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BACKGROUND AND AIMS: Progressive liver fibrosis related to non-alcoholic fatty liver disease (NAFLD) is associated with all-cause and liver-related mortality. We assessed vibration-controlled transient elastography (VCTE) as a predictor of mortality. METHOD: Data from patients who underwent VCTE for NAFLD at four large health services in Victoria, Australia between the years 2008 and 2019 were linked to state-wide data registries. Cause of death (COD) and predictors of all-cause mortality were subsequently analysed using descriptive statistics and Cox-proportional regression analysis. RESULTS: Of 7079 VCTE records submitted for data linkage, 6341 were matched via data registry linkage. There were 217 deaths over a 22 653 person-year follow-up. COD included malignancies other than hepatocellular carcinoma (HCC) (18.0%, n = 39), sepsis (16.1%, n = 35), decompensated liver disease (15.2%, n = 33), cardiac disease (15.2%, n = 33) and HCC 6.0% (n = 13). Controlled attenuation parameter (CAP) was not associated with mortality in univariable analysis (HR = 1.00, CI 1.0-1.0, p = .488). Increased liver stiffness measurement (LSM) (HR 1.02 per kiloPascal, CI 1.01-1.03, p < .001), Charlson comorbidity index (CCI) (HR 1.32 for each point, CI 1.27-1.38, p < .001) and age (HR 1.05 per annum, CI 1.03-1.07, p < .001) were each associated with higher rates of all-cause mortality in multivariable analysis. LSM ≥10 kPa suggestive of compensated advanced chronic liver disease (cACLD) was associated with mortality in multivariable analysis (HR 2.31, CI 1.73-3.09, p < .001). CONCLUSION: VCTE LSM, in addition to age and CCI, is independently associated with increased all-cause mortality in a large cohort with NAFLD.

Conventional models of health care for the hepatitis C virus (HCV) underserve people with serious mental illness. In a 6-month proof-of-concept study, colocated HCV care coordination was assessed within community mental health settings. The program, which relied on referrals to a visiting hepatologist and was augmented by a part-time nurse practitioner, received 18 referrals for HCV management. From this group, 11 individuals achieved sustained virological response at 12 weeks after direct-acting antiviral therapy. Seven individuals declined treatment or were lost to follow-up. Overall, colocated integrated services may play an important role in HCV health care parity for people with serious mental illness.

Background and Aim: Hepatitis C virus (HCV) is now a highly treatable condition. HCV is overrepresented in people with serious mental illness, largely as a consequence of substance misuse. People with serious mental illness are marginalized in terms of access to care. Strengthened community engagement to optimize population HCV management could feasibly reduce overall HCV seroprevalence, while likely reducing disease incidence. As such, we aimed to investigate the prevalence of HCVin a tertiary mental health service and, hence, identify barriers to care and opportunities to optimize community-based HCV management. Method(s): We retrospectively analyzed 4492 people admitted to a multisite mental health service between January 2017 and December 2018. We appraised patterns and rates of HCV screening using medical records, electronic pathology, and ICD-10 coding. Referral pathways were analyzed for people with serious mental illness and potentially treatable HCV. Intensified access to HCV care was prospectively provided to eligible, untreated people within community mental health services. Result(s): HCV seroprevalence was 6.2%, based on pooled serology together with HCV ICD-10 coding. In a sensitivity analysis, 19.1% (35/ 183) of those with identified HCV risk factors remained unscreened. We identified 209 people who required additional HCV work-up or treatment. Multiple opportunity losses were manifest in the care cascade, particularly through lack of referral to treatment (89, 42.6%) and failure to attend specialist outpatient clinics (52, 25.8%). Given this attrition, we identified 48 community-managed patients who were untreated or incompletely worked up for HCV. Of these, 10 people (20.8%) with longstanding mental health service integration achieved a sustained virological response at 12 weeks through bolstered community support. However, 22 people (45.8%) could not be engaged (Fig. 1). Conclusion(s): HCV screening and treatment should be prioritized in people wit

