Viral Hepatitis Nursing Support: Patient information sheet
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Viral Hepatitis Nurses are clinical practice consultants who work with patients in the community, general practice or hospital setting. They provide a link between public hospital specialist services and general practice, and give specialised support to general practitioners (GPs) to assist in the management of patients with hepatitis B or hepatitis C.
With advanced knowledge and skills in testing, management, and treatment of viral hepatitis, they assist with the management of patients on antiviral medications and work in shared care arrangements with GPs who are experienced in prescribing medications for hepatitis C or accredited to prescribe section 100 medications for hepatitis B.
The Viral Hepatitis Nurses are located across the Adelaide metropolitan area and support can also be arranged for people in country areas. The nurses can be contacted directly by patients or their GP:
The South Australian Public Health Act 2011 requires medical practitioners and diagnostic laboratories to notify SA Health of cases (including deaths) suspected of having or diagnosed with specified infections and diseases. These infections or diseases are commonly referred to as 'notifiable conditions', and include hepatitis B and hepatitis C.
From June 2019, the Communicable Disease Control Branch will routinely refer notifications of positive hepatitis B and hepatitis C pathology tests to SA Health Viral Hepatitis Clinical Practice Consultants, enabling these specialist nurses to contact diagnosing clinicians and if required, offer support to facilitate the follow up of patients and contacts and the provision of guideline based care.
It is important for GPs to follow up the hepatitis C antibody test with a hepatitis C PCR (Polymerase Chain Reaction) test as approximately 25% of people clear the virus naturally. Patients who have a positive hepatitis C PCR test have active infection and should receive further assessment.
Contacts of patients who have a positive hepatitis C PCR test should be traced according to risk history, particularly needle and syringe sharing partners/networks.
With highly effective and tolerable direct acting antiviral medications now available for the treatment of hepatitis C, many people living with hepatitis C can be treated by their general practitioner in the community. For more information on the provision of treatment to people living with hepatitis C and eligibility to prescribe, see Hepatitis C Community Prescribing.
Consistent screening of high-risk groups forms a key pillar of the Australian public health response to hepatitis B.
It is important for GPs to complete all three serology tests required to diagnose chronic hepatitis B (HBsAg, anti-HBc & anti-HBs). If the patient is suspected to be acute, an additional test can be ordered (IgM anti-HBc). It is now known that people who were previously considered to have 'unresolved hepatitis B virus carrier state' do in fact have chronic hepatitis B infection, there is no such thing as a ‘healthy carrier’ of hepatitis B.
Contacts of patients with chronic hepatitis B should be traced according to risk and family history, particularly mother-to-baby transmission.
Lifelong recall and six to twelve monthly monitoring for all people with chronic hepatitis B, including those who are asymptomatic, is strongly encouraged. If left untreated, up to a quarter of patients with chronic hepatitis B will progress to liver disease or liver cancer in the long term.
Early detection and prolonged, adequate suppression of viral replication should be the goal for the management of chronic hepatitis B.
For more information on prescribing section 100 medications for the treatment of chronic hepatitis B, see HIV, Hepatitis B and Hepatitis C Community Prescriber Programs.
People with hepatitis C infection are at risk of severe liver disease if co-infected with either hepatitis A or B. A hepatitis C patient’s current hepatitis A and B vaccination status should be investigated.
As part of SA Health’s High Risk Hepatitis B Immunisation Program, certain susceptible groups including people with hepatitis C and household contacts or sexual contacts of people with hepatitis B are eligible for free vaccination.
The Viral Hepatitis Model of Care Reference Group (the Reference Group) oversees initiatives to increase access to viral hepatitis care in South Australia. This Reference Group was originally established to develop a comprehensive Nursing Model of Care for Hepatitis C Treatment in South Australia. The hepatitis C Clinical Practice Consultant nurses have led the development of the Nursing Model of Care for Hepatitis C Treatment in South Australia, which was endorsed by the Reference Group in December 2010.
The Nursing Model for Hepatitis C Treatment in South Australia was revised in January 2016 to incorporate the management of people with hepatitis B and D and renamed Nursing Model of Care for Viral Hepatitis Management in SA, and again in November 2017 to reflect updated guidelines for the management of viral hepatitis. This revised model of care provides the overarching framework to guide the implementation of the Viral Hepatitis Nursing Program.
We now know there is no such thing as a healthy carrier of hepatitis B. Current estimates suggest 1 in 5 people will die from liver cancer or liver failure if hepatitis B is left untreated. All patients with chronic hepatitis B (CHB) infection need lifelong management and routine follow-up by their GP. A vaccine is available to prevent CHB and associated liver cancer.
Additional information about diagnosis and management of viral hepatitis in general practice, and relevant training courses, can be found on the ASHM website. A copy of the National hepatitis B and hepatitis C testing policies can be accessed via the ASHM Testing Portal.