Theme: Models of Care Year: 2022
Background: Many people who inject drugs present to acute hospital services, often with
complications of drug use, increased risk of hepatitis C virus (HCV) infection and complex social
backgrounds. We describe a model which opportunistically identifies inpatients with untreated HCV
and links them to HCV care during their inpatient stay, simplifying the treatment pathway, requiring
no referrals or outpatient consultations. A collaborative multidisciplinary approach is key to this
novel HCV treatment pathway.
Description of model of care/intervention: Daily electronic lists are generated from hospital records
which identify inpatients with substance misuse needs. Those with documented HCV infection are
followed up by a hepatology clinical nurse specialist (HCNS) and, where appropriate, are offered an
HCNS consultation for liver/HCV treatment assessment on the ward. Once a treatment regimen is
agreed the HCNS liaise with a multidisciplinary Inclusion Health Team, linking HCV treatment care
with appropriate drug/social/housing support. HCV treatment may be started in hospital or
following discharge via community pharmacy dispensing along with opiate substitution therapy if
appropriate.
Effectiveness: Over 3 months, 18 patients were identified with documented active HCV. 5 were
already on HCV treatment pathways. 7 patients were discharged prior to being reviewed by HCNS. 6
inpatients received HCV treatment assessment – one disengaged with HCV treatment services post
discharge and 5 patients commenced HCV treatment, one as an inpatient. Treatment outcomes are
awaited.
Conclusion and next steps: Identification of inpatients with HCV infection enables opportunistic
liver/HCV assessment during the admission leading to successful initiation of antiviral treatment.
Collaborative working between HCNS, addiction teams, social support and ward staff enables
individualised, holistic, patient-centred care, promoting shared decision making. Treatment
outcomes will indicate if discharge to supported environments facilitates HCV treatment completion
and cure.
Disclosure of Interest Statement:
The authors have no conflict of interest to declare.