Psychiatric inpatients are an at-risk group for hepatitis C infection yet are under-served in terms of screening and treatment.

Findings presented at Australian Gastroenterology Week 2018, confirm that psychiatric patients such as people with schizophrenia typically have a higher prevalence of HCV than the general population.

The study of 260 patients attending four inpatient facilities in South Australia found 10.8% of patients with HCV antibodies and 6.2% positive for HCV RNA.

Overall prevalence of HCV in the Australian community is estimated at 1.2-1.8%.

Most patients (80%) had at least one risk factor for HCV infection such as a history of injecting drug use or a custodial stay.

Dr Jeyamani Ramachandran, from Flinders Medical Centre, told the limbic that all of the HCV antibody positive patients had been previously notified to the National Notifiable Diseases Surveillance System (NNDSS).

Yet only five patients had received prior treatment – highlighting the difficulty of engaging with this group of patients.

Of 16 viraemic patients in the study, eight were successfully initiated on direct acting antiviral (DAA) therapy with at least seven achieving a sustained viral response.

However eight other patients did not receive treatment for their hepatitis C due to the uncontrolled nature of their psychiatric illness or lack of contact with health services.

Dr Rhamachandran said psychiatric admission was a valuable opportunity for HCV screening and would likely be cost-effective.

As well, there would be opportunities to screen less acute patients in the community during monitoring of toxicity associated with their antipsychotic medications.

“Previously we only had interferon which could not be used in this population because of the risk of worsening psychiatric symptoms. So now that we have the new medicines which are safe, I think it is time to prioritise this population.”

“In most of these patients the diagnosis was already there, it was just that they were not linked to treatment. Psychiatric colleagues have to be aware of this and start screening patients and linking them with care.”

She said a team approach tagging onto existing services including hepatitis nurses who were monitoring compliance with medications and blood tests and community pharmacists making up Webster packs.

“So the patients were told their hepatitis C medication was added to their other medications. If it’s in the pack, they just have to take it. It’s less effort from their side.”

“It is possible to achieve success if we persevere. We have to actively look for infection in this group and treat with a team approach so they are not confronted with new faces.”

She said not all patients would agree to screening first time round but consent might be achieved after the topic was brought up in multiple consultations or at a time when patients were well.

The study was funded by an unrestricted educational grant from MSD Australia.