Nurse-led Hepatitis Research Articles

Cholelithiasis management during hepatitis C treatment: a case report including pathophysiology and literature review

This case reports a 56-year-old male attending a nurse-led hepatitis C (HCV) clinic complaining of abdominal pain. Right upper quadrant abdominal tenderness on palpation with a positive Murphy's sign (pain on inspiration during palpation to the right subcostal area) encouraged timely investigation and diagnosis of non-obstructive cholelithiasis (gallstones). This was managed with interval review and regular clinical assessment pending successful HCV treatment and surgical referral. The main lessons from this case study emphasise the importance of considering concurrent diagnoses for patients complaining of abdominal pain when presenting with a primary diagnosis of HCV. This case also supports a pragmatic approach in considering the treatment of HCV before the surgical intervention of uncomplicated gallstones. Furthermore, it also highlights the value of advanced nurse practice within the multi-disciplinary team.

A costing analysis of a state-wide, nurse-led hepatitis C treatment model in prison.

Hepatitis C is highly prevalent among prisoners. The simplicity of direct-acting antiviral (DAA) treatment for hepatitis C makes it possible to use novel models of care to increase treatment uptake within prisons. We estimate the average non-drug cost of initiating a prisoner on treatment using real world data from the State-wide Hepatitis Program (SHP) in Victoria, Australia - a coordinated nurse-led model of care. Data were considered from prisoners presenting to the SHP (following antibody-positive diagnosis) during the evaluation period, November 2015 to December 2016. All costs associated with the SHP were estimated, including staffing salaries, medical tests, pharmacy costs and overhead costs. DAA costs were excluded as in Australia an unlimited number are available, covered by a federal government risk-sharing agreement with pharmaceutical companies. The average non-drug cost of treatment initiation through the SHP was compared to equivalent costs from primary and hospital-based models of care in the community. The total non-drug cost accumulated by prisoners in the SHP was AUD$749,470 (uncertainty range: AUD$728,905-794,111). 659/803 were PCR positive, 424/659 had sentences long enough to be eligible for treatment, and 416/424 were initiated on treatment, resulting in an average non-drug cost of AUD$1,802 (95% CI: AUD$1799-1841) per prisoner initiated. A protocol change allowing prisoners with short sentences to start treatment reduced the average non-drug cost to AUD$1263 (95% CI: AUD$1263-1287) per prisoner initiating treatment - 11% and 56% cheaper than estimated equivalent costs in primary (AUD$1654) and hospital-based (AUD$2847) models of care in the community, respectively. Delivering hepatitis C treatment in prison using a nurse-led model of care is cheaper than delivering treatment in the community. These findings provide an economic rationale for implementing coordinated prison-based hepatitis C treatment programs.

Innovating access to the nurse-led hepatitis C clinic using co-production.

Many reasons for missed appointments are given by people who inject drugs and it is suggested that one solution cannot solve this complex issue (Poll etal., 2017). Increasingly, nurses and other health professionals are expected to actively involve patients and service users in developing innovative, effective and accessible services. This project used co-production as the approach to address this challenge. This paper describes how a co-production method was used to develop accessible nurse-led hepatitis C virus services for people who inject drugs. Using research evidence from a study conducted by the lead author as a starting point, a series of co-production workshops were run using creative co-design methods to identify the barriers to engagement with clinics. Potential solutions were then co-produced. The solutions included myth-busting posters, peer-support, a mobile clinic van and the offer of incentives and enablers (travel costs or a reward for attendance). The service-development project illustrates how, with the right methods, it is possible to successfully engage with hard-to-access groups to co-produce innovative solutions for an important clinical challenge.

Commentary: Innovating access to the nurse-led hepatitis C clinic using co-production.

Commentary: Innovating access to the nurse-led hepatitis C clinic using co-production.

P65 Nurse-led hepatitis C treatment models in drug and alcohol services can support, treatment uptake, healthcare engagement and community prescribing

P65 Nurse-led hepatitis C treatment models in drug and alcohol services can support, treatment uptake, healthcare engagement and community prescribing

Community help for people with hepatitis C

A nurse-led hepatitis C clinic is getting to work on boosting treatment rates and helping dispel the stigma surrounding the infection.

Hepatitis A/B vaccine completion among homeless adults with history of incarceration

Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men.

Prisoner health: assessing a nurse-led hepatitis C testing clinic

Prisons provide an ideal setting in which to carry out blood-borne virus testing among a high-risk population. This paper describes a nurse-led testing programme offered to all prisoners within the substance misuse unit at a local prison in South Wales over a 4-year period. Challenges to organizing such a clinic within the prison setting are discussed. Between April 2006 and April 2010, approximately 4500 prisoners were admitted through the substance misuse unit. Blood-borne virus testing took place among 176 prisoners, of which 24 were hepatitis C seropositive, 19 were confirmed as virus-positive, and eight were referred to specialist teams to consider treatment. Among prison populations blood-borne virus testing needs to be encouraged and improved. Offering testing provides opportunities for harm minimization, education and referrals for treatment. Such provisions are needed to benefit the health of individuals, their families and the wider public health.

