“The new era of hepatitis C treatment means the hepatology nurse’s role is changing,” says Dr Jacqui Richmond, co-author of the Australasian Hepatology Association Consensus Guidelines for the Provision of Adherence Support to People with Hepatitis C taking Direct Acting Antivirals which was launched at the 10th Australasian Viral Hepatitis Conference on Friday 30 September 2016.
On March 1st 2016 Australia became one of the only developed countries globally to publicly subsidise
Direct Acting Antiviral (DAA) treatments for people with hepatitis C regardless of their stage of liver disease. Currently there is limited evidence to inform clinical practice on providing adherence support to people taking DAAs. Medication adherence is potentially complex and requires multiple strategies to support patients’ adherent behaviour.
Dr Richmond, Hepatology Nurse Consultant (Melbourne Health) and Research Fellow at La Trobe University, Melbourne, led the steering committee that convened an expert panel consisting of six advanced practice Hepatology nurses, a hepatologist, hospital-based pharmacist, a consumer with hepatitis C and DAA therapy experience, and a representative of Hepatitis Australia (the peak consumer organisation). The panel discussion focused on the facilitators and barriers to DAA adherence and the resultant guidelines underwent three rounds of consultation in May and June 2016.
The twenty four consensus guidelines focus on pre-treatment assessment and education, assessment of treatment readiness, and monitoring medication adherence. The guidelines promote a patient-centred approach that espouses that all patients are at risk of medication non-adherence. ‘Treatment readiness’ is a pivotal concept that influences subsequent adherent behaviour. The guidelines recommend supporting DAA adherence through implementing interventions focused on the patient such as identifying memory triggers and hooks; linguistic advice for health professionals including using non-confrontation and non-judgemental language; and tools to measure and support medication adherence such as visual analogue scales, pharmacy data and directly observed treatment.
“Supporting patients with hepatitis C to adhere to the medication schedule is critical to ensure the amazing cure rates observed in clinical trials translate to real world,” said Dr Richmond. “These guidelines are the first of their kind in the world”.