Non-alcoholic fatty liver disease (NAFLD) is common, affecting approximately 25% of the general population. The evidence base for the investigation and management of NAFLD is large and growing, but there is currently little practical guidance to support development of services and delivery of care. To address this, we produced a series of evidence-based quality standard recommendations for the management of NAFLD, with the aim of improving patient care. A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group produced the recommendations, which cover: management of people with, or at risk of, NAFLD before the gastroenterology or liver clinic; assessment and investigations in secondary care; and management in secondary care. The quality of evidence for each recommendation was evaluated by the Grading of Recommendation Assessment, Development and Evaluation tool. An anonymous modified Delphi voting process was conducted individually by each member of the group to assess the level of agreement with each statement. Statements were included when agreement was 80% or greater. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice. It is hoped that services will review their practice against our recommendations and key performance indicators and institute service development where needed to improve the care of patients with NAFLD.

Summary: Background  Injecting drug use is the main risk factor for hepatitis C virus (HCV) infection. Secondary‐care‐based strategies for the management of HCV do not effectively target this vulnerable population.Aims  To evaluate the feasibility, safety and efficacy of a primary‐care‐based model for the delivery of HCV services including anti‐viral therapy to injecting drug users.Methods  A partnership between a clinical nurse specialist employed by, and working under the supervision of, a secondary‐care‐based hepatitis service and drug workers and general practitioners. Three hundred and fifty‐three clients attending opiate substitution clinics in primary care were evaluated. Outcomes were: number of new diagnoses of HCV infection, number of clients assessed as suitable for anti‐viral treatment, and number of patients treated.Results  174 HCV antibody positive clients were identified. Of these, 124 were chronically infected with HCV of whom only six had been previously identified. Of 118 new chronically‐infected individuals, 86 entered the care pathway, 43 were assessed as suitable for anti‐viral treatment and 30 have so far been treated. Outcomes of anti‐viral treatment are comparable with those obtained in secondary care settings.Conclusion  A primary‐care‐based model offers a new paradigm for the treatment of HCV in injecting drug users.

Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.

Cirrhosis represents a major cause of morbidity and mortality, leading to a marked impairment in the quality of life of patients and their caregivers, and resulting in a major burden on healthcare systems. Currently, in most countries, nurses still play a limited role in the care of patients with cirrhosis, which is mainly restricted to the care of patients hospitalised for acute complications of the disease. The current manuscript reviews the established and potential new and innovative roles that nurses can play in the care of patients with cirrhosis. In the hospital setting, specialised nurses should become an integral part of interprofessional teams, helping to improve the quality of care and outcomes of patients with cirrhosis. In the primary care setting, nurses should play an important role in the care of patients with compensated cirrhosis and also facilitate early diagnosis of cirrhosis in those at risk of liver diseases. This review calls for an improved global liver disease education programme for nurses and increased awareness among all healthcare providers and policymakers of the positive impacts of advanced or specialist nursing practice in this domain.

RE is a research methodology, otherwise known as a system of enquiry, that provides a framework for conducting an evaluation of a healthcare intervention.1 An RE approach enables researchers to develop theories about how their intervention works by asking ‘What works for whom, in what circumstances, in what respects, and how?’ (Pawson and Tilley, p2).2 This contrasts with traditional approaches to evaluations which simply measure and report the results without considering the environment, culture or what the human behaviours and emotional reactions between the intervention and outcome may be. This style of evaluation has been described as a ‘black box’, meaning that the inner workings are hidden from view.3 The RE approach is a ‘clear box’ evaluation where in addition to the outcomes, the processes of how the intervention has worked, in terms of peoples’ actions and reactions, …