Effectiveness of Intervention on Improvement of Drug Use Among Methadone Maintained Adults

ABSTRACT The purpose of this study is to evaluate the effectiveness of three interventions (individual motivational interviewing, group motivational interviewing, or nurse-led hepatitis health promotion) in reducing drug use. A randomized, controlled trial was conducted with 256 methadone maintained moderate-to-heavy alcohol-using adults attending one of five MM outpatient clinics. Drug use in the overall sample was significantly reduced from baseline to 6-month follow-up, as assessed by a 30-day recall (p < 0.0001), with a trend apparent for 6-month recall (p = 0.09). The group and individual programs revealed significant decreases in drug use at the 30-day recall.

The development and implementation of a nurse-led hepatitis C protocol for people with serious mental health problems

Hepatitis C (HCV) is a significant health issue for people with serious mental health problems (SMHP). Factors associated with this include high rates of substance use, injecting drug use, and lack of knowledge regarding the transmission and prevention of HCV. This population are at higher risk of experiencing conditions where transmission rates are high, e.g. night shelters and homelessness. People with SMHP also often have factors associated with acceleration of the disease, including excessive alcohol use and poor physical health. Nurses across services collaborated to develop and implement a protocol to address the needs of clients of an Assertive Outreach Team with or at risk of HCV. It has been successful in developing an effective approach to addressing the needs of people with or at risk of HCV and serious mental health problems. It guides staff in providing a flexible, accessible service for clients delivered across organizational boundaries. It has demonstrated improved health outcomes for clients. It is believed that this project can be used as a template to address other health needs of this client group for example diet, obesity and smoking.

PTH-078 Safety and efficacy of a nurse-led hepatitis C service in a district general hospital

<h3>Introduction</h3> In England and Wales, approximately 200 000–500 000 people are infected with hepatitis C virus (HCV).1 In 2005, a survey carried out by the department of health revealed a relatively low uptake of HCV treatment. Traditionally, patients diagnosed with HCV infection have been managed in the tertiary centres. However, with the recognised increasing load of HCV infection in the UK, there has been a trend towards setting up of specialist nurse-led hepatitis C clinics in the district general hospitals. <h3>Methods</h3> A specialist nurse-led hepatitis C clinic was established in Barnsley hospital in November 2008. The aim of this service was to streamline the care of patients diagnosed with HCV infection ensuring a quick and efficient route to diagnosis and treatment. After the confirmation of active HCV infection, patients are assessed in the nurse-led clinic with a detail history, examination, psychological assessment and relevant investigations. Once they are deemed suitable to undergo treatment by a consultant gastroenterologist, patients are counselled by the nurse and treatment is initiated. Follow-ups are arranged in the review clinic in line with NICE guidelines. 43 patients have been initiated on treatment for HCV infection between November 2008 and November 2009 in this clinic. The aim of our audit was to assess the safety and efficacy of this nurse-led service. <h3>Results</h3> Of the 43 patients (mean age 35 years), 62.7% are males and 37.3% are females. Incidence of different HCV genotypes are as follows – 1a (18.6%), 1b (7%), 2b (18.6%), 3a (53.5%) and 4a (2.5%). All the 12 patients belonging to the type 1 or 4 genotype had a 2 log drop in their viral load at 12 weeks and are currently on course for completing 48 weeks of treatment. Of the 31 patients belonging to the type 2b/3a genotype, 20 have completed 24 weeks of treatment (18 patients had an end of treatment viral count of zero and 2 patients did not attend to have their bloods checked. All are currently waiting to have their 6-month post treatment viral load checked), 9 are undergoing treatment, 1 dropped out of treatment and treatment was stopped in one patient because of development of decompensated liver disease. Five patients developed dyspnoea and anaemia which required a dose reduction of ribavirin initially and increased to the usual dose subsequently. Of these, three required blood transfusion. There has been no major morbidity or mortality. <h3>Conclusion</h3> The nurse-led clinic has been a safe and effective way to streamline the management of patients with HCV infection. Patients have been highly satisfied with this locally available service and appreciate the continuity of care provided by the specialist nurse. This has led to increased uptake of HCV treatment locally and reduction in the number of patients referred to the local tertiary unit.

Predictors of HAV/HBV vaccination completion among methadone maintenance clients

This randomized, controlled study (N = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion among clients undergoing methadone maintenance (MM) treatment. Participants were recruited from five MM treatment sites in Southern California and randomized into three groups: Motivational Interviewing-Single (MI-Single), Motivational Interviewing-Group (MI-Group); and Nurse-Led Hepatitis Health Promotion (HHP). All were offered the three-series HAV/HBV vaccine. A total of 148 participants completed the vaccine. Groups did not differ in rate of vaccination completion (73.6%, HHP group, vs. 65% and 69% for the MI-Single and MI-Group, respectively). The equivalence of findings across groups suggests the value of including nurses with a comprehensive health focus in promoting vaccination completion.

Effect of motivational interviewing on reduction of alcohol use

Background Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population. Objective To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use. Methods A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions ( n = 87); (2) MI delivered in group sessions (MI-group; n = 79), or (3) MI delivered one-on-one sessions (MI-single, n = 90). Results Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample ( p < .05). In multiple logistic regression analysis controlling for alcohol consumption at baseline and other covariates, no differences by condition were found. Discussion As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.