Quirky Hawaiian shirts, inflatable flamingos, and a bright yellow van might not be what comes to mind when thinking of a successful hepatitis C care model, but Australia’s Kombi Clinic proves that a non-judgmental approach and a healthy dose of fun could be key to eliminating hepatitis C.
Brisbane, the capital of Queensland’s Sunshine State in Australia, is home to 2.3 million residents. For the past four decades, outer western suburbs like Inala and Darra have faced significant challenges, including poverty, high prevalence of drug use, and related health issues. Recognising a need, Dr. Matt Young OAM established the Medico Medical Centre Inala (which now runs the Kombi Clinic), driven by a commitment to serve some of Brisbane’s most disadvantaged communities.
The game-changing introduction of DAAs
In Inala, we face an incredibly high rate of intravenous drug use, which is an area not many GPs are involved in. However, the need for support is undeniable. There is a lot of heroin addiction, and as a way to help we operate a methadone, Suboxone and Buvidal clinic.
The introduction of Direct Acting Antivirals (DAAs) to Australia in 2016 was an absolute game-changer for the hepatitis C treatment in the country. With a 95% cure rate, Dr Matt Young and colleague Dr Joss O’Loan became extremely busy treating their existing patient base for hepatitis C.
It was a huge shift in what we could do; previously, you’d have to say, ‘Hey look, you’ve got hep C, I’ll send you off to the hospital, and you might be seen and on the waitlist. And then lots of issues around patients of mine getting to the hospital. Then suddenly, I have the ability to write the script in general practice and hand it to them. Yeah, it was huge.
The announcement of the new hepatitis C treatment brought well-deserved excitement to thousands of Australians who had been living with the disease for decades. At the Medico Medical Centre in Inala, patients like Alex and Martin had contracted hepatitis C in their early adulthood and had held onto hope for a breakthrough treatment.
I thought hep C would basically halve my life. But when I met Martin and realised that life is beautiful and there are people who care about me, I thought, I want to live way longer than 50.
Taking hepatitis C care on the road
After years of hard work treating the backlog of hepatitis C patients, two passionate doctors found themselves brainstorming ambitious ideas for the future of hepatitis C testing and treatment. One of those ideas—a mobile hepatitis C testing clinic—would soon become a world-leading model of care.
We were chatting in the tea room, coming up with what seemed like grandiose ideas. We thought, if we’re going to launch a mobile hepatitis C clinic, let’s make it energetic, appealing, and open to everyone. If we’re having fun, we’ll project positive energy, and patients will feel that. They’ll want to come in because we don’t want it to be sterile, corporate, or clinical. Let’s have fun with it. That led to…why not get a Kombi van?
As the pair of doctors began acting on their vision – quickly named The Kombi Clinic – they realised they needed help. The pair thought there was no one better than the exceedingly passionate nurse Mim O’Flynn, who had significant experience treating people for hepatitis C with the old interferon-era medications as well as the new DAAs.
While Mim could’ve been enjoying retirement, she jumped at the chance to begin operating Queensland’s first mobile-based testing and treatment program. Soon, the team was joined by a phlebotomist and other volunteers eager to assist the Kombi Clinic with pop-up testing events.
Minimising stigma through fun
Over the past seven years, the Kombi Clinic has remained true to its core mission while adapting to the evolving needs of its clients. The small, dedicated team provides nimble and flexible services, accessing a variety of sites and spaces to meet their clients’ needs. Community members have come to know and love the Kombi Clinic, often joking about the number of Kombi vans the team has gone through before settling on a more reliable Toyota van.
As of 2024, the Kombi Clinic has established strong partnerships with various services across Brisbane, including homeless services, drop-in centres, opioid agonist therapy (OAT) services, and probation and parole centres. They also regularly hold pop-up testing events at community gatherings and in areas where marginalised individuals congregate or sleep rough.
Through the persistence and consistency of the Kombi Clinic team, their smiles, Kombi (or should we say Toyota) van, and now-iconic Hawaiian shirts have become well-known across the greater Brisbane region. The Kombi Clinic has played a crucial role in reaching and treating hard-to-reach community members who might not otherwise seek testing independently.
Nurse Mim understands the many valid reasons people avoid healthcare, especially when they’ve faced discrimination or stigma due to their substance use.
We’re not just testing and treating; we’re educating. We want people to understand that we’re about harm minimisation, not judgement. We’re friends in a yellow bus who just want to help people.
Expanding into correctional settings
As we already know, the introduction of DAA medication was a game-changer for hepatitis C treatment. According to Kombi Clinic nurse Mim O’Flynn, the next significant advancement has been the adoption of point-of-care testing.
As a small, agile team with at least one prescribing doctor always present, the Kombi Clinic can now test individuals for hepatitis C and, if positive, provide them with a prescription just a few hours later. This ability to fast-track treatment has revolutionised Kombi Clinic’s model of care.
Point-of-care testing has also allowed Kombi Clinic to expand its collaboration with Queensland Health and enabled partnerships with Queensland Corrective Services, where there was a significant need for scalable hepatitis C testing and treatment models.
According to Graeme Kraak, Director of Queensland’s Department of Health, around 2,000 people in Queensland are prescribed DAAs for hepatitis C each year, with approximately three-quarters treated in prison settings.
What began as a pilot at one correctional centre has quickly grown into a well-coordinated effort, conducting High-Intensity Testing and Treatment (HITT) campaigns across Queensland’s correctional centres, where hepatitis C is more prevalent.
While Kombi Clinic leads these testing blitzes, success relies on partnerships with organisations like Hepatitis QLD, QuIHN, Flinders University, and the Kirby Institute at the University of New South Wales, through the National Australian HCV Point-of-Care Testing Program.
The HITT campaigns have become a crucial tool for Queensland Health in reaching the Hepatitis C elimination targets for 2030. Graeme Kraak believes that part of the success of these campaigns due to their delivery by a third party.
They are vital for fostering collaboration between non-government providers and people within prisons. There’s often suspicion towards government workers or uniformed personnel, which can deter prisoners from coming forward for testing or treatment. It’s also done in such a way that it’s not threatening prisoners, and they’re more likely to be open and honest with a non-government person. This is why our collaboration with the Kombi Clinic is so important.
As the Kombi Clinic strengthens its work within corrective services, the team remains dedicated to reaching new areas of the community and exploring new partnerships.
This year, I’ve organised visits to several more correctional centres. I’d like to explore the watch house (a facility typically attached to a police station where people suspected of a crime are held under temporary arrest). Imagine capturing even a few people there with a simple finger stick test. We could start their treatment quickly and quietly. That would be amazing. I also want to explore drug courts, where our mobility could allow us to make a significant impact.
The Kombi Clinic’s innovative approach and unwavering commitment have transformed hepatitis C care in Brisbane and provided inspiration to the world. By fostering partnerships and expanding their reach, the passionate team continues to break down barriers and provide crucial services to the most vulnerable communities. As they look towards new frontiers, the Kombi Clinic exemplifies how a dedicated, flexible team can drive meaningful change in public health.
