一种由护士主导的外展护理模式，该服务得到了消除丙型肝炎澳大利亚合作关系的支持。服务点包括酒精和其他药物服务、针具和注射器计划以及心理健康服务。该项目为客户提供了整个丙型肝炎护理途径的临床护理，包括检测、治疗以及治疗后的支持和丙型肝炎教育。
在 2020 年 7 月至 2022 年 7 月期间，一名临床护士顾问总共访问了 43 个地点。在临床护士顾问提供服务的 219 天中，共与 695 名客户进行了互动。总共对 383 名客户进行了丙型肝炎检测（抗体、RNA 或两者兼有）。共诊断出 75 名丙型肝炎 RNA 阳性患者，其中 95%（71/75）开始治疗，83%（62/75）完成治疗，52%（39/75）在治疗完成后至少 12 周时获得了阴性丙型肝炎 RNA 检测结果。
在社区服务中提供外展丙型肝炎服务，有效地接触到了丙型肝炎患者和高危人群，开展了教育、检测和护理工作。护士主导、以患者为中心的护理对项目的成功至关重要。我们的评估强调了在社区环境中提供丙型肝炎护理模式时采用合作方法的重要性，以及在与非专业医疗保健专业人员合作时开展劳动力教育和能力建设活动的重要性。
