Globally, viral hepatitis is a leading cause of death and a major public health threat; in 2017, more people were infected with Hepatitis C Virus (HCV) than were cured (Cook et al. 2019).
Following the advent of well-tolerated, simple, short-course direct acting antiviral (DAA) interferon-free regimens with cure rates >95%, there is potential to reverse the rising burden of advanced liver disease and achieve the goal of global elimination. Nurses have a key role to play in the elimination of hepatitis C in Australia, both for their role in screening, testing and linkage to care, as well as the prescribing eligibility of Nurse Practitioners (NP) following changes to the Pharmaceutical Benefits Scheme in June 2017 (Department of Health [DOH] 2018).
Recognising the need to support NPs to work to their full scope of practice to effectively test for, treat and manage HCV, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), in collaboration with the Kirby Institute, UNSW, held a one-day workshop for NPs alongside the 2018 DANA Conference (Drug and Alcohol Nurses of Australasia).
The workshop, Hepatitis C in Primary Care and Drug and Alcohol Settings, was delivered for 26 NPs across Australia and New Zealand. The workshop was focused on didactic presentations given by local experts, and small group roundtable case study discussions where participants were led through different patient scenarios to increase confidence in translating learning into practice.
Participants were asked to provide feedback after the workshop as to how it would change their clinical practice.
Nurse Practitioner Wendy Blanch noting she would be able to provide ‘a more person centred care for people who have drug and alcohol problems, comorbidities and mental health’, and ‘an exclusive service for patients that feel they are being listened to and have the time to manage their health and wellbeing.’
The NPs were asked to rate their confidence before and after the workshop against the six core competencies of the program. The competency where participants reported the greatest shift in confidence was in their ability to advise patients about new therapies for hepatitis C.
Ninety five per cent indicated they felt confident or very confident at the end of the day, this increased from 15% pre-workshop. NPs are currently leading innovative models of hepatitis C care in settings where there may be a higher incidence of HCV infection, including alcohol and other drugs services, sexual health, needle and syringe exchanges, prison settings, psychiatric services, and in collaboration with peer workers, other nursing and non-nursing specialists.
Nurses and NPs are increasingly well positioned to support Australia’s hepatitis C elimination response, as identified in the Fifth National Hepatitis C Strategy (DOH, 2018), through nurse led services, case finding and supporting patients with their treatment and management for improved health and wellbeing outcomes.
The Hepatitis C in Primary Care and Drug and Alcohol Settings Workshop will be run as a post conference workshop to the 2019 DANA Conference in Sydney, NSW.
Australian Government Department of Health. 2018. Fifth National Hepatitis C Strategy health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1/$File/Hep-C-Fifth-Nat-Strategy-2018-22.pdf Accessed Feb 2019
Australia Government Department of Health. 2018. General Statement for Drugs for the Treatment of Hepatitis C pbs.gov.au/info/healthpro/explanatory-notes/generalstatement-hep-c Accessed Feb 2019
Cook, G., Andrieux Meyer, I., Applegate, T., Aturn, R., Burry, J., Cheinquer et al. 2019. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission; Lancet Gastroenterology & Hepatology; 4(2):135-184
Olivia Dawson is Project Officer at the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)
Melinda Hassall is Clinical Nurse Lead-Nursing Program at the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)