• Michael Braude, Timothy Phan, Danny Con, Ian Woolley, Suresh Sundram, David Clarke, Anouk Dev, and William Sievert.
• Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia.
• Intern Med J. 2023 May 1; 53 (5): 700708700-708.

BackgroundPeople with serious mental illness (SMI) are underserved from a hepatitis C virus (HCV) screening and treatment perspective.AimsTo examine the HCV care cascade in people with SMI and to pilot a supported HCV treatment integration programme.MethodsHCV prevalence was retrospectively analysed from 4492 consecutive individuals admitted to a tertiary hospital mental health service between January 2017 and December 2018. Subcohort 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 programme was assessed.ResultsScreening for HCV had been performed in 18.6% (835/4492) of the cohort. Seroprevalence was 4.6% (207/4492). HCV seropositivity was associated with age >40 years (odds ratio (OR) = 9.30; confidence interval (CI) 3.69-23.45; P < 0.01), injecting drug use (OR = 24.26; CI 8.99-65.43; P < 0.01) and previous incarceration (OR = 12.26; CI 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 programme, 10 people were successfully treated for HCV, although 22 could not be engaged.ConclusionPeople with SMI are underserved by traditional models of HCV healthcare. Intensified community-based support can partially bolster the treatment cascade, although investment in innovative screening and management strategies are required to achieve healthcare parity.© 2021 Royal Australasian College of Physicians.

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