At Health Works in Footscray, people drop in to pick up clean injecting needles, grab a cup of tea and undertake health checks.

This not-for-profit community health organisation offers a range of health and support services to people who use drugs and alcohol, who often face severe disadvantage.

It is part of the Eliminate Hepatitis C Partnership (EC Partnership), a Burnet-led collaboration of Victorian-based service providers, government departments, community organisations and researchers focused on meeting the World Health Organization target of eliminating HCV in Australia by 2030.

This story appeared in the Spring edition of IMPACT. Read the entire edition here online.

General practitioner Dr Fran Bramwell has worked at Health Works for many years and says HCV testing is incorporated in routine primary health care for those who visit.

“If we are aiming to eliminate hepatitis C, we need to expand strategies in terms of access to testing, including opportunities and locations,” Dr Bramwell said, in her consulting room.

“People are attending needle exchanges less often and getting bigger quantities of needles at each visit, so there’s less opportunity to engage them in health care.”

The ‘Rapid-EC’ study at Health Works is trying to lower barriers to treatment by reducing the numbers of appointments that clients need to attend. This starts with an oral mouthswab – the OraQuick – to screen for the presence of HCV antibodies.

“This test can give a result in 20 minutes and tells us if they’ve ever been exposed, but not if they’re currently infected. We then do another rapid test for virus detection which gives a result in two hours,” Dr Bramwell said.

This test uses a sample of blood from the vein and is run on a Cepheid GeneXpert machine on-site.

“If the test shows the person is infected, they come through and talk to me about what treatment involves – it can be one tablet a day, from eight to 12 weeks.”

Follow-up testing 12 weeks after the end of treatment shows whether the virus has been cleared.

“There can be barriers to getting treatment for these people, with everything else that’s happening within their world,” Dr Bramwell said.

“I guess we’re in the very unique situation whereby the supply of a medication is not the limiting issue. It’s actually getting people to be able to be engaged long enough to enable them to have treatment.

Image: Testing with the OraQuick mouth swab.

“We do explain the consequences of not having treatment – long term liver damage and liver cancer. That’s not necessarily well known.”

Both the OraQuick test and the GeneXpert tests are highly accurate, but currently awaiting approval for diagnostic use in Australia – so standard-of-care testing is performed for all participants to confirm results.

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EC Partnership Coordinator Dr Alisa Pedrana said reaching the target of elimination by 2030 would require a major shift from tertiary to community-based services, and an integrated approach.

“We have a unique opportunity to cure people of a chronic disease and potentially eliminate hepatitis C as a public health threat,” Dr Pedrana said.

“The more people with hep C we can get on treatment now the greater the impact, and the quicker we reach elimination targets the cheaper it will be for society.

“However many people with hepatitis C have had bad experiences with old treatments and people who inject drugs are heavily stigmatised – so we need to reduce barriers to testing and treatment.”

The EC Partnership, led by chief investigators Professor Margaret Hellard, Professor Alex Thompson and Dr Joe Doyle, is working to dramatically increase uptake of treatment for HCV infection among people who inject drugs (PWID), targeting a range of approaches including increasing awareness, training health practitioners, clinical service delivery, surveillance and evaluation. Lessons from this program will inform HCV elimination models globally.

“Our approach is to target the elimination of HCV through nurse-led models of care in community and prison settings,” Dr Pedrana said.

The collaborative network of partners includes the Department of Health and Human Services Victoria, Justice Health Victoria, Hepatitis Victoria, Harm Reduction Victoria, St Vincent’s Hospital Victoria, and The Alfred hospital. Implementation at over 20 primary care sites, (such as Healthworks in Footscray), 14 correctional facilities and six tertiary hospitals is underway.

The program is funded by a partnership grant from the National Health and Medical Research Council, with a contribution by Gilead Sciences.

The EC Partnership is also trialling point-of-care testing for HCV in community clinics through the ‘Rapid-EC’ pilot study, as a way to increase access to testing, diagnosis and treatment.