Developing a comprehensive hepatitis C treatment program for western Victoria
Timeline: March 2017 to July 2018
Lead investigator: Dr Amanda Wade
Dr Amanda Wade is an infectious diseases physician and Director of the Liver Clinic at Barwon Health, and a senior research fellow at the Burnet Institute. Her interest is in blood borne viruses and health care equity, especially for people living in rural and regional areas. Amanda’s research focuses on expanding access to hepatitis C testing and treatment – which is key to achieving the World Health Organisation hepatitis C elimination targets.
Study investigators and primary affiliations:
- Professor Eugene Athan, Barwon Health and Deakin University
- Professor Margaret Hellard, Elimination Program, Burnet Institute
- Dr Greg Weeks, MPham, Barwon Health
- Margaret Wardrop, Barwon Health
- Dr Mark Davies, Barwon Health and Primary Health Network Western Victoria
- Ms Christine Roder, Barwon Health and Deakin University, research assistant
- Mr Angus McCormack, Deakin Medical School, volunteer research assistant
- Western Victoria Primary Health Network (PHN)
- University Hospital Geelong
- Drug and Alcohol Services
- Western Victoria Primary Health Network
- Warrnambool Physicians Group
- WRAD clinic
- Primary Health Network
- Ballarat Health Services
Description of study
In 2016 over 230,000 Australians had hepatitis C. The majority were untreated because therapy available at the time was toxic, often unsuccessful and accessible only via specialist doctors. Untreated hepatitis C can lead to liver cancer and death.
New direct acting antiviral (DAA) treatment for HCV became available in March 2016. DAA treatment is highly effective and well tolerated. Australia is now well positioned to eliminate hepatitis C, with the key being increased access to treatment.
Our project aimed to increase access to treatment in Western Victoria by developing a program, which facilitated general practitioner DAA prescribing and provided a clear referral network.
Background: To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe DAA to treat hepatitis C – in consultation with a specialist if inexperienced in hepatitis C management. This study describes the development, implementation and outcomes of a remote consultation pathway that supported GPs to treat hepatitis C.
Methods: Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented a remote consultation pathway for hepatitis C. Pharmaceutical Benefits Schedule prescription data was used to evaluate GP DAA prescription 12 months pre and post pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post pathway inception was undertaken to determine the care cascade.
Results: Hepatitis C treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12-month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post treatment hepatitis C virus (HCV) RNA data was available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 – 11 post treatment. No treatment failure was detected.
Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing hepatitis C. Follow-up post treatment could be improved, however no treatment failure has been documented. To eliminate hepatitis C as a public health threat, it is vital that specialists support GPs to prescribe DAA.
In addition to the information presented in the abstract above, the group also:
- Developed a pharmacy DAA support service; GP DAA phone line staffed by pharmacist; Integrated a pharmacist into nurse led hepatitis C assessment clinic.
- Obtained a FibroScan XL probe via rental from the Burnet Institute, enabling FibroScans to be performed with an XL probe on obese patients for the first time in Geelong.
- Telehealth access to hepatitis C education is currently being developed, in collaboration with the PHN.
Lessons from this study
This study demonstrated that collaborative development and implementation of a remote consultation pathway engaged regional GPs in hepatitis C treatment. Key to the success of our initiative was including all relevant stakeholders in the design and implementation of the system. Regular meetings, accurate minutes and clear communication facilitated achieving the intended outcomes.
Ongoing monitoring of testing and treatment data is necessary in order to keep on track with the elimination targets. This will be achieved by using both the PBS prescriber data, and the ACCESS sentinel surveillance system. The group then needs to respond to these findings, and tailor interventions accordingly.
This program involves direct implementation of a new service, which enables people with hepatitis C to access curative treatment via their GP. In addition it has created a network of hepatitis C care providers, who are working together to improve services in our region.
Publication and dissemination
Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C, Wade AJ, McCormack A, Roder C, McDonald K, Wardrop M, Athan E, Hellard ME, J Viral Hepat. 2018 Sep;25(9):1089-1098
Outcome of general practitioner prescription of direct acting antiviral therapy utilising a remote consultation referral pathway in Western Victoria, (poster) Wade AJ, McCormack A, Roder C, McDonald K, Wardrop M, Athan E, Hellard ME, Australasian Viral Hepatitis Elimination Conference, Cairns August 2017
An interdisciplinary hepatitis C clinic in a regional tertiary hospital: Scope of pharmacist roles, Smeets R, Thethy S, Wade AJ, Weeks G, (poster) National Society of Hospital Pharmacist Conference, Sydney November 2017