Aboriginal and Torres Strait Islander peoples have a significantly higher prevalence of Hepatitis C Virus (HCV). In 2015, an estimated 240,000 Australians were living with chronic HCV. While accounting for approximately 3% of the overall Australian population, 9% of the newly diagnosed HCV cases identified as being Aboriginal or Torres Strait Islander.
People with HCV are at risk of progressive liver disease. Hence, early diagnosis and treatment are vital. Historically, antiviral therapy for HCV had several limitations: it was accompanied by significant toxicities; cure rates were estimated at 65%; and, it was largely limited to tertiary hospital settings. Recently, new HCV antiviral treatments have become available, with fewer side effects, a higher cure rate, and that are easier to administer, while having a shorter duration. This enables a shift from tertiary care to community and primary health care for HCV antiviral therapy. However, primary health care providers perceive significant barriers to prescribing this new treatment, predominantly due to lack of experience in prescribing.
This study examines the feasibility, efficacy, acceptability and practicalities of a new model of care in which primary care providers at First Nations Health Services will be supported in the new treatment options of HCV patients by a specialist hepatology team at the Princess Alexandra Hospital. The primary care team and the Princess Alexandra Hospital hepatology team case-conference via telehealth at regularly scheduled clinics to assess potential patients, prescribe medications, and review patient progress during the full course of treatment. Each First Nations Health Service will have the opportunity to present their patients’ cases during the telehealth clinics. The hepatologist will validate the proposed treatment type and duration as well as assess drug-drug interactions if applicable. The First Nations Health Service primary care team then arranges patient prescriptions and commences patient treatment.
Implementation of this HCV treatment service will facilitate specialist hepatology knowledge transfer to the primary care team at First Nations Health Services and thus build workforce capacity. Evaluation of the service will enable its improvement and inform roll-out to other health services and jurisdictions within Queensland and other regions in Australia.
