Theme: Models of Care Year: 2024
Background: Direct Acting Antivirals, if taken as prescribed, are 98% effective. As the patient cohort get more complex with competing priorities; a lack of motivation; or ability to engage in treatment, concerns around drug resistance need to be considered if treatment is not taken as prescribed.
Description of model of care/intervention: A multidisciplinary approach was developed by Hepatology following cases where drug resistance has been identified. This includes colleagues from NHSE, virology, prisons pharmacy and the Hepatitis C Trust. Patients’ records are scrutinized and treatment histories obtained which can be challenging due to the various places and areas someone can be treated. One patient had 5 treatments both in the community and in custody, with varied compliance and many professionals involved in their care. They remained RNA+ after every treatment. The decision was taken to do resistance testing after the 4th and 5th treatment regime. Patient was finally successfully treated with a combination including Interferon.
Effectiveness: The public health risk of onward transmission of a resistance strain of HCV was avoided in the case above and has informed earlier resistance testing across the network. The multi-disciplinary sharing of information has been essential in these cases. Flexibility and nonjudgmental nurse care enables patients to feel valued and respected. It was important not to assume a detected viral load post treatment is down to poor concordance. The patients have been kept informed every step of the way with care centered on their needs. The cost of multiple treatments and professional time can be offset by prompt resistance testing.
Conclusion and next steps: Further research on resistance is needed with earlier or timely resistance testing considered. Post treatment blood tests are essential in sequencing and to minimise the risk to elimination. Working and sharing information across disciplines is imperative.