Rather than recap the individual speakers it is worth noting the common trends between their presentations.
The focus of the discussion was addressing the missing link in viral hepatitis management being access to diagnosis. The need for a varied approach between the urban and remote rural settings was a consistent message. Similarly the future in the developed world will vary from the requirements in resource scarce settings of the developing countries.
The approaches in these setting may vary by:
- Centralised testing verses decentralised (POC) testing.
- Cost of testing being significant barrier in developing countries.
- The risk of loss to follow up in high risk and remote communities needs to be considered in choosing the most appropriate test. The current EASL and WHO recommendations require 4 visits up to SVR 12. With access to pangenotypic treatments the removal of genotyping and viral load will remove at least one of these stages. This would require the removal of the genotype requirement for PBS authorisation of DAA scripts.
Amanda Wade presented a study of outcomes of remote consultation pathways in Barwon Health
This study assessed the implementation of the remote consultation pathway to increase GP management of HCV in the community. The notable feature of this program was the early consultation with local GP’s in the development of the remote consultation form and referral pathways.
This was followed up with GP education and support by PHN Health Pathways.
The number of GP’s prescribing showed a significant increase following the implementation of the program in 2016.
Despite the initial success the prescription numbers have fallen off in the 2017-2018, but this is a trend that has been seen in most regions. In response future plans for the program include accessing clients via existing NSP, AOD and mental health services as well as ongoing GP engagement.
Stephen Arthur has worked extensively in rural general practice for over 20 years. During this period he has been mainly involved in Aboriginal health in Western Australia. His employment has included various roles both in hospital based procedural general practice and in community primary health. During the last ten years he has primarily worked as the Senior Medical Officer for a regional Aboriginal Medical Service.