Background and Aim: People with serious mental illness have high rates of bloodborne viruses (BBVs) but often have poor access to medical care. We sought to define the burden of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV in a long-stay inpatient cohort with serious mental illness. Emphasis was placed on elucidating BBV prevalence, risk factors, and access to care. Method(s): We prospectively approached all patients (n = 46) admitted to a long-stay mental health admission unit at a tertiary referring hospital over a 2-week period and invited each person to complete a BBV risk factor survey, opt-out BBV screening, and liver assessment using transient elastography and other non-invasive liver stiffness assays. This was part of a quality assurance initiative. Result(s): Baseline demographics showed a young cohort (median age, 39.5 years), with a male preponderance (71.7%). The primary psychiatric diagnoses were schizophrenia and schizoaffective disorders (95.7%). Almost two-thirds (63%) had a secondary diagnosis of substance-misuse disorders. Serology was obtained for 31 patients (67.4%). Of those screened for HBV, 15 (53.3%) were unvaccinated, four (13.3%) had previous HBV exposure, and 10 (33.3%) were vaccinated. No cases of HBV viremia were identified. HCV serology was positive (HCV antibody positive) in 11 patients (36.7%). Each had a history of intravenous drug use. Importantly, seven patients (23.3%) had successfully been treated for HCV and one (3.3%) had active viremia. The remaining cases likely reflected spontaneous clearance. To assess disease severity, transient elastography and the aspartate aminotransferase to platelet ratio index (APRI) were used as validated markers of liver fibrosis. APRI showed higher rates of fibrosis in the HCV antibody positive cohort, but this was not statistically significant compared with the HCV-naive cohort. Liver stiffness measurement conducted in the HCV antibody positive study group was similar and showed two

BACKGROUND: People with serious mental illness (SMI) are underserved from a hepatitis C Virus (HCV) screening and treatment perspective. AIMS: To examine the HCV care cascade in people with SMI and to pilot a supported HCV treatment integration program. METHOD(S): HCV prevalence was retrospectively analysed from 4,492 consecutive individuals admitted to a tertiary hospital mental health service between January 2017 and December 2018. Sub-cohort analysis of screening patterns and predictors of seropositive infection was performed. Referral pathways and community care integration were analysed for HCV positive individuals, and a prospective community-based 'identify and treat' HCV program was assessed. RESULT(S): Screening for HCV had been performed in 18.6% (835/4,492) of the cohort. Seroprevalence was 4.6% (207/4,492). HCV seropositivity was associated with age >40-years (OR = 9.30, CI 3.69-23.45, p <0.01), injecting drug use (IDU) (OR = 24.26, CI 8.99-65.43, p <0.01), and previous incarceration (OR = 12.26, 4.51-33.31, p <0.01). In a cohort of treatment-eligible individuals, 43.3% (90/208) had neither been referred to specialist services or general practitioners for HCV management. Amongst those referred to specialist services, 64.7% (57/88) did not attend scheduled follow-up, and 48.3% (15/31) of attendees were lost to follow-up. Through an intensified community access program, 10 people were successfully treated for HCV, though 22 could not be engaged. CONCLUSION(S): People with SMI are underserved by traditional models of HCV healthcare. Intensified community-based support can partially bolster the treatment cascade, though investment in innovative screening and management strategies are required to achieve healthcare parity. This article is protected by copyright. All rights reserved.

Aims To assess the prevalence and management of depressive disorders in people with Type 2 diabetes in different countries. Methods People with diabetes aged 18–65 years and treated in outpatient settings were recruited in 14 countries and underwent a psychiatric interview. Participants completed the Patient Health Questionnaire and the Problem Areas in Diabetes scale. Demographic and medical record data were collected. Results A total of 2783 people with Type 2 diabetes (45.3% men, mean duration of diabetes 8.8 years) participated. Overall, 10.6% were diagnosed with current major depressive disorder and 17.0% reported moderate to severe levels of depressive symptomatology (Patient Health Questionnaire scores >9). Multivariable analyses showed that, after controlling for country, current major depressive disorder was significantly associated with gender (women) (P<0.0001), a lower level of education (P<0.05), doing less exercise (P<0.01), higher levels of diabetes distress (P<0.0001) and a previous diagnosis of major depressive disorder (P<0.0001). The proportion of those with either current major depressive disorder or moderate to severe levels of depressive symptomatology who had a diagnosis or any treatment for their depression recorded in their medical records was extremely low and non-existent in many countries (0–29.6%). Conclusions Our international study, the largest of this type ever undertaken, shows that people with diabetes frequently have depressive disorders and also significant levels of depressive symptoms. Our findings indicate that the identification and appropriate care for psychological and psychiatric problems is not the norm and suggest a lack of the comprehensive approach to diabetes management that is needed to improve clinical outcomes.