A successful hepatitis C intervention program in Western Sydney will be rolled out across New South Wales thanks to a substantial NHMRC partnership project grant.
The research collaboration, bringing together the Kirby Institute and the Centre for Social Research in Health (CSRH), both based at UNSW, the South Australian Health and Medical Research Institute (SAHMRI), with the NSW Ministry of Health and a number of Local Health Districts (LHD), will implement the proven approach to increasing participation in testing for blood-borne viruses and STIs among Indigenous communities.
The intervention project, called Deadly Liver Mob, or DLM, has been operating in Mt Druitt for three years and in Penrith for about 18 months. Its focus is on interaction with trusted Aboriginal health workers combined with a “yarning” or peer education approach to information. This pilot project in Western Sydney has shown the potential for engagement with Aboriginal people in unprecedented numbers, according to the head of the Kirby Institute’s Sexual Health Program, Professor Basil Donovan.
“Initially, this program was primarily driven by an identified need to increase testing and treatment for hepatitis C,” Professor Donovan said. “Addressing sexual health needs at the same time is a bonus.” One of the objectives of the wider program is to map its impact on service delivery, and Professor Donovan believes it has the potential to change service delivery across state-wide services.
“Earlier diagnosis and treatment of hep C, particularly in this era of highly effective treatments, and testing and treating of all the blood-borne viruses and STIs could have a substantial effect on the community disease burden,” Professor Donovan said.
The five-year study will evaluate the health outcomes and impact of Deadly Liver Mob, examine its acceptability and establish a translational framework that would enable DLM to be scaled up across NSW and even further afield.
The study, Deadly Liver Mob: Engaging Aboriginal people in viral hepatitis, HIV and sexual health services, has attracted $1.5 million in funding and in-kind contributions from partners. The NHMRC partnership grants require matching funding and are not for new research but to extend a model already shown to be successful.
The Director of the CSRH, Professor Carla Treloar, who is leading the program, said the research will lead to better health outcomes for Aboriginal people and provide evidence to shape policy, health care delivery and surveillance of sexually transmitted infections and hepatitis among Aboriginal people.
Rates of sexually transmissible infections and blood-borne viruses such as hepatitis are disproportionately high among Indigenous people but more traditional methods of hepatitis and sexual health education have had low success in engaging Aboriginal communities.
An initiative of the Harm Minimisation teams of Western Sydney and Nepean Blue Mountains Local Health Districts, Deadly Liver Mob is a peer-driven incentive-based program that offers education and screening for blood-borne viruses and sexually transmissible infections. It focuses on existing clients and seeks to engage with their networks, increasing people’s access to services.
Delivered by Aboriginal health workers, the program offers shopping vouchers as incentives for participants to be educated about blood-borne viruses, to consider hepatitis C and sexual health screening, and to recruit and educate their peers. Clients receive a $20 supermarket voucher when they participate in the initial education and can claim additional vouchers on subsequent visits.
Professor Treloar acknowledged that the shopping vouchers might be contentious but said they have resulted in much wider networks of people attending hepatitis education, testing and counselling, including several generations of family members.
“The incentives are interesting but it’s a really modest investment for a very large impact,” she said. “And being able to say we value you for turning up is an important thing.”
In its first 12 months, the project engaged more than 400 Aboriginal people in a hepatitis health promotion activity, with subsequent referral of more than 300 people to sexual health screening and a 1023% per annum increase in access to sexual health services.
The Aboriginal project workers have been essential to trust in the program, Professor Treloar says. “The key to making it work is to have Aboriginal people there to greet people when they come to the service and to introduce it, not to mention having their expertise on how to work with the community,” she said. “In communities where more traditional medical services may be regarded with suspicion, that’s really important.”