Health Systems Strengthening Program for Sexually Transmitted Infections (STIs) and Blood Borne Viruses (BBVs) in a regional Aboriginal Community Controlled Health Organisation

This project is a partnership between Bulgarr Ngaru Medical Aboriginal Corporation (BNMAC), Eliminate Hepatitis C (EC) Australia Partnership and Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) that aims to increase viral hepatitis, HIV and STI testing and treatment among Aboriginal and Torres Strait Islander Peoples in regional settings.

Objective

The program objective is to implement a community, co-designed, evidence based BBV and STI program that includes staff education, prevention and treatment services in an Aboriginal Community Controlled Health Organisation (ACCHO), a primary health care setting.

The program aims to:

• improve ACCHO workforce knowledge, skills, motivation and confidence to screen, treat and manage BBVs/STIs, hepatitis B, hepatitis C through education and training
• improve clinical management (screen, manage and follow up) and prevention of STIs, hepatitis B, and hepatitis C by implementing a structured, whole-of-practice Continuous Quality Improvement (CQI) activity
• improve engagement with priority populations and reduce stigma related to BBV and STIs through community awareness campaigns and the trial of peer-referral incentives programs
• increase access to STI, hepatitis B, hepatitis C testing through the use of rapid point-of-care tests
• improve linkages and networking between ACCHO and local district partners services, including tertiary hospitals and drug and alcohol services
• evaluate the effectives and cost-effectiveness of the above interventions and health promotion program.

Timeline

2021–2024.

Approach

Phase 1 (Year 1): STI/BBV/HIV education and training and workforce development

These activities built staff knowledge and awareness of culturally appropriate approaches to increase testing and coverage rates for STIs and BBVs. This training was provided by ASHM and co-produced alongside BNMAC and EC Australia. The training focussed on building skills, motivation, and confidence of staff to integrate STIs and BBVs into 715 Aboriginal health checks and explored cultural aspects impacting on high rates of STIs and BBVs with the local community.

Phase 2 (Year 1-2): Implementing an iterative continuous quality improvement framework to improve surveillance and clinical indicators of STIs/BBVs

Continuous Quality Improvement (CQI) activities will be undertaken to improve whole of practice screening, management and follow up. The National Framework for Continuous Quality Improvement in Primary Health Care for Aboriginal and Torres Strait Islander People, 2018-2023 will underpin these activities using four domains:

1. being culturally respectful
2. doing CQI
3. supporting CQI
4. informing CQI.

Discrete activities include development of STIs/BBVs clinical audits to identify priority patient groups with the service and implement an iterative process of Plan-Do-Check-Act to increase testing, treatment and management of STIs and BBVs among priority patient groups, including:

• provide education to clinical staff around how to start the conversation
• incorporate STI & BBV testing as part of routine 715 health checks and to better identify clients at risk
• implement active follow up and patient recall systems
• implement GP prescribing prompts for treatment assessments
• develop and implement follow-up care and ongoing monitoring for people with cirrhosis or as required
• implement routine clinical audits of STIs/BBVs to monitor above activities. 

Phase 3 (Year 2): Community campaigns with rapid point-of-care (POC) testing and peer-referral incentives campaign

Community campaigns will be implemented across three services that will aim to increase awareness and increase access to viral hepatitis and STI screening, targeting new clients through the use of rapid point of care testing and a peer-referral incentive program.  

These hepatitis C testing campaigns will coincide with local events or community days where events are held at community outreach clinics or partner sites over several days to attract clients to these services, and will offer on-site testing. Small monetary incentives will be incorporated into these campaigns to attract new clients on the day and to link clients to follow up appointments at BNMAC services.

The use of peer-referral incentive program will provide patient disbursements to attend screening and then at key points across the care cascade to assist clients with travel costs to attend any follow up clinic appointments.

Disbursements will be provided for undertaking baseline STI/BBV testing & completing patient registration form, for attending follow up appointments and treatment initiation, and for referring a friend to undergo testing during the campaign period. 

The GeneXpert platform will be used to provide rapid point-of-care (POC) testing for hepatitis B and C. This will enable clients to be diagnosed within 60 minutes and be linked to care and treatment on the same day.

Community impact

Anticipated outcomes of the project will be:

• enhanced capacity and confidence of workforce to manage and prevent BBVs & STIs within the local community
• increased testing and treatment of at-risk individuals for BBVs & STIs who may otherwise not be engaged
• improved surveillance and monitoring of BBVs and STIs clinical indicators within the selected ACCHO
• a new network of trained and competent Aboriginal & Torres Strait Islander Health Workers and nurses/nurse practitioners experienced in operating point-of-care testing using GeneXpert machines
• robust evidence for CQI activities and community campaigns to increase testing, treatment and management of BBVs & STIs, including for utility and cost-effectiveness
• developed a template for how to successfully implement an integrated BBV and STI awareness, prevention and testing program within a network of ACCHOs; and a plan to scale this up to other ACCHOs.