Abstract

Author(s)

Judith Byaruhanga, Meghan Macdonald, Emily Pollock, Elizabeth Roberts, Suresh Sharma, Cassandra Lane, Benjamin Moran, Annette Slater, Swathy Girijakumary Manohar, Paul McNab, Josh Louis, Lawrence Dadd, Hemalatha Varadhan, Jane Drury, Jonathan Holt, Cath Wood, David McLeod, Lisa Brankely, Anand Swamy, Bron Rose, Fionna Murphy, Bianca Prain, John Wiggers, Melanie Kingsland

Introduction

Hepatitis C virus (HCV) disproportionately impacts individuals experiencing mental illness (19%) versus the general population (1.2%). This pilot project aimed to assess: i) feasibility and acceptability of routine HCV testing and treatment in mental health services (MHS); ii) efficacy of implementation strategies to increasing HCV testing; iii) barriers and enablers of implementation.

Method

Pre-post mixed method study in two MHS in-patient wards in the Hunter New England, NSW. Implementation strategies (including executive support, site champion, staff training and prompts) supported delivery of the following model-of-care: all patients offered HCV testing; treatment access via a nurse-led remote-prescribing model. Medical records provided testing data; validated surveys and focus groups assessed clinician acceptability and explored implementation barriers and enablers.

Results & Findings

Over 7 months of implementation support, HCV testing increased by 34% (Taree: 35%; Mater: 32%). 75% of clients diagnosed, started treatment. 100% of surveyed clinicians agreed HCV-testing was important;100% welcomed routine testing as usual care; And 90% of clinicians reported HCV testing is implementable. Barriers to HCV care included: clinician’s self-efficacy to prescribe medication, staff turnover leading to inconsistent testing, and patient-level challenges (e.g., short stays, acutely ill). Prominent enablers were: clinician’s motivation to test, curative treatment, and champion support.

Discussion

Routine HCV care in MHS is feasible and acceptable and implementation support increased HCV testing in MHS units. Data on barriers and enablers to HCV care maybe used to refine implementation strategies to support mental health clinicians. These strategies should then be tested using more robust evaluation methods, via a randomised controlled trial.