3D illustration of 4 empty beds in a hospital ward. Credit: AdobeStock

Treatment of HOsPitalised Inpatients for hepatitis C (TOPIC)

The challenge

Admission to hospital with an injecting related infectious disease (IRID), occurs far more frequently in people with current injecting drug use than the general population, and of people admitted with IRID up to 75% have a history of hepatitis C virus (HCV) infection. A significant challenge is to engage people who inject drugs who do not traditionally link to health services, in HCV treatment and care. The period of hospitalisation for management of IRID, particularly when prolonged, may represent an ideal opportunity to engage HCV-infected people who inject drugs (PWID). Currently in-hospital commencement Is not allowed, and instead patients must wait to be treated in outpatient services.

The project

Treatment of HOsPitalised Inpatients for hepatitis C: Strategic therapeutic intervention to enhance linkage to care in people who inject drugs. Given that recent PWID are at high risk of transmission and risk behaviour post-discharge, eradication of HCV viraemia with successful direct-acting antiviral (DAA) therapy commenced during hospitalisation may be an important strategy for broader HCV elimination. One of the greatest challenges to inpatient treatment initiation lies in the completion of the therapeutic course after discharge. Following discharge competing priorities may limit treatment completion and loss to follow-up is a real concern.

The method

This study aims to complete as much of the DAA treatment course as possible during admission. This will be facilitated by two strategies:

  1. The provision of point-of-care RNA testing on site, reducing the anticipated wait time between venepuncture and RNA result by several days and allow for HCV treatment initiation within the first few days of admission.
  2. The use of short course DAA regimens to minimise the period of outpatient treatment.
The impact

This project brings together a group of clinical, academic and community leaders who have vast experience in viral hepatitis and addiction medicine to design and evaluate a novel model of care likely to change current practice with the overall aim of improving health outcomes for hospitalised PWID.

PWID experiences within the hospital setting are often negative, reflecting widespread stigmatisation at both the individual and institutional level, and reflected in discharge against medical advice (DAMA) resulting in suboptimal health outcomes. Data derived from this project aims to inform the education of both staff and consumers to improve inpatient care and experience.

Project collaborators

St Vincent’s Hospital, Sydney; Prince of Wales Hospital, Sydney; Blacktown Mt Druitt Hospital, Sydney; St Vincent’s Hospital, Melbourne; The Alfred Hospital, Melbourne; Royal Adelaide Hospital, Adelaide; Cepheid.

Project funding

Triple I Clinical Academic Group Seed Grant Funding.