At Health Works in Footscray, people drop
in to pick up clean injecting needles, grab a
cup of tea and undertake health checks.
not-for-profit community health organisation
offers a range of health and support services
to people who use drugs and alcohol, who
often face severe disadvantage.
It is part of the Eliminate
Hepatitis C Partnership (EC Partnership),
a Burnet-led collaboration of Victorian-based service
providers, government departments,
community organisations and researchers
focused on meeting the World Health
Organization target of eliminating HCV
in Australia by 2030.
This story appeared in the Spring edition of IMPACT. Read the entire edition here online.
General practitioner Dr Fran Bramwell has
worked at Health Works for many years and
says HCV testing is incorporated in routine
primary health care for those who visit.
“If we are aiming to eliminate hepatitis C,
we need to expand strategies in terms of
access to testing, including opportunities
and locations,” Dr Bramwell said, in her
“People are attending needle exchanges
less often and getting bigger quantities
of needles at each visit, so there’s less
opportunity to engage them in health care.”
The ‘Rapid-EC’ study at Health Works is
trying to lower barriers to treatment by
reducing the numbers of appointments that
clients need to attend. This starts with an
oral mouthswab – the OraQuick – to screen
for the presence of HCV antibodies.
“This test can give a result in 20 minutes
and tells us if they’ve ever been exposed,
but not if they’re currently infected. We then
do another rapid test for virus detection
which gives a result in two hours,” Dr
This test uses a sample of blood from the
vein and is run on a Cepheid GeneXpert
“If the test shows the person is infected,
they come through and talk to me about
what treatment involves – it can be one
tablet a day, from eight to 12 weeks.”
Follow-up testing 12 weeks after the end
of treatment shows whether the virus has
“There can be barriers to getting treatment
for these people, with everything else
that’s happening within their world,”
Dr Bramwell said.
“I guess we’re in the very unique situation
whereby the supply of a medication is not
the limiting issue. It’s actually getting people
to be able to be engaged long enough to
enable them to have treatment.
Image: Testing with the OraQuick mouth swab.
“We do explain the consequences of not
having treatment – long term liver damage
and liver cancer. That’s not necessarily
Both the OraQuick test and the GeneXpert
tests are highly accurate, but currently
awaiting approval for diagnostic use in
Australia – so standard-of-care testing
is performed for all participants to
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Coordinator Dr Alisa Pedrana said reaching
the target of elimination by 2030 would require a major shift from
tertiary to community-based services, and
an integrated approach.
“We have a unique opportunity to cure
people of a chronic disease and potentially
eliminate hepatitis C as a public health
threat,” Dr Pedrana said.
“The more people with hep C we can get on
treatment now the greater the impact, and
the quicker we reach elimination targets the
cheaper it will be for society.
“However many people with hepatitis C
have had bad experiences with old
treatments and people who inject drugs are
heavily stigmatised – so we need to reduce
barriers to testing and treatment.”
The EC Partnership, led by chief
investigators Professor Margaret Hellard,
Professor Alex Thompson and Dr Joe Doyle,
is working to dramatically increase uptake
of treatment for HCV infection among
people who inject drugs (PWID), targeting
a range of approaches including increasing
awareness, training health practitioners,
clinical service delivery, surveillance and
evaluation. Lessons from this program will
inform HCV elimination models globally.
“Our approach is to target
the elimination of HCV
through nurse-led models of
care in community and prison
settings,” Dr Pedrana said.
The collaborative network of partners
includes the Department of Health and
Human Services Victoria, Justice Health
Victoria, Hepatitis Victoria, Harm Reduction
Victoria, St Vincent’s Hospital Victoria, and
The Alfred hospital. Implementation at
over 20 primary care sites, (such as Healthworks in Footscray), 14 correctional
facilities and six tertiary hospitals is
The program is funded by a
partnership grant from the National Health
and Medical Research Council, with a
contribution by Gilead Sciences.
The EC Partnership is also trialling
point-of-care testing for HCV in community
clinics through the ‘Rapid-EC’ pilot study,
as a way to increase access to testing,
diagnosis and treatment.