Eliminate C (EC) Victoria partnership

This project informed the design and implementation of the national Eliminate Hepatitis C (EC) Australia partnership.

Objective

The project aimed to:

• support health services to increase hepatitis C virus (HCV) treatment uptake in people who inject drugs (PWID) using nurse-led models of care in primary care and prison services
• assess the feasibility and impact of treating over 1,500 PWID annually in Victoria on prevalence and incidence of HCV in community and prison populations
• inform HCV elimination models in Australia and globally.

Timeline

2016–2021.

Approach

EC Victoria used a partnership approach involving researchers, healthcare providers, policy makers, community organisations and drug user networks. There were 5 main components of EC Victoria:

1. Increase demand through health promotion, including funding community partner organisations Harm Reduction Victoria and Hepatitis Victoria/LiverWELL to develop new and improved health promotion resources, and convening a EC Health Promotion Working Group to coordinate community activities. This included Fitpack stickers and Be Free From C - Getting Treated on the Outside booklet produced by LiverWELL with support from EC Victoria and  Hep C Treatment 'Ezy Card' Resource produced by Harm Reduction Victoria with support from EC Victoria.
2. Increase clinical capacity through training & education, including delivering education and training sessions and mentoring healthcare providers to increase testing and DAA prescribing, FibroScan training & certification program and loaning agreement to increase FibroScan access in regional Victoria, and producing a series of clinical resources including a toolkit to streamline clinical pathways.
3. Increase access to HCV testing & treatment through clinical support and streamlined clinical pathways in community and prison settings using nurse-led models: We partnered with 16 primary care services to implement enhanced HCV testing & treatment programs with EC nurses delivering a tailored package of support that included delivery of on-site pathology, point-of-care testing, incentives, FibroScans, treatment assessment and/or referrals and support to service staff to recall and follow up clients. Under the state-wide prison program led by St Vincent’s Hospital, EC Victoria supported the delivery of an HCV treatment program in 14 prisons, a trial of a care navigator program to link people released from prison into community based care and established a reporting mechanism for hepatitis C in prisons.
4. Establish integrated HCV data and surveillance system to monitor trends in HCV prevalence and incidence over time, including expanding the ACCESS surveillance system to an additional 16 sites, and developing indicators to monitor the HCV care cascade at the service level.
5. Research and evaluation to trial new interventions to increase uptake of HCV testing & treatment, including:
   • a trial of rapid point-of-care testing (Rapid-EC)
   • the EC Experience cohort to identify barriers and enablers to care
   • the Peer Assisting Treatment of Hepatitis C (PATH) project integrating peers into HCV models of care
   • a World Hepatitis Day 2019 campaign demonstrating the utility of incentives to reach new clients.

Community impact

EC Victoria: 

• supported 16 primary care services to conduct 14,293 tests (antibody and RNA) and treat 1,342 people
• supported 14 prison sites to conduct 2465 clinical assessments and treat 1,928 people. 

In total, approximately 3,270 PWID were treated for HCV over five years.

Many of the lessons and learnings from EC Victoria were used to inform the design and implementation of the larger, national EC Australia Partnership. Findings from EC Victoria implementation and research projects influenced several national and global policy and guidelines.   

Further evaluation of the EC Victoria components are being used to inform ongoing HCV elimination efforts in Victoria and other jurisdictions.