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C57. Making Hepatitis C our Business: Nurse Practitioner- led Hepatitis C Treatment in Opioid Agonist Therapy Programs

Making Hepatitis C our Business: Nurse Practitioner- led Hepatitis C Treatment in Opioid Agonist Therapy Programs

Learner category:

  • Novice Level

Learning objectives:

  • Participants will be able to identify the importance of treating hepatitis C in an opioid agonist therapy program to promote micro elimination.
  • Participants will be able to identify barriers to hepatitis treatment and recognize Nurse Practitioner-led clients can help with barrier mitigation and improved client engagement and satisfaction.

Abstract

Providing Nurse Practitioner (NP)-Led Hepatitis C Virus (HCV) programs within Opioid Agonist Therapy (OAT) Clinics has a positive effect on the elimination of HCV infection within a high-risk vulnerable population. The Canadian Network on Hepatitis C (2019) found 85% of new HCV infections occur among people who inject drugs (PWID), but few initiate treatment. Addiction and Mental Health NPs utilize a harm reduction, low barrier, de-stigmatizing and culturally sensitive approach, promoting engagement with PWID. Calgary’s Opioid Dependency Program (ODP) and Injectable Opioid Agonist Therapy (iOAT) program have established independent algorithms to facilitate treatment of HCV. Utilizing a NP-led approach, iOAT incorporates HCV treatment into daily appointments, while ODP refers clients to their in-house HCV program. Multidisciplinary teams conduct screening, assessment and treatment planning, including directly observed therapy or take-home doses. Client education is provided with an emphasis on harm reduction. Challenges of treating HCV at iOAT include obtaining medication coverage and difficult phlebotomy; where as a larger population and less frequent clinical contact are barriers at ODP. Using an NP-led approach for HCV treatment within OAT programs has the benefit of fostering more regular client contact and reducing barriers to care. Calgary’s OAT clinics demonstrate that this client-centred approach yields increased HCV identification, barrier mitigation, treatment completion, post-treatment monitoring and client satisfaction. In alignment with the World Health Organization (2018), these Calgary OAT programs offer treatment to all clients diagnosed with HCV, and are integrating harm reduction approaches, thereby improving access to care and minimizing the risk of reinfection.

Authors

Natasha Bansley
Nurse Practitioner Alberta Health Services

Natasha Bansley is a master’s prepared Nurse Practitioner, focusing her career on addiction medicine and vulnerable populations at Calgary’s Opioid Dependency Program (ODP) and The Alex Community Health Centre. Natasha has developed and implemented a Hepatitis C program within ODP and is a Rapid Access Addiction Medicine clinic program lead.

Cristina Zaganelli
Nurse Practitioner, Alberta Health Services

Cristina is a nurse practitioner with a practice focus in substance use, mental health, and homelessness. She graduated from the University of Calgary and Dalhousie University. Cristina works at the Injectable Opioid Agonist Therapy Clinic, Youth Substance Use and Mental Health Services, and The CUPS Health Clinic.

Comments (5)

  1. Dennis Hagarty

    Nicely done presentation. HCV patients also have a lot of stigma associated with this disease. The support your program gives does make a difference in the patients life.

  2. Cristina Zaganelli

    Thanks for your feedback. It can’t be said enough how satisfying it is as a clinician to ‘cure’ a disease, and clients love it too!

  3. Rita Hanuschock

    Hi…So fascinating; a true way to reduce harm;
    Please clarify for me; up to 250mg dilaudid per dose? or 250 mcg?
    IV or IM administration??
    Thanks, Rita (Ohio)

  4. Oluremi Adejumo

    Indeed, a true way for a severe opioid-related harm reduction. Like Rita, it seems as if the dose “up to 750mg/day” of hydromorphone (Dilaudid) is pretty high. Could you clarify?

  5. Rachel Shuster, BSN, RN, CARN, CAAP

    Thank you so much for your presentation. I learned a couple things in comparison to what I knew from implementing a HCV tx program within an office-based opioid treatment program that was embedded within a large, hospital-based outpatient clinic. Dissimilarly, we don’t have prescribed agonist therapies in the US with the exception of tightly-controlled methadone and the partial-agonist buprenorphine (also more tightly controlled than other substances of misuse).

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