Outreach and engagement to achieve hepatitis C micro-elimination in Cairns, Australia.

Author: Darren Russell, Clancy Barrett, Carla Gorton, Michael Rodriguez, Rhhonda Lewis, Mel Pearson, Rawinia Frost , Kathy Clark, Joshua Janke, Mellissa Bryant, Kelly Maynard, Nick Scott, Linda Selvey, Andrew Smirnov, Robert Kemp, Alisa Pedrana

Theme: Models of Care Year: 2023

Background: Cairns and Hinterland in Queensland, Australia, has a population of approximately 257,000 and was one of the first locations to lead a hepatitis C micro-elimination response in Australia. Seven years since the introduction of direct acting antivirals (March 2016) the number of clients presenting to clinics for testing and treatment has dramatically declined.

Description of model of care/intervention: The Cairns ‘Final Phase of Elimination’ program includes a nurse-led community outreach model working closely with Aboriginal and Torres Strait Islander Health Workers to deliver rapid point-of-care (POC) RNA testing 60 minutes (GeneXpert®) utilising cash incentives, and peer-support. We have delivered sessions across 10 community services, including probation & parole, homeless shelters and mental health services.

Effectiveness: From July 2022-March 2023, we enrolled 366 eligible clients with median age of 42 years, majority male (73%), 24% were experiencing housing instability and 199 (44%) were Aboriginal and/or Torres Strait Islander. Key risk factors included a history of injecting drug use (46%) and incarceration (47%). While the majority (72%) were new clients, over half (52%) had a history of HCV testing – of which 40% reported previous HCV diagnosis. Among the 349 who underwent POC testing, 10 were RNA positive (2.8%) and 7 have commenced treatment. HCV positivity ranged from 0-11% across the outreach sites, highest at NSP services (6/57 – 10.9%) and Probation and Parole (4/187- 2.1%). Most clients (75%) did not wait 60mins for a POC test result, instead receiving results via phone. Incentives were used to engage 96% of participants.

Conclusion and next steps: The Cairns Sexual Health Service outreach model has successfully engaged clients experiencing social disadvantage and a high proportion of Aboriginal and Torres Strait Islander people and people in touch with the justice systems. This approach to active case-finding is critical to achieving micro-elimination and ensuring people are linked to treatment.

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