Jacqui Richmond, Burnet Institute, Melinda Hassall, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Health, Jack Wallace, Burnet Institute; Australian Research Centre in Sex, Health and Society, La Trobe University and Centre for Social Research in Health, University of New South Wales
Source: APNA Primary Times Winter 2025
Australia has committed to eliminating hepatitis C by 2030 and primary health care (PHC) nurses can make a major contribution towards achieving this goal. PHC nurses have unique and direct access to people with and at risk of hepatitis C, and their person-centred approach to care means they can meaningfully engage people and reduce experiences of stigma. We studied the vital role of PHC nurses in hepatitis C care delivery and identified factors that will enable the elimination response.
In Australia, there were an estimated 68,890 people living with hepatitis C at the end of 2023. Australia supports the World Health Organization’s global target to eliminate hepatitis C by 2030.1 Elimination is possible since the development of safe, curative, oral direct acting antiviral (DAA) treatment, which has revolutionised clinical responses to hepatitis C. Since the launch of DAAs through the Pharmaceutical Benefits Scheme in March 2016, 68% of people living with hepatitis C in Australia (i.e., 108,458 people) had been treated to June 2024.2
Australia’s hepatitis C elimination response is underpinned by the mobilisation of the PHC system to deliver simplified, decentralised service models that are integrated with local healthcare systems and often embedded within the communities most affected. The safety and simplicity of the DAAs allow general practitioners and nurse practitioners in Australia to prescribe without extra training. The combination of DAA dispensing through community pharmacies and point-of-care testing in accessible settings creates multiple opportunities for PHC nurses to play a central role in delivering hepatitis C care. Increasing testing rates to diagnose and connect people to treatment is essential.3 Enabling nurses to work to their full scope of practice, including initiating discussions and offering hepatitis C testing and treatment in settings where people at risk feel comfortable, will enhance the efficiency of PHC services and drive hepatitis C elimination efforts.
In 2020, in the depth of the COVID-19 pandemic, we interviewed 16 nurses from across Australia working in general practice, community health, alcohol and other drug services, and custodial settings about their experiences of testing and treating people with hepatitis C in PHC, with a particular focus on identifying the enablers for engagement.
Our study4 showed PHC nurses are highly motivated by social justice principles, demonstrating empathy, flexibility, and advocacy, especially for marginalised populations, and particularly among people who do not access mainstream health services. These nurses play a vital role in making hepatitis C care more accessible by fostering trust and reducing stigma, and often serve as the first point of engagement for a broad range of often complex healthcare issues. Supportive work environments enhance PHC nurses’ ability to manage hepatitis C care, whereas funding models, restrictive workflows, and lack of prescribing rights limit their potential. While countries like New Zealand and Scotland have expanded nurse prescribing rights, similar reforms in Australia would help to streamline hepatitis C service delivery.
As we get closer to achieving Australia’s elimination targets and the number of people living with hepatitis C declines, the role of PHC nurses becomes more important. Offering hepatitis C testing to a broad range of people will assist in identifying people with current and past risk factors. Rather than asking people to disclose potential risk factors, we recommend presenting them with a list of reasons to test for hepatitis C.5 You could then ask, ‘Based on these potential transmission routes of hepatitis C, would you like to be tested for hepatitis C?’ This is a practical way to reduce the stigma associated with hepatitis C infection.
There are still people living with hepatitis C who are in regular contact with the healthcare system and who remain undiagnosed.6 Linking people to care and the hepatitis C cure through culturally appropriate care pathways, after testing and diagnosis, is vitally important to prevent the potentially serious outcomes of untreated hepatitis C. Be proactive! Search your clinic’s patient management system for people with incomplete test results. Is anyone anti-HCV positive without a confirmatory HCV RNA test? Does anyone have documented risk factors (e.g., a history of injecting drug use or experience of incarceration)? Have you offered hepatitis C tests to people born in regions with high hepatitis C prevalence (e.g., Africa, the Middle East [particularly Egypt], the Mediterranean, Eastern Europe, and South Asia5)? This could be an opportunity to link people to care.7
Providing education and support is a core component of nursing activity. In the hepatitis C context, this can involve education about the availability of the hepatitis C cure (all oral regimens taken for 8 to 12 weeks) and adherence guidance.8 It can also extend to harm reduction and hepatitis-C-prevention strategies as well as actively challenging stigma,9 all of which can help to create a holistic approach to hepatitis C care delivery.
PHC nurses are at the frontline of hepatitis C elimination. Their ability to engage people with and at risk of hepatitis C, provide holistic, non-judgemental care, and support individuals to navigate the health system makes them indispensable in both the clinical and public health context.
To be inspired and learn more about what you can do to contribute to the hepatitis C elimination efforts in Australia, read our full study!
JA Richmond, M Hassall and J Wallace, ‘Hepatitis C elimination: amplifying the role of primary care nurses in Australia’, Aust J Prim Health, 2024, 30, PY23198, doi:10.1071/PY23198.
Australian Government Department of Health, Fifth National Hepatitis C Strategy 2018–2022, Department of Health and Aged Care website, 2018, accessed 16 April 2025.
J King, H McManus, J Kwon, R Gray and S McGregor, HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2023: Hepatitis C, Kirby Institute website, 2023, accessed 16 April 2025.
N Scott, R Sacks-Davis, AJ Wade et al., ‘Australia needs to increase testing to achieve hepatitis C elimination’, Med J Aust, 2020, 212, 365–370, doi:10.5694/mja2.50544.
JA Richmond, M Hassall and J Wallace, ‘Hepatitis C elimination: amplifying the role of primary care nurses in Australia’, Aust J Prim Health, 2024, 30, PY23198, doi:10.1071/PY23198.
Australian Government Department of Health, National Hepatitis C Testing Policy 2017 (v1.1), Department of Health, Canberra, 2017.
G Mnatzaganian, JH MacLachlan, N Allard, C Brown, S Rowe and BC Cowie, ‘Missed opportunities for diagnosis of hepatitis B and C in individuals diagnosed with decompensated cirrhosis or hepatocellular carcinoma’, J Gastroenterol Hepatol, 2023, 38(6):976–983, doi: 10.1111/jgh.16162.
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), Beyond the C: Hepatitis C Elimination in General Practice, ASHM website, 2020.
JA Richmond, S Sheppard-Law, S Mason, SL Warner, ‘The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals’, Patient Prefer Adherence, 2016, 13(10):2479–2489, doi: 10.2147/PPA.S117757.
J Ellard, A Farrugia, A Whalley, E Lenton, R Fomiatti and S Fraser, Reducing stigma and discrimination associated with blood-borne viruses and sexually transmissible infections: a stigma reduction toolkit for the Victorian healthcare workforce, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, 2022.
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