While Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) people account for 2–3% of the population, they constitute 8–10% of all Australians living with chronic hepatitis C (HCV). Reducing HCV incidence and increasing access to HCV therapy are priorities of national and jurisdictional hepatitis C strategies, all of which highlight Aboriginal people as a priority population, given the significant burden of disease, rising HCV incidence and low rates of treatment uptake. Marginalised populations often fare less well in relation to access to health care innovations, and this is particularly the case for Aboriginal people. In this context, it cannot be guaranteed that the roll out of new HCV treatments (direct acting antivirals or DAAs) will have equal impact for Aboriginal people. Understanding how HCV treatment is accessed by Aboriginal people is essential to avoid creating further gaps in liver disease and Aboriginal health outcomes.
In the SCALE-C study, an established HCV test and treat model will be rolled out in four regional Aboriginal health services (AHS). The study will evaluate the impact of this test and treat model on HCV treatment uptake and the long-term impact on HCV prevalence and ongoing transmission within those Aboriginal communities.
SCALE-C is an interventional cohort