1 September 2026
As part of our Community of Practice on hepatitis C in regional and remote Australia, our third webinar explored what it takes to embed hepatitis C testing and treatment into existing health and community services.
The discussion centred on a model developed by the Queensland Injectors Health Network (QuIHN) in Mount Isa, where outreach, point-of-care testing and collaboration across local services helped reach people who may otherwise have missed out on testing and care.
But the experience also highlighted a challenge: reaching people is only one part of the equation. Integrated care also means making sure the next steps, from confirmatory testing and prescribing to accessing medication and follow-up, are as simple as possible.
It’s time to Prick and Go
Between 2023 and 2024, QuIHN took hepatitis C testing out of the clinic and into the outback city of Mount Isa. Located in far northwest Queensland, it sits roughly 1,800 kilometres inland from Brisbane and about 883 kilometres west of Townsville.
For three days each month, Harm Reduction Coordinator Nikki May and Nurse Practitioner Mary Fenech flew in to provide point-of-care testing for hepatitis C, HIV and syphilis alongside harm reduction support and education. They affectionately called the model “PAG”, or “prick and go”, and a FIFO, “Fly in fly out” model of care.
Testing was offered across 10 locations, including alcohol and other drug and sexual health services, Aboriginal and Torres Strait Islander service Gidgee Healing, police detention facility the Mount Isa Watch House, community centres, outreach services, a men’s hostel and even the Mount Isa Rodeo Street Festival, as well as through home visits.
“While we were physically testing from these Mount Isa locations, many people being tested actually came from even more remote areas,” Nikki said. “It was quite a diverse group of people who hadn’t heard about safe injecting practices, and who didn’t know about hep C testing.”
Across the 18-month program, approximately 224 point-of-care tests were conducted across 10 locations in Mount Isa, including testing for hepatitis C, HIV and syphilis.
Five people had HCV detected, seven received SVR confirmation following previous treatment, and 17 returned positive syphilis antibody results.
Alongside testing, QuIHN worked with local services to upskill staff in hepatitis C and harm reduction, helping build local knowledge and capability alongside the outreach program.
For Nikki, one of the biggest reasons the model worked was simple:
“We didn’t sit inside one service and wait for people to come to us. We were just trying to find as many spots as we could to go to people.”
The approach also helped address concerns around confidentiality and small-town gossip. Some people did not want to visit their GP or a local health service because they worried about being seen, or because someone they knew worked there.
Another thing the team added to the model was incentivisation. Twenty dollar Coles Supermarket vouchers were popular, but the real winner was something much simpler.
“What went over really well? Free thongs,” says Nikki. “We just went to the cheap shop and bulked up on pairs of thongs, like the NRL team ones. They flew out of the basket. Everyone wanted a hep C test because they wanted the NRL thongs. It got so much engagement going and opened up all sorts of chats.”
Other practical lessons from the model included:
- Keep it informal. The team wore casual clothes and made testing visible and approachable, allowing curiosity to start conversations
- Make testing easy. Finger-prick testing removed barriers such as difficult venous access, pathology requests and waiting for another appointment
- Use incentives to open conversations. From snack packs to inexpensive NRL-branded thongs (flip flops for those reading who are not from Australia), small incentives helped create opportunities to talk about testing and harm reduction
- Work through local services. Partners promoted upcoming visits, while community organisations provided familiar spaces for testing.
- Address stigma within services too. QuIHN worked with local organisations to reinforce that access to hepatitis C care should not depend on whether someone stops or reduces their drug use
Building a model that could last after they left
The FIFO clinics were never intended to continue indefinitely.
Alongside testing, QuIHN brought local services together to establish a model that could continue after the monthly visits ended. Mount Isa’s alcohol and other drug service was identified as the home for a GeneXpert machine, working collaboratively with sexual health and supported by Gidgee Healing, outreach services and the Watch House nursing team. Community organisations offered spaces for outreach testing, while an in-house nurse practitioner provided a pathway to prescribing.
This was particularly important because, as Nikki explained, identifying someone who needs a hepatitis C test is not enough if the next step requires them to find a GP, obtain a pathology request or travel elsewhere.
“We know that working with people who are using drugs, you want to nab them while they’re there,” says Nikki. “Sometimes even doing the screening questions is absolutely amazing, but what do you do with it from that point? You can go, ‘Yep, you’re high risk. You need to get a test,’ but that’s where that gap and losing people to follow-up comes.”
Point-of-care testing offered a way to close that gap.
“Being able to have a GeneXpert and go, ‘Hey, we can do this in like 10 minutes. It’s just a finger-prick test. You don’t need pathology. You don’t need anyone who is a clinical medical professional,’ really stops that barrier,” says Nikki.
But despite the local model being ready, health service approvals took almost two years. During that time, trained staff left, testing dropped away and some of the rapport and momentum built through the regular visits was lost.
“They were used to seeing us coming out once a month,” Nikki said. “It built a lot of rapport and that reliability that they could just drop by and chat.”
The necessary approvals have now come through, meaning the local team can begin rebuilding that momentum and putting the GeneXpert to use in the community. Some staff will need to be retrained and community engagement rebuilt, but the pathway developed through the project can now move forward.
For Nikki, making testing easier to access remains key.
“I think we just need to flood as many services as possible with GeneXperts,” she said. “Just that accessibility to non-venous pathology to get people tested as soon as possible.”
The Mount Isa experience shows both the potential and the challenge of integrated hepatitis C care in regional communities. Bringing services together can make testing and treatment easier to access, but sustaining that integration requires the governance, workforce and infrastructure to support it.
Closing the gaps between testing and treatment
The broader webinar discussion highlighted that integration doesn’t end once someone receives a positive result.
In regional and remote communities, every additional step can create another opportunity for someone to be lost to care. Participants shared practical ways they are trying to reduce those gaps:
- Make medication easier to access. Nikki described having medication ordered through a Townsville pharmacy and express posted to Mount Isa when that was faster than sourcing it locally
- Plan follow-up while the person is there. For people without reliable contact details, this might mean agreeing on a trusted worker or family member who can be contacted, identifying places and times someone can usually be found, or discussing what should happen if they are incarcerated
- Consider providing the full treatment course at once. Participants discussed using Regulation 24 prescriptions, where appropriate, so people don’t have to return to a pharmacy each month
- Don’t let liver disease assessment unnecessarily delay treatment. The group discussed using tools such as APRI and FIB-4 or other forms of liver assessment where FibroScan is unavailable, while ensuring people at risk of advanced liver disease receive appropriate follow-up.
- Build in peer support. Nikki found some people felt isolated during treatment because they had not disclosed their drug use or hepatitis C status to those around them. QuIHN linked people with peer workers by phone and other remote channels where face-to-face support wasn’t available
Across the discussion, a common principle emerged: make the most of the moment when someone is ready to engage.
For regional and remote services, that means looking beyond where hepatitis C care traditionally sits and asking what can be done there and then. Can testing happen in the service the person already uses? Can unnecessary appointments be removed? Can medication be brought to them? Can local organisations share equipment, expertise and follow-up?
As the Mount Isa experience shows, integrated care isn’t necessarily about building a new hepatitis C service. It can be about connecting the services, people and resources that are already there, and making the pathway between them as easy as possible.
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