Authors: (including presenting author): :
All nurses from the GI nursing Work group
Affiliation: :
All nurses from the GI nursing Work group
Keyword 2: :
Nursing roles
Keyword 3: :
WHO viral hepatitis elimination
Introduction: :
Hepatitis C is a curable yet under-diagnosed disease. In line with the World Health
Organisation’s goal to eliminate hepatitis C as a public health threat by 2030, Hong Kong has adopted a micro-elimination strategy, targeting specific populations and healthcare sectors for focused elimination efforts. To operationalise this strategy, the Hospital Authority Head Office (HAHO) launched the Hepatitis C Callback Programme, which generated a centralized list of patients with previous anti-HCV-positive results within the Hospital Authority system. Besides the HAHO callback initiative, local hospitals continue to receive referrals from other services and work closely with non-governmental organisations (NGOs) to identify and engage patients in the community. Nurses play a pivotal role throughout this process, ensuring that every identified patient is contacted, confirmed for HCV RNA status, assessed for liver fibrosis, and promptly started on antiviral treatment when indicated.
Objectives: :
This retrospective cohort study aimed to evaluate the effectiveness of the HAHO-
initiated callback programme in enhancing the HCV screening-to-cure cascade and to identify barriers faced by nurses, affecting patient engagement.
Methodology: :
The study involved multiple clusters. Eligible patients were those listed by HAHO with documented anti-HCV-positive results. Nurses were responsible for recalling patients, arranging confirmatory HCV RNA testing, and coordinating further management for those who tested anti-HCV positive. Patients with significant fibrosis, indicated by the transient elastography of liver reading of 10 kPa or above, were kept in the hepatology outpatient monitoring. A simplified and fast-tracked clinical pathway was adopted to expedite treatment, allowing patients to initiate Direct-Acting Antiviral (DAA) therapy within approximately three appointments. This streamlined process aimed to minimise delays and improve treatment adherence.
Result & Outcome: :
From 2022 onward, a total of 9,401 patients were identified through the HAHO callback list, supplemented by 1,056 additional referrals from various sources, including NGOs, methadone clinics, other hospital departments, and family medicine outpatient clinics. Among these individuals, 8,312 were confirmed to be anti-HCV positive, and 5,071
were found to have detectable or unknown HCV RNA levels. Within this group, 517 patients exhibited significant liver fibrosis (≥10 kPa) on the transient elastography of the liver, warranting specialist evaluation and
management. Nurses made the initial contact with 423 patients through nurse clinics, providing
education and arranging necessary blood investigations before specialist consultation. Following this coordinated approach, 2,135 patients successfully commenced DAA therapy and achieved sustained virological response at 12 weeks post-treatment (SVR12), indicating virological cure. The number of patients achieving SVR12 continues to increase as follow-up data are
updated. To date, 1,714 patients—representing a substantial proportion of those treated have been discharged from specialist care, no longer requiring follow-up owing to confirmed cure. Common challenges encountered during the Hepatitis C Callback Programme included patients repeatedly defaulting on follow-up appointments, being unreachable by phone, or refusing further care as they were asymptomatic or claimed to
have received treatment elsewhere. Duplicated referrals from different sources created an extra workload, and some patients were reluctant to undergo blood taking due to poor venous access. Nurses also spent much time explaining treatment details and tracing defaulters.
