Preparing for the final phase of elimination: A test-and-treat approach to micro-elimination of hepatitis C in Cairns, Australia.

Author: Alisa Pedrana, Carla Gorton, Clancy Barrett, Rhondda Lewis, Michael Rodriguez, Mellissa Bryant, Kelly Maynard, Nick Scott, Amanda Wade, Margaret Hellard , Stephanie Franet, Linda Selvey, Andrew Smirnov, Robert Kemp, Darren Russell

Theme: Epidemiology & Public Health Research 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. Between 2016-2020, >1,368 people received treatment and HCV RNA prevalence in a community sample of people who inject drugs dropped from 26% to 4%. However, in 2019 an outbreak in the local prison seeded a resurgence of new infections in the community, particularly among Aboriginal and Torres Strait Islander populations. Efforts to identify people with hepatitis C and link them to treatment in a timely manner are critical to elimination efforts.

Methods: The ‘Final Phase of Elimination’ program includes a same-day test & treat trial, which delivers rapid point-of-care (POC) RNA testing 60 minutes (GeneXpert®) and simplified same-day dispensing of treatment to reduce time to cure using a nurse-led approach, incentives, and peer-support.

Results: From July 2022-March 2023, 126 eligible clients were consented and 121 completed POC RNA testing. Median age was 41 years, majority were male (59%), unemployed (80%), 20% were experiencing homelessness or in supported/crisis accommodation. Over a third (39%) were Aboriginal and/or Torres Strait Islander, the majority had injected drugs in the past month (87%), mostly methamphetamine (81%). Over half (54%) had a history of incarceration– of whom 65% had been tested while in prison. Of the 121 tested, 17 were RNA positive (14.1%), 13 were eligible for same-day treatment, with 12 initiating treatment (median time to script was 7 days, range 0-45 days). This model engaged a high proportion of new clients (52%) by offering POC testing along with cash incentives.

Conclusions: Delivering a package of interventions involving POC testing, incentives, peer support and outreach nurse-led models is helping to find the remaining people who haven’t yet engaged in HCV testing or treatment.

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