Judith Byaruhanga

Dr Byaruhanga is an Early Career Researcher with HIV/AIDS and Related Program (HARP) at Hunter New England Population Health District. Judith has previously worked as a clinician and researcher treating HIV/AIDS and Hepatitis infections. While working with Hunter New England Local Health District, She has contributed to various research projects including the pilot hepatitis C research projects and other public health research projects.


Title: Routine Hepatitis C virus management in mental health settings is feasible: a pilot implementation trial

Author(s): Judith Byaruhanga, Meghan Macdonald, Emily Pollock, Elizabeth Roberts, Suresh Sharma, Cassandra Lane, Benjamin Moran, Annette Slater, Swathy Girijakumary Manohar, Paul McNab, Josh Louis, Lawrence Dadd, Hemalatha Varadhan, Jane Drury, Jonathan Holt, Cath Wood, David McLeod, Lisa Brankely, Anand Swamy, Bron Rose, Fionna Murphy, Bianca Prain, John Wiggers, Melanie KingslandĀ 

Introduction: Hepatitis C virus (HCV) disproportionately impacts individuals experiencing mental illness (19%) versus the general population (1.2%). This pilot project aimed to assess: i) feasibility and acceptability of routine HCV testing and treatment in mental health services (MHS); ii) efficacy of implementation strategies to increasing HCV testing; iii) barriers and enablers of implementation.

Method: Pre-post mixed method study in two MHS in-patient wards in the Hunter New England, NSW. Implementation strategies (including executive support, site champion, staff training and prompts) supported delivery of the following model-of-care: all patients offered HCV testing; treatment access via a nurse-led remote-prescribing model. Medical records provided testing data; validated surveys and focus groups assessed clinician acceptability and explored implementation barriers and enablers.

Results & Findings: Over 7 months of implementation support, HCV testing increased by 34% (Taree: 35%; Mater: 32%). 75% of clients diagnosed, started treatment. 100% of surveyed clinicians agreed HCV-testing was important;100% welcomed routine testing as usual care; And 90% of clinicians reported HCV testing is implementable. Barriers to HCV care included: clinician's self-efficacy to prescribe medication, staff turnover leading to inconsistent testing, and patient-level challenges (e.g., short stays, acutely ill). Prominent enablers were: clinician's motivation to test, curative treatment, and champion support.

Discussion: Routine HCV care in MHS is feasible and acceptable and implementation support increased HCV testing in MHS units. Data on barriers and enablers to HCV care maybe used to refine implementation strategies to support mental health clinicians. These strategies should then be tested using more robust evaluation methods, via a randomised controlled trial.