Stage 4: Test, Treat and Care

Follow up patients and offer care.

In this stage of the program, you will be recalling patients and offer further testing, treatment and support.

Completing this step requires your practice to design the processes you will follow in order to offer testing and treatment and ongoing care.

Understand your testing options

A key consideration is that hepatitis C can be identified through antibody testing and RNA; however, antibody tests will remain positive even after a person has been cured of hepatitis C, so an RNA test is required to determine whether a person has a chronic or active viral infection.

While most practices will test for hepatitis C using venous blood sent to the local pathology service, it may be useful to know that there are other options available for hepatitis C testing:

Venous blood tests
Dried blood-spot testing (DBS)
Point of Care Testing (PoCT).

In NSW, DBS testing can be accessed by patients. Patients can register online and a kit is sent to them in the mail. It is free and can be done almost anonymously. Enough details are required to ensure results can be received. Results are given to patients by phone, SMS text or email. It is important to be aware that DBS has a lower sensitivity so false negatives are possible. For more information, see the DBS testing website.

Point of Care Testing may be available to you or useful in services with a high caseload or outreach programs. A blood sample for point-of-care HCV RNA testing can be collected and interpreted by trained healthcare professionals, frontline workers, and peers. Blood is taken from a finger prick made with a lancet (a special medical blade with a sharp point) and capillary blood is collected into a Minivette®. The blood is dispensed into a cartridge, then loaded into the GeneXpert System, which generates an HCV RNA result within 60 minutes.

Each method has advantages and challenges, so you need to choose the method that’s right for your practice and your patients.

Antibody testing methods such as dried blood-spot testing and certain rapid tests can be useful as a low-impact screening test if your patients have trouble with venous blood tests. You can learn more about your testing options in the online learning modules.

Design your model of care

Your model of care is the holistic view of how you will support and guide your patients through the process of testing and treatment. For example, your model of care might be:

Offer a PoCT test to all patients who have a history of drug-injecting or incarceration
If positive, meet with the clinician to discuss history and determine whether they have ever been treated
If they have never been treated, offer a venous blood test to confirm RNA, and prescribe treatment on the same day
Create a follow-up process where the practice nurse or clinician phones the patient:
- After 3-4 weeks to support the treatment process
- At the end of the treatment process to book a retest appointment.

You will find many examples of different models of care at INHSU’s website.

Supported clinical decision-making

There are plenty of resources available to support you through the testing and treatment process, including:

Decision-making flowcharts
Online learning modules
Webinars and websites
Your Practice Nurse Advisor or Local Health Services.

Refer to the Resources page to find out more.

Timing: It’s expected that most practices will spend 5 to 6 months completing this step.

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