World-first Hep C Point-of-Care Testing Program

South Australian Viral Hepatitis Nurses are joining a world-first HCV point-of-care testing program being rolled out nationally in Australia. This follows community campaigns last year that brought hepatitis C rapid testing to the Riverland and Port Pirie.

Murray Bridge – the site of Hepatitis SA’s first LiverBetterLife project in 2017 – is one of the rural sites for the National Australia HCV Point of Care Testing Program’s initiative in South Australia.

Viral Hepatitis Nurses Rosalie Altus and Lucy Ralton from the Southern Adelaide Local Health Network (SALHN) together with Hepatitis SA have connected with local services to plan regular point of care testing sessions in the regional city, beginning in March.

Why Murray Bridge?

“Murray Bridge is an area with a lower socio-economic index that’s been deeply affected by drug use in recent years,” said Lucy. “Compared to Greater Adelaide, it has a higher proportion of unemployment and people looking for work as well as people with a disability.

“These are all factors associated with a higher risk of hepatitis C infection.”

Hepatitis SA educators will provide a series of free education sessions to workers in mental health care, community corrections, drug and alcohol services, and other community services, as well as GP networks.

The sessions will cover basic hepatitis C information, risk factors, diagnosis and treatment, and also inform the workforce about the national point-of-care testing program and its roll out in Murray Bridge.

Rosalie and Lucy will coordinate with services which express interest in hosting the point-of-care testing clinics for their clients and work out the best time and format for each clinic location.

Because it takes a bit of time for new projects to build up momentum and for relationships with key local people and services to develop, the nurses will trial regular testing clinics for six months to see what the uptake is like.

“We’ll adapt the where, when and how as we go so that we can optimise the opportunity to bring hepatitis C point of care testing to people in the Murray Bridge area,” said Lucy.

ACCHO Clinics

In addition to community clinics run by the viral hepatitis nurses, there will be hepatitis C point-of-care testing clinics at the Moorundi Aboriginal Controlled Health Service in Murray Bridge and Pangula Mannamurna in Mount Gambier, both of which are also registered HCVPOCT sites.

According to HCVPOCT Project Coordinator, David Silk, rural sites make up around 25% of total testing sites. Murray Bridge together with Moorundi and Pangula Mannamurna will form the core of South Australia’s rural testing sites.

Moorundi’s Aboriginal Health Clinical Director, Beth Hummerston, said hepatitis C point of care testing will work well at their clinics, particularly in Murray Bridge as they will soon become a Clean Needle Program (CNP) site.

“Community feedback was that the current options available to access clean needles are not places where people feel comfortable going,” she said.

“Having a CNP available may provide opportunities to talk to people about hepatitis C testing and is a way of addressing disparities in health services for people who likely don’t access health services regularly.”

She said testing could be provided on a day to day basis as need and opportunity arise, or there could be clinic days where people are encouraged to turn up for pointof-care testing. “It depends on community response,” she said.

“We have very experienced Aboriginal Health Practitioners who can perform the testing services independently, so we would be able to offer point of care testing opportunistically, in response to circumstances. We can be flexible.”

She said Moorundi hopes to eventually take the point of care machine to other communities where they have clinics at Raukkan and Victor Harbor.

Aboriginal Health Practitioners Gordon Rigney (left) and Kelly Smith (photo by Beth Hummerston/Moorundi)

Treatment and Follow-up

Hepatitis C treatment is just a matter of taking tablets daily for eight or twelve weeks. Close to 100% are cured with retreatment options available to the very small percentage of people for whom treatment did not work the first time.

“For people who test positive, we can book them with our GPs. This will ensure the experience is culturally comfortable and nonintimidating,” Beth said.

Similarly, those who test positive at the clinics run by the viral hepatitis nurses can be immediately referred on for treatment to be managed by their GPs. For those who don’t have a GP, alternative arrangements can be made.

“People in rural and regional areas often face significant barriers accessing GPs,” said Lucy. “Metro based Viral Hepatitis Nurse Consultants are experienced in working with individuals remotely to enable them to access hepatitis C testing and treatment.

“We can arrange for blood tests, help interpret results, discuss results with patients over the phone, diagnose a hepatitis C infection and arrange for prescriptions if needed.

“We also check for other pre-treatment issues and support people through the treatment process and organise post treatment testing.

“These days, people don’t have to travel to a major centre to check their hepatitis C status or to get treatment. In South Australia, they can just call a Viral Hepatitis Nurse.”

National Picture

The objective of the National Australian HCV Point-of-Care Testing Program (HCVPOCT) is to scale up hepatitis C testing in higher risk and harder to reach communities including rural and Aboriginal communities, and prisons. One of the objectives of the Program is to see if increasing testing in targeted communities will improve treatment uptake and completion.

Nationally, a total of 93 sites have registered including 27 prisons and 10 Aboriginal Community Controlled Health Organisation (ACCHO) sites. New South Wales leads the way with 44 sites, followed by Queensland with 23 and South Australia punching above its weight with 10.*

In South Australia, testing clinics have been held in prisons and drug and alcohol service locations.

Point-of-care testing is done by taking a small drop of blood with a finger stick and processing it in a portable GeneXpert machine that provides results within an hour. The portability of the equipment means testing can be taken to the community, where people go regularly for other services.

Viral Hepatitis Nurse, Lucy Ralton giving a rapid hepatitis C test to Kat Menz at the Barmera Pharmacy.

Each testing site is provided with a machine unless the service already has one. So far, 60 sites have started operating and 150 operators have been trained to operate the testing machines. Over 6,650 HCV pointof-care tests have been conducted via the Program with 850 people testing positive for chronic hepatitis C and 622 treated.

“Sites are often larger areas such as whole health districts and the operators move around the area. Operators do not normally work across different sites,” David explained.

The impetus behind the National Hepatitis C Point-of-Care Testing Program is the decline in hepatitis C testing and treatment after the initial surge following the approval of new treatments in 2016.

The latest report from the Burnet and Kirby Institutes reveal that although over 95,300 people with hepatitis C had been treated between 2016 and the end of 2021, about 117,800 people still live with hepatitis C—a disease that can be cured in weeks with daily tablets.

An estimated 18% of those living with chronic hepatitis C were Aboriginal and Torres Strait people. In general, rural communities have less access to health information and services, having to deal with distance.

First Nations communities often deal with these same issues as well as additional cultural barriers.

Health workers who would like to help their clients access HCV point of care testing can find out more by calling 02 9385 0900 or emailing hcvpoct@kirby.unsw.edu.au.

Cecilia Lim

*Provided by The National Australian HCV Pointof-Care Testing Program, Coordinating Principal Investigator, Professor Jason Grebely.

About the National Australian Point-of-Care Testing Program

The National Australian HCV Point-ofCare Testing Program is run by The Kirby Institute, UNSW Sydney and the International Centre for Point-of-Care testing at Flinders University. It is funded by the Australian Government Department of Health and Aged Care .

The objective of the Program is to establish a network of sites to scale up point-of-care HCV testing in settings which provide services to people at higher risk of hepatitis C, in order to increase testing and linkage to treatment.

The Program will be the first internationally to evaluate whether increasing point-of-care HCV RNA testing will improve treatment uptake among people at-risk of HCV.

It will contribute to understanding barriers to scaling up testing and treatment uptake, and inform HCV elimination efforts in Australia and globally.