Innovative project tests and treats people with hep C, in the community

Publication date: 9 September 2021

APHG’s Southern Community Laboratories (SCL), and the South Island regional Hepatitis C group are working on a project that brings together digital and telehealth tools to support a mobile test and treat clinical service for people with hepatitis C.

The initiative has received funding from the Ministry of Health’s Digital Enablement Programme, which provides support for innovation in digital health care. The programme has a particular focus on co-investing in projects that improve access or participation for people who do not access health services and need to. It’s all about improving equity.

The Ministry is working closely with project teams, sharing learning between participating organisations as a community of practice and looking for opportunities to help others learn from these initiatives as they adopt and promote these or similar services elsewhere. The projects are examples of the types of innovation that will be supported by the better access to information enabled by the Hira programme. Hira will be an ‘ecosystem’ of data and digital services that will enable consumers to access and control their health information through their choice of website or application using a digital device such as a smartphone, tablet or computer.

Trevor English, relationship manager at SCL, says current medications have made hepatitis C more treatable – the challenge is identifying the people who have it.

‘If we could identify everyone with hep C, we could pretty much eliminate it from the community. The direct acting antiviral drugs are very effective. And of course, if you successfully treat someone with hep C, they don’t pass it on and you reduce the number of patients with liver disease.’

However, he says people with hepatitis C can be wary of the health system.

‘While we can now treat it successfully, people who were exposed to previous treatment regimes may have had bad experiences, as the treatment could be worse than the disease. There were other people who were found to have hep C, but then couldn’t be treated because the available medications would only work for some forms of the illness. There was also a relatively high failure rate of these unpleasant treatments.

‘Therefore, you have a cohort who are harder to reach anyway, and who may not have had the best experience of the health sector.’

The project will use laboratory and primary care data to identify at-risk populations.

‘We know people with hep C are less likely to be enrolled in general practice, and even regional hep C services are not able to reach everyone. We will go to the places where people with hep C might be, such as needle exchange programmes, and test them there.’

Studies from all over the world have shown patients get lost to follow-up at every stage of screening, assessment and treatment. The aim of this programme will be to minimise this risk by having an all-encompassing test-treat system.

The Ministry of Health funding will go towards mobile ‘point-of-care’ equipment – suitcase-size molecular testing analysers. The equipment is simple to run, and the hope is to teach hepatitis nurses and others how to use it. The first pilot will run in Invercargill, Christchurch and Nelson.

The project is modelled on a testing approach introduced because of COVID-19.

‘We had already been working on a project involving point-of-care testing and data capture. When COVID came, we pushed the project along quickly. COVID test results are captured in an information system, put into the lab system, and then sent back into clinical data repositories so they become available at a regional and national level. Hep C results will also be able to be captured from point-of-care testing environments.

‘We had to get the COVID testing out to the smaller regions because it was just too hard to bring people in. This required portable analysers with connectivity.’

Trevor says when the opportunity came to apply for the Ministry of Health digital enablement funding, they recognised the same model could be used to test for hep C.

‘We could test the patient at a community site, assess their result, and if they have hep C, provide them with medication.’

The project also includes the deployment of a patient app for smartphones, developed overseas. The app allows the lab and clinical staff to interact with patients.

‘For example, we will send you your results. If it’s a green screen you can put the phone away, if it’s an orange screen we likely want a meeting with you soon, and if it’s a red screen, you need to get in touch with us straight away.’

He says deploying the patient app and bringing it across on a cloud-based platform will be challenging, but worthwhile.

‘It’s a concept that is portable across a whole range of diseases and allows the patient to take a lot more control over their condition.

‘The most exciting thing about the whole project is that you can get close to people with hep C and treat them. It would be very cool to be able to do that in this diverse cohort of people. If you can remove some of the health problems and get them engaged in the system, the overall benefits are huge.’

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