Curing The “Hard to Reach”

Author: Rachael Bryett Winnie Nguyen Jeanette Tibbs

Theme: Models of Care Year: 2022

All jurisdictions in Australia now have well-established models of care for hepatitis C (HCV) in the
prison setting however, these programs only service people in prisons. Despite common population
risk factors for HCV transmission, care coordination, testing and treatment are not easily accessible
in the probation and parole setting. Hepatitis Queensland (HQ) established a first of its kind onsite
HCV testing and treatment model for people reporting to probation and parole offices.
Description of model of care/intervention:
The HCV clinic was implemented at three probation and parole offices in Queensland, Australia. The
one-stop-shop model comprises a general practitioner (GP), a nurse with Fibroscan and a
phlebotomist. At one location, Point-of-Care testing has been piloted. The community nurse
provides continuous post clinic support to HCV positive clients. Such support is essential due to the
life circumstances and acute needs that take precedence over health for this cohort. An extensive
evaluation was undertaken to assess the effectiveness of this model in engaging a hard-to-reach
From August 2020 to December 2021, 139 probation and parole clients attended an onsite clinic. Of
these clients, 34 tested HCV RNA positive (24%) and 66% reported a history of injecting drug use. 25
clients have been scripted and 12 clients have completed treatment. Five clients have been referred
to a specialist. The model effectively addresses the issue of accessing hepatitis C cure while not
having a regular GP or fixed address, a common scenario with this cohort. As one client put it, “This
was so easy to do. Thank you”.
Conclusion and next steps:
On-site HCV testing and treatment clinics at probation and parole offices represent a unique
opportunity to link people who inject drugs to life-changing healthcare. The model can be replicated
in other jurisdictions and is a significant opportunity to contribute to the elimination of hepatitis C in
Disclosure of Interest Statement:
This project is funded by the EC Australia Partnership through the Paul Ramsay Foundation and the
Burnet Institute.

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