The Kombi Clinic Driving Out Hep C In South East Queensland Disenfranchised Communities

Author: O’Loan J, O’Flynn M, Hoger C, Young M

Theme: Models of Care Year: 2018

In Australia, Hepatitis C disproportionately affects the disenfranchised and most
marginalised patients. While some clinicians see this patient population as the “hard to
reach”, the Kombi clinic takes the alternate view that it is ‘us’ the medical fraternity that are in
fact difficult to access. There is pressing need to take the cure to the patient rather than sit in
fortified offices with the well documented barriers to access (cost, complexity, distance,
stigma etc).
Description of model of care/intervention
The Kombi Clinic takes two General practioners (GPs / primary care physician), a
phlebotomist and a fibroscan nurse in a 1978 Kombi Van, to 7 venues including drug rehab
centres and rough sleeping locations throughout South East Queensland. These venues
have a higher proportion of patients with hep C that are not able to access the ‘usual’ route
of care. It is a 2 visit process, the first being a GP consultation, bloods and fibroscan and at
the second visit a script is written as appropriate.
Over the past 8 months we have provided 696 occasions of service to 188 patients. Of
which, 112 patients were HCV serology positive and 83 patients were RNA positive. We
have started 62 patients on HCV treatment. In terms of suitability for community treatment
(of those with RNA positive HCV) 88% had a fibroscan of <12.5Kpa and 70% <9.5Kpa. There were no significant drug-drug interactions and no co-infections of HIV or HBV. The Kombi van has broken down only twice! Conclusion and next steps The Kombi Clinic has found that a mobile GP lead model of care can break down the traditional barriers to access HCV treatment. We are getting patients into the clinic and on to treatment that are otherwise disengaged. More Kombi Clinics are needed to liberate patients from the tyranny of HCV. Disclosure of Interest Statement: The Kombi clinic has received a competitive industry grant from Gilead fellowship award

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