Background: Kirketon Road Centre
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1 AN INTEGRATED PRIMARY HEALTH CARE SERVICE IS EFFECTIVE AT RETAINING AND LINKING MARGINALISED GROUPS IN HEPATITIS C CARE: A STUDY OF THE KIRKETON ROAD CENTRE, KINGS CROSS 10 th Australasian Viral Hepatitis Conference Gold Coast, QLD 1 October 2016 Rosie Gilliver, Rebecca Lothian, Karen J Chronister, Wendy Machin, John Kearley, Greg Dore, and Phillip Read 1
2 Disclosure Rosie Gilliver has received funding from Abbvie to attend this conference. No grants or other funding was received in the development of this study. 2
3 Background: Kirketon Road Centre Aim to prevent, treat, and care for HIV, hepatitis and other transmissible infections among o People who inject drugs o Sex workers o At risk young people Established in Primary health care model Provide episodes of care for >3500 people per annum: 45% of whom inject 3
4 Background: Kirketon Road Centre Free, anonymous, walk-in Harm reduction framework One-stop-shop integrated service including o Hepatitis, HIV, and STI prevention treatment and care o Drug and alcohol treatment including OST o Mental health care o Injection related injuries and safer injecting o Overdose prevention and naloxone distribution o General medical care o Counselling, housing, legal and welfare assistance o Health promotion groups and activities o Needle and Syringe Program 4
5 Evolution of Hepatitis services at KRC Specialist monthly hepatitis service since 2002 o Low numbers treated with PEG-IFN/RBV o Weekly nurse led clinics, one GP prescriber o Focus on prevention, awareness, surveillance and diagnosis Since hepatitis services available daily o 6 doctors now prescribing o All nurses up-skilled; Hepatitis C project- CNC/CNS2 o Prevention and diagnosis routine care o Monthly ID specialist now for complex case review o Participation in clinical trials and elimination projects 5
6 Outreach hepatitis partnerships Evening bus outreach to rough sleeping locations Regular primary care outreach (nurse-led) o o o o o o o NUAA Needle and Syringe Program Medically Supervised Injecting Centre Mathew Talbot Hostel Sydney Sexual Health Centre Haymarket Foundation Clinic Wayside Chapel Edward Eagar Lodge Bloods & Fibroscan Assessment for treatment Treatment monitoring 6
7 Aims Investigate care pathways of clients who accessed hepatitis C (HCV) related care at the Kirketon Road Centre Establish which other Kirketon Road Centre services were utilised by these clients, and therefore may be important in linkage and retention in HCV care 7
8 Methods Retrospective clinical cohort Clinical database extraction All clients engaged in any HCV related care between 1 January 2014 and 31 August 2016 Data on clients with chronic HCV infection were analysed with respect to types of services utilised, demographic characteristics, and where they accessed KRC care Retention in care defined as subsequent attendance at Kirketon Road within 12 months of an initial consultation relating to HCV 8
9 Results: Demographics Between January 2014 and August 2016 o 3798 consultations related to HCV care among 1539 clients o 575 clients with chronic HCV infection o 150/575 (26%) were new clients to KRC who first presented for HCV care during the timeframe o 359/575 (62%) male, 203 (35%) female, 7 (1%) transgender o Median age: 42 years (IQR 35-49) o 112 (19%) Aboriginal and/or Torres Strait Islander o 565 (98%) people who had ever injected drugs o 290/565 (51%) PWID in last 6 months 9
10 Results: Linkage and Retention in Care 368/575 (64%) clients with chronic HCV returned for at least one subsequent consultation o 315/368 (86%) returned for care related to HCV o 296/368 (80%) clients accessed other KRC services Outreach (among clients who returned) o 45/368 (12%) were first seen in an outreach setting o 92/368 (25%) received some service in an outreach setting 10
11 Other KRC Services Accessed: Existing clients Odds ratio for subsequent HCV care if engaged in other KRC services = (95% CI = ) p<
12 Other KRC Services Accessed: New clients Odds ratio for subsequent HCV care if engaged in other KRC services = (95% CI = ) p<
13 Discussion Population often homeless, mobile, not engaged with other health services 64% retention in care; need to understand the 36% Outreach important component of engagement and follow-up High utilisation of other services Significantly associated with subsequent HCV care Primary health care model desirable for this population Treatment outcomes- next presentation 13
14 Questions? For further information, please contact: Kirketon Road Centre PO Box 22 Kings Cross NSW Rosie.Gilliver@health.nsw.gov.au 14
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