Since 2015, the Ministry of Health has been working with the four DHB regions to set up and implement an integrated approach to the delivery of hepatitis C services across primary and secondary care in New Zealand.
This change in approach was in part informed by a Pilot carried out by the Hepatitis Foundation of New Zealand 2012–2014 in the Central and Midland regions.
Hepatitis C Coordinators are in place in each of the DHB regions to support the development of services based on a national clinical pathway that has been tailored to meet the needs of regional populations.
A clinically led Hepatitis C Implementation Advisory Group developed guidance covering the high level hepatitis C clinical pathway, minimum requirements, quality assurance frameworks, minimum standards and data collection. These guidelines are updated regularly.
DHB regions are now implementing hepatitis C services that provide: early identification primarily through non-invasive liver scanning, which, where possible, is community based; diagnosis, assessment, triage and management, including monitoring, support and education to people with hepatitis C within the general practice environment.
Supporting primary care prescribing
Supporting primary care prescribing is a key priority for DHB regions. Actions include:
- raising awareness and providing education to people with and at risk of hepatitis C and to GP practices
- making information available on how to reduce the risks of infection and transmission
- providing training and education sessions on prescribing and support needed for the new funded hepatitis C treatments
- engaging and supporting diagnosis and treatment within high risk populations through the needle exchange services, community alcohol and drug services, opioid substitution treatment services and Corrections Department facilities.
Diagnosing the undiagnosed
The hepatitis C national clinical pathway includes awareness raising, targeted testing in order to identify undiagnosed individuals living with chronic hepatitis C infection, identification of people previously diagnosed but lost to follow-up, and assessment and management.
Actions to increase identification/diagnosis in each DHB region includes:
- engaging with:
- local Māori
- immigrants from South East Asia and Middle East
- at-risk and hard to reach groups, including people who inject drugs and prisoners
- needle exchange services, prisons, opioid substitution treatment providers, and community alcohol and drug services
- supporting primary and community care to trace those previously identified with hepatitis C but lost to follow-up
- opportunistic targeted testing at general practice and within the community.
Hepatitis C regional services delivered in the community
DHB regions are delivering a range of hepatitis C services in the community.
The Northern Region is delivering hepatitis C services, diagnosis, management, treatment and now cure into the community. The region’s DHBs and primary healthcare networks, representing their general practices, are working in partnership to make fibroscanning available as a simple diagnostic in various community settings without the requirement for a specialist appointment. Coordination and collaboration across health services is fostered with a number of initiative underway to engage previously diagnosed patients, as well as increasing awareness and promoting testing amongst potential patients at risk for hepatitis C.
The Midland Region Community Hepatitis C Service is a free mobile service covering the five Midland DHB areas. The service actively works to ensure geographical coverage and to reduce disparity. The Midland community hepatitis C nurse has extensive experience working with people with hepatitis C and two liver specialists provide clinical oversite of this service. The service uses a ‘one stop shop’ approach as much as possible to reduce patient visits within the health sector. Clinics are held in the community so those with hepatitis C feel comfortable attending for example in needle exchanges and community centers.
The Community Hepatitis C Programme in the Central Region takes referrals for fibroscans, and organises fibroscan clinics in the community, hospitals and prisons, with results being sent back to the referrer and/or referral to secondary care if appropriate. Support and advice on treatment for hepatitis C is offered along with a wide ranging education programme. Monthly clinics are held in all of the regions Needle Exchanges with referral on for treatment and support for those not engaged with medical care.
South Island Region
The Southern Region is delivering a range of hepatitis C services into the community. Fibroscanning is available throughout the region in secondary care, general practices by appointment and via needle exchanges and community clinics by arrangement. Coordination and collaboration across health services is fostered with specialist nursing resource based in secondary care and in the community supporting primary care.