Introduction In England and Wales, approximately 200 000–500 000 people are infected with hepatitis C virus (HCV).1 In 2005, a survey carried out by the department of health revealed a relatively low uptake of HCV treatment. Traditionally, patients diagnosed with HCV infection have been managed in the tertiary centres. However, with the recognised increasing load of HCV infection in the UK, there has been a trend towards setting up of specialist nurse-led hepatitis C clinics in the district general hospitals.
Methods A specialist nurse-led hepatitis C clinic was established in Barnsley hospital in November 2008. The aim of this service was to streamline the care of patients diagnosed with HCV infection ensuring a quick and efficient route to diagnosis and treatment. After the confirmation of active HCV infection, patients are assessed in the nurse-led clinic with a detail history, examination, psychological assessment and relevant investigations. Once they are deemed suitable to undergo treatment by a consultant gastroenterologist, patients are counselled by the nurse and treatment is initiated. Follow-ups are arranged in the review clinic in line with NICE guidelines. 43 patients have been initiated on treatment for HCV infection between November 2008 and November 2009 in this clinic. The aim of our audit was to assess the safety and efficacy of this nurse-led service.
Results Of the 43 patients (mean age 35 years), 62.7% are males and 37.3% are females. Incidence of different HCV genotypes are as follows – 1a (18.6%), 1b (7%), 2b (18.6%), 3a (53.5%) and 4a (2.5%). All the 12 patients belonging to the type 1 or 4 genotype had a 2 log drop in their viral load at 12 weeks and are currently on course for completing 48 weeks of treatment. Of the 31 patients belonging to the type 2b/3a genotype, 20 have completed 24 weeks of treatment (18 patients had an end of treatment viral count of zero and 2 patients did not attend to have their bloods checked. All are currently waiting to have their 6-month post treatment viral load checked), 9 are undergoing treatment, 1 dropped out of treatment and treatment was stopped in one patient because of development of decompensated liver disease. Five patients developed dyspnoea and anaemia which required a dose reduction of ribavirin initially and increased to the usual dose subsequently. Of these, three required blood transfusion. There has been no major morbidity or mortality.
Conclusion The nurse-led clinic has been a safe and effective way to streamline the management of patients with HCV infection. Patients have been highly satisfied with this locally available service and appreciate the continuity of care provided by the specialist nurse. This has led to increased uptake of HCV treatment locally and reduction in the number of patients referred to the local tertiary unit.
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