Hepatitis C virus in people with serious mental illness: Putting the retrospectoscope to good use.

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