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Addressing viral hepatitis in the opiate substitution setting: an integrated nursing model of care
Vince Fragomeli1, Martin Weltman
1Department of Gastroenterology and Hepatology Services, Nepean Hospital, Penrith, New South Wales, Australia.
Insights
Hepatitis C (HCV) and B (HBV) treatment uptake is low among people who inject drugs (PWID). Integrating screening and treatment into opioid substitution therapy (OST) settings significantly improves access for this marginalized population.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) and Hepatitis B virus (HBV) infections are prevalent in people who inject drugs (PWID), with high rates of HCV positivity (41-68%) and HBV exposure (28-59%) in Australia.
- Despite effective antiviral therapies, treatment uptake for chronic HCV and HBV remains low among PWID due to various patient, physician, social, and logistical barriers.
- Traditional referral pathways to secondary or tertiary centers have shown limited success in increasing therapy uptake for viral hepatitis in this population.
Purpose of the Study:
- To evaluate the effectiveness of a nursing model of care integrating viral hepatitis services into opioid substitution therapy (OST) settings.
- To improve access to screening, assessment, and treatment for HCV and HBV among marginalized PWID.
- To address the low uptake of antiviral therapies for viral hepatitis in the injecting drug user population.
Main Methods:
- Implementation of a nursing-led model of care over 11 years at a Sydney teaching hospital.
- Integration of viral hepatitis screening, assessment, and treatment directly within the OST setting.
- Targeting approximately 50,000 Australians receiving opioid substitution therapy.
Main Results:
- Enhanced access to viral hepatitis services for the marginalized injecting drug use population.
- Demonstrated a successful model for identifying and treating individuals at risk for or infected with HBV and HCV within OST services.
- Overcame traditional barriers to care for PWID through integrated service delivery.
Conclusions:
- Integrating viral hepatitis screening and treatment into opioid substitution therapy settings is an effective strategy to improve healthcare access for people who inject drugs.
- A nursing model of care can successfully bridge the gap in treatment uptake for HCV and HBV in this high-risk population.
- The OST setting provides an ideal platform for managing viral hepatitis among PWID, leading to better health outcomes.
Abstract:
Despite the availability of effective therapies for hepatitis C virus (HCV) and B virus (HBV), only a minority of infected patients receive treatment. In the general population, morbidity and mortality associated with chronic HCV is now successfully being addressed through the use of antiviral therapy. In Australia, an estimated 41% to 68% of people who inject drugs (PWID) are HCV positive, and between 28% and 59% of users are estimated to have been exposed to HBV. Although current treatment guidelines suggest that active drug use should not preclude people from HCV treatment, uptake of therapy thus far has been low. Patient, physician, social, and logistical-related barriers contribute to the low uptake of HCV treatment among PWID. Traditional means of managing HCV infection—referral to secondary or tertiary health centers—historically has a poor track record in increasing therapy uptake among this population. The same is true for people with chronic HBV who inject drugs. Close to 50,000 Australians receive opioid substitution therapy (OST) through a range of services, including public and private clinics, thus this setting is an ideal target for identifying and treating people at risk for and already infected with HBV and HCV. Over the last 11 years, a nursing model of care initiated by a teaching hospital in Sydney, Australia that integrates viral hepatitis screening, assessment, and treatment into the OST setting has enhanced access to services among the marginalized injecting drug use population.
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