Hepatitis C Model of Care in Community Corrections – an opportunity to engage with a high-risk cohort with simplified testing and treatment

By Winnie Nguyen

Hepatitis Queensland is a community based, non-government organisation representing the interests of people affected by, or at risk of viral hepatitis. They want all Queenslanders to enjoy the benefits of a healthy liver and ensure everyone has access to appropriate medical treatment, up to date and accurate health information and opportunities to learn and understand how to manage their own wellbeing.

The campaign

At Hepatitis Queensland (HQ), we aim to increase HCV treatment rates in Queensland by responding to the care coordination gap between prisons and community health systems. We sought to access HCV RNA positive individuals reporting to several Queensland Community Corrections district offices and provide them with HCV treatment and cure.

Community Corrections are responsible for the management and supervision of offenders in the community. These individuals may be serving court-imposed orders either as an alternative to imprisonment or as a condition of their release on parole. Hepatitis Queensland has been providing hepatitis C testing and treatment services in selected Community Corrections offices since August 2020. 1 in 5 (22%) clients are found to be HCV positive, a higher rate than observed in many Correctional Centres in Queensland (10-15%).

HQ is working in partnership with selected Community Corrections district office to deliver this clinic. The unique model provides a one-stop-shop with access to a GP and/or community outreach nurses, providing Fibroscans, and phlebotomy services. The model offers people reporting to Community Corrections a direct pathway to access testing and treatment while supporting their willingness to engage in treatment, ongoing monitoring, and reducing rates of DAA treatment non-adherence or discontinuation. The community outreach nurse supports clients through education, follow-up care, linkages to other service providers, and monitoring while on treatment.

 

 

 

 

 

Achievements

Between August 2020 to November 2021, we have tested 148 clients, 48% of the clients we test are HCV antibody positive.

Clinic data:

  • 33 clients (22%) have tested HCV RNA positive
  • 21 HCV RNA positive clients have been provided with a treatment script with a further 6 referred to a tertiary specialist
  • We have maintained engagement with 100% of clients who are on treatment through our clinic or referred to the specialist

Keys to success

  • Collaboration with key stakeholders – especially case managers as they were able to reach clients who were unable to be contacted via phone. As clients had mandatory reporting to their case managers, this was a great communication pathway to ensure we didn’t lose any clients to follow up.
  • Ability to adapt to the changing landscape of COVID-19 and offering different avenues to engage and connect with clients.
  • A team who are dedicated, compassionate and willing to meet clients where they are at in their hepatitis C treatment journey.
  • Our unique offering with our model of care is focused on single visit initiation where clients get to speak to the GP, get a Fibroscan and also get full bloods done. The clinic is delivered onsite at the Community Corrections office so it simplifies the process.
  • Our Community Outreach Nurse provides high-touch, dynamic support for clients seeking treatment, all the way from referral to cure. Her role has been critical to the success of our clinics and the high engagement rates.

Challenges

  1. COVID-19 lockdowns meant that we had to postpone clinics – we opted and trialled different models of clinic delivery including telehealth
  2. Many clients often had other challenges too – some clients were homeless, unemployed or experienced financial hardship. We provided care packages to all clients who attended the clinic as well as providing access to our treatment fund to cover the cost of medication.
  3. Some clients were not ready to commence treatment – our nurse remained in contact with clients to check up on them, some clients took more than 6-8 months to start treatment and some clients had to be re-engaged. We made sure no clients who were hepatitis C positive was left behind.

Lessons learned

This model has clearly allowed a synergy between reaching a group of clients at high risk of HCV whilst connecting clients from care to cure in a simplified pathway.

We also learned that providing HCV testing and treatment services on-site to groups who have poor access to preventive healthcare could be expanded to provide more general health services (including COVID vaccinations).

Key messages

  1. Offer flexible logistics and being adaptable to clients changing needs and priorities
  2. Community Corrections is a key setting that should be considered alongside corrections in order to achieve hepatitis C elimination.
  3. Partnerships are vital – work with case managers, GP’s, other health professionals, involving Queensland Corrective Services in advocacy work. It’s all about shared resources and highlighting the need for investment within this setting.

 

Success stories

Clients who had been released from incarceration explained their motivation to get tested and treated. They understood how prevalent HCV when in prison, and acknowledged the risks that they had been exposed whilst serving their sentences.

One client realised that by injecting drugs, he was at a high risk of contracting HCV, and was anxious about the ongoing implications of that. He welcomed the opportunity to get tested and treated as soon as he was released.

One long-term prisoner had been treated for HCV while incarcerated, but later became re-infected. Being sentenced to life in prison and drug use had ultimately led to despair and loneliness and this had resulted in the loss of relationships with family and friends. He understood that his liver was already damaged, but he had made the decision that he didn’t want to die, and was determined to use the opportunity that Hepatitis Queensland offered to help turn his life around.

Another client said that he didn’t have to pretend to be someone that he wasn’t, he felt he could be straight with people about his background. He felt more comfortable than he would have if he had gone somewhere else for the same service.

Another highlighted the discrimination they had been subjected to in another healthcare setting. He thought that his history made the staff at HQ clinic more concerned about their health, and focused on trying to help.

Find out more

If you are interested in finding out more, please contact Winne at winnie@hepqld.asn.au