The EC Partnership is establishing an HCV treatment program in which at least 1,160 HCV-positive Victorian people who inject drugs (PWID) will be treated annually. We estimate that the ongoing treatment of this number will eliminate HCV transmission in Victoria by 2030.

The overarching aim of this grant is to inform the elimination of HCV in Australia and globally.

The EC Partnership aims to:

• Establish a community-based treatment program to increase HCV treatment uptake in PWID using nurse-led models of care in the community and the prison system
• Assess the feasibility and impact of treating at least 1,160 people who inject drugs (PWID) annually in Victoria
• Inform HCV elimination models in Australia and globally.

The partnership will be implemented at 21 primary care sites, four correctional facilities and six tertiary hospitals. Eleven nurses will provide care at these sites; each nurse will be supported by a physician from their related tertiary hospital.

Infection with hepatitis C virus (HCV) is a major public health concern; in Australia over 230,000 people live with chronic HCV infection which can lead to liver cancer and liver failure if not treated. In Australia the group most affected by HCV are people who inject drugs (PWID), with the vast majority of new HCV infections occurring among this group. However fewer than two percent of PWID in Australia receive HCV treatment annually, due to the side-effects of treatment regimens and the provision of treatment primarily through tertiary hospital outpatient clinics that are not well suited to manage the needs of this population.

Recently more effective treatment has become available for HCV; unlike previous treatments, these direct-acting antivirals (DAAs) have minimal side effects, require a shorter time frame of treatment (usually eight to 12 weeks) and have cure rates of over 90 percent. In March 2016, several DAAs became available on the Pharmaceutical Benefits Scheme (PBS), increasing treatment availability and reducing cost barriers.

One way to increase PWID access to HCV treatment is to provide treatment through community settings that include other services for PWID, such as those providing of opioid substitution therapy (OST), counselling, and needle and syringe program (NSP).

We have previously demonstrated that integrating viral hepatitis nurses into community-based settings can increase PWID uptake of HCV treatment, and have trialled nurse-led models of care in Victorian prisons. Our modelling suggests that treating as few as 58 out of 1000 PWID annually would reduce new HCV infections by 80 percent and reduce HCV prevalence in PWID to less than 10 percent by 2030; this equates to treating 870–1,450 PWID annually (midpoint 1,160). These outcomes are in line with the targets anticipated from the World Health Organization (WHO) under the forthcoming strategy to eliminate HCV as a public health concern by 2030.

Chief investigators

• Professor Margaret Hellard – Burnet Institute
• Professor Alex Thompson – St Vincent’s Hospital and University of Melbourne
• Dr Joseph Doyle – Alfred Health, Monash University, Burnet Institute
• Professor Paul Dietze – Burnet Institute
• Professor Emma McBryde – James Cook University
• Professor William Sievert – Monash Health and Monash University
• Associate Professor Mark Stoové – Burnet Institute
• Dr Peter Higgs – Burnet Institute
• Dr Denis Petrie – University of Melbourne
• Professor Peter Vickerman – University of Bristol

Associate Investigators

• Professor Margaret Kelaher – School of Population and Global Health University of Melbourne
• Louise Galloway – Prevention and Population Health branch, Department of Health and Human Services, Victoria
• Larissa Strong – Justice Health Victoria
• Melanie Eagle – Hepatitis Victoria
• Professor Stuart Roberts – Alfred Hospital
• Dr Joe Sasadeusz – Royal Melbourne and Alfred Hospitals
• Dr Scott Bowden – Victorian Infectious Diseases Reference Laboratory
• Bev Hanley – Victorian Aboriginal Health Service
• Lyn Morgain – CoHealth

Study partners

• Victorian Department of Health and Human Services (DHHS)
• Victorian Department of Justice
• Hepatitis Victoria
• Harm Reduction Victoria
• Alfred Health
• St Vincent’s Hospital

Timeline

The partnership will run for five years including six months to set up, three years to establish and implement of the treatment model throughout Victoria, a year to transition the program to the state government for management, and six months for the partnership evaluation. The treatment model is expected to start in early 2017.

Outcomes

At study completion we will measure:

• The impact of the program on increasing the number of PWID treated for HCV and reducing HCV prevalence among PWID
• Whether treatment outcomes for those treated in the community are equivalent to outcomes in a tertiary hospital setting
• The cost-effectiveness of nurse-led community HCV treatment.

This data will provide key information to inform long-term strategic responses to eliminate HCV locally, nationally and globally.