Background:
To achieve Australia’s goal of eliminating Hepatitis C virus (HCV) by 2028, innovative case finding and treatment algorithms are required. In the state of New South Wales, Australia, all HCV positive tests are by law, reported by pathology service providers to the Public Health Unit. These notifications can assist in identifying infections, although some records may be inconclusive, reporting only hepatitis C antibody (Ab) positive results. We developed a nurse led model of care to improve hepatitis C case finding and treatment through the public health notification system.
Description:
The Hepatology Integrated team utilises a structured approach following receipt of a list of patients who have tested positive for either HCV Ab and/ or HCV ribonucleic acid (RNA) from the Public Health Unit. Subsequently, hepatology nurses exclude tests ordered by a gastroenterologist, infectious disease specialist, a liver clinic, correctional facility, or an unknown ordering clinician. The remaining clinicians are contacted via phone or a letter to determine if they have treated the patient, or if support and resources are required from the Hepatology Integrated team. If the ordering clinician is unable to treat a patient, a referral is sent to the hospital liver clinic and patients are contacted for further testing and /or antiviral treatment. Patients receive continuous support and engagement from the nursing team throughout the care cascade.
Effectiveness:
There were 1333 notifications received from July 2019 to December 2024. Of these, 244 patients were treated for their HCV, 156 are under review and scheduled for treatment, 491 did not require treatment (HCV Ab supplemental negative and/or HCV PCR negative), 251 were lost to follow up, deceased or refused treatment, and 191 are awaiting review.
Conclusion:
The Public Health Notification program has enabled an increase in treatment uptake and education through this micro-elimination initiative to help achieve Australia’s HCV elimination targets. |