2 July 2026
As part of our Community of Practice on hepatitis C in regional and remote Australia, we explored the role of incentives in supporting engagement in testing, treatment and care.
Across the webinar and follow-up discussions, three distinct approaches emerged. While each operates in a different setting, all are responding to the same challenge: how do we reach people who are not engaged with traditional healthcare services and support them through the hepatitis C care pathway?
The discussion highlighted an important lesson. Incentives can help create opportunities for engagement, but they are rarely the reason people stay connected to care. Trust, relationships, flexibility and addressing practical barriers remain the foundations of successful models.
Peer-led outreach with incentivised testing, Alice Springs, Northern Territory AIDS and Hepatitis Council (NTAHC) and Clinic 34
Karen Nicolaysen from NTAHC and Khim Tan from Clinic 34 shared a peer-led model, “The HEPLINK Peer Outreach Project”, combining outreach, point-of-care testing and rapid linkage to treatment.
Testing is offered through the needle and syringe program and outreach sites, including pharmacies, hostels, and alcohol and other drug services. Incentives are used throughout the care pathway, with participants receiving $40 for hepatitis C antibody testing, $40 for RNA testing, $60 for starting treatment and a further $60 for treatment completion. During the It’s Your Right campaign, testing incentives increased to $60 for people who inject drugs.
The impact has been substantial. Before the model was introduced, just 37 tests had been completed over approximately 10 months. Since September last year, the service has conducted 474 antibody tests and around 20 RNA tests. Four people tested positive for hepatitis C, and all were linked to treatment, despite not being engaged with mainstream healthcare services.
As Khim explained, peer workers lead the process “from the initial conversations, testing itself, brief interventions, and any follow up required” before linking people into clinical care.
However, the presenters cautioned against assuming that larger incentives automatically lead to greater engagement.
“Even when we were doing It’s Your Right and we were able to offer $60 for a test for all of our NSP clients, some of them declined,” Karen said. “Whether it was $40 or $60 didn’t seem to make that much of a difference.”
But the biggest takeaway? The team felt that being available when people were ready to test, offering a low-barrier service and building trust through a consistent peer presence were ultimately more important than the dollar amount itself.
Work and Development Orders
For many people at risk of hepatitis C, accumulated fines and debt create significant barriers to healthcare engagement. The consequences can include licence suspensions, loss of vehicle registration and reduced access to transport, making attendance at appointments increasingly difficult and push healthcare needs into the background.
Work and Development Orders (WDOs) – or Work & Development Permits, as they’re called in some states, provide an alternative pathway. Rather than paying fines directly, eligible individuals can reduce their debt by participating in approved activities, including hepatitis C testing, treatment, education and training.
In New South Wales, for example, eligible individuals can work with a WDO Sponsor – who can be a health professional – to clear up to $3,000 in fines by undertaking hepatitis C testing and treatment
For a quick introduction to WDOs, check out this short video from NSW:
Similar (but not exactly the same) schemes operate in Queensland, Victoria, Western Australia, and the ACT.
Services such as the HIV and Related Programs (HARP) service on the Mid North Coast of NSW have demonstrated the impact of this approach, supporting clients to work off more than $2.5 million in fines since 2022 while increasing engagement with care.
Inspired by this work, the ECA II team at the Burnet Institute are undertaking a project to explore how WDOs are being used in hepatitis C elimination across the country. With the support and insights of an advisory group, with people from each state and territory, they are developing a short, written resource to help tell the story of WDOs – and how they can help people living with hepatitis C, and the services supporting them. It aims to raise awareness about how useful these tools can be and point people in the direction of where to get more information about WDOs in their part of Australia.
The WDO resource should be available online in mid-2026.
Meanwhile, the advisory group continues to meet and share experiences and practice tips so that people across different parts of the country can learn about how to work with WDOs to help people using their services.
Unlike traditional incentives, WDOs address a structural barrier that may otherwise prevent people from accessing healthcare. By linking care with meaningful outcomes such as reducing debt and regaining a driver’s licence, they create a practical pathway into treatment.
For more information about the ECA II WDO Project, please contact Paul Armstrong at the Burnet Institute at [email protected]
Targeting the right moments, Hepatitis ACT
Following the webinar, in a chat with INHSU Director of Programs Nikitah Habraken, Hepatitis ACT shared a different approach focused on refining where incentives are used at different points along the care pathway.
Initially, their model distributed incentive payments across multiple points in the pathway, including testing, treatment initiation, cure and for education sessions. However, they found people often dropped off the pathway at the point of doing confirmatory blood tests and coming back to test for sustained virological response (SVR).
The service responded by changing the amount of money provided at these critical stages. Payments were reduced in some areas and increased for confirmatory blood testing and SVR completion.
This targeted approach has improved both treatment initiation and treatment completion.
A partnership approach
The model is primarily an outreach model, with testing delivered in partnership with community-based services. Pharmacies, particularly those providing opioid agonist treatment, have become important partners, alongside housing, corrections and food relief services.
A practical feature of their approach is reducing the burden on partner organisations. Hepatitis ACT provides ready-to-use promotional materials and manages much of the coordination, making participation straightforward for the community partners.
Another key aspect of their model is ensuring timely payments of the incentives. Incentives are paid via direct bank transfer, typically processed at the end of each testing day. They also ensure the process is clearly explained to clients at the start, ensuring a shared understanding of when and how the payments will be made.
Another insight was the role incentives can play in reducing stigma. Some clients reported that being able to say they were attending “for the incentive” removed pressure to discuss risk factors or disclose personal information.
Shared insights & key takeaways
