Hepatitis C management via a regional nurse-led telehealth initiative: A cascade of care from referral to cure in Victoria

Background and Aim: Regional and rural populations with chronic hepatitis C virus (HCV) infection remain undertreated due to low primary care uptake, combined with limited access to specialist care and follow-up Telehealth (TH) addresses many barriers to treatment access, has previously proven successful for HCV management in rural and prison settings, and has been proposed as an alternative for patients who remain geographically and socioeconomically disadvantaged, particularly in the coronavirus 2019 era We aimed to report the clinical outcomes and the cascade of care of a novel nurse-led HCV TH clinic set in regional Victoria Methods: We performed a retrospective cohort analysis of all patients referred to a regional HCV TH service between 1 April 2017 and 10 June 2020 Data were collated from outpatient and electronic medical records, as well as prospectively collected qualitative patient surveys Results: A total of 55 patients were booked into the HCV TH clinic, and the outcomes are shown in Figure 1 Twenty-five patients (54%) had a history of alcohol use disorder, 24 (52%) had psychiatric comorbidity, and five (11%) had obesity Thirteen of the 14 (93%) who received treatment achieved sustained virological response We additionally demonstrated successful TH-driven hepatocellular carcinoma surveillance among the subgroup of patients with cirrhosis An average of 46 48 km of travel, 54 64 min, and A$30 67 was saved per patient for each visit Overall patient satisfaction gathered via Likert scale surveys was positive, with observed benefits including increased medical engagement, adherence to treatment, and improvement in long-term health outcomes at a personal and cohort level Conclusion: Nurse-led HCV management via TH has allowed access for a marginalized regional population with high levels of substance misuse and psychiatric comorbidity Clinical outcomes were comparable to those previously reported from tertiary and community-based cohorts, with additional cost benefit, efficiency gains, and carbon footprint reduction among a previously unreported regional Victorian population with HCV