Photo: Midland Region Community Hepatitis C Service team members Nancy Carey, Jo de Lisle and Waikato DHB endoscopy specialist Frank Weilert with one of the fibroscanners.
Dramatic changes in the way hepatitis C is diagnosed and treated are underway in Waikato and the wider Midlands health region, thanks to research, advances in technology, new treatment drugs, funding decisions and a spirit of collaboration.
As a result, people diagnosed with hepatitis C can be treated (and often cured) with new anti-viral drugs in their own community.
Jo de Lisle, who is coordinating changes across the Midland region, says the key to these improvements is a focus on “curing, community and collaboration”.
The result is a Midland Region Community Hepatitis C service – and an approach that involves both primary care practitioners and hospital specialists using one agreed patient pathway.
The key change is that responsibility for treating patients with hepatitis C has moved to primary care. This avoids a lot of visits to hospital clinics during the treatment stage.
A working group, including a patient representative, developed the regional patient pathway last year following a pilot by the Hepatitis Foundation of New Zealand in the Bay of Plenty district.
This pathway is now being implemented across the five Midland district health boards (DHBs) – Waikato, Bay Of Plenty, Tairawhiti, Lakes and Taranaki – as the Midland Region Community Hepatitis C Service, coordinated by Waikato Hospital in partnership with the Hepatitis Foundation.
“All the major groupings of district health boards are doing something similar across New Zealand. What makes it easier for us is the electronic referral system we already have in Midland for primary care referrals to a regional-based service,” says de Lisle.
Initial patient assessment and blood testing is done through general practices then referred to the Midland Community Hepatitis C service for a fibroscan*. This simple diagnostic procedure tells the clinical team the stage of the hepatitis, which will determine what sort of treatment is available. It’s also an opportunity for education and discussion.
Some fibroscans are done at Waikato Hospital but community fibroscan nurse Jillian White provides the same diagnostic and education service by clinics held where and when they are needed in communities across the region.
Once the diagnosis is done and it is clear what stage the hepatitis C is at, then any treatment medication can be prescribed and managed locally by general practitioners and prescribing nurses.
De Lisle says that the combination of community GP and nurse prescribing, mobile services, electronic referrals, more portable and cheaper fibroscanners, means the service can provide hepatitis C support and services much closer to home for patients.
The new anti-viral drugs (Viekira Pak and Viekira Pak-RBV) were approved by the Ministry of Health and are now fully funded by PHARMAC. These new medications are dramatically increasing the cure rate for people with hepatitis C to over 90 percent compared to 50 percent before the new medication was available.
They are one of the direct acting anti-viral (DAA) group of medications that are a focus of international development in the treatment of hepatitis. Waikato Hospital’s Gastroenterology Clinical Trials Unit has participated in international clinical trials of DAA medications since 2004.
* A fibroscan (also known as a transient elastography) is similar to an ultrasound, using a tool held against a person’s side close to where the liver is located. It checks the amount of scarring or fibrosis by measuring the degree of stiffness in the liver. In the past, this diagnosis was done by biopsy, where a piece of liver was taken from a person for analysis. With the fibroscan, the diagnosis is non-invasive, not painful, and quick. Waikato Hospital got its first fibroscan machine in 2010 for $200,000, and it was a cumbersome machine compared to the current very portable models that cost around $80,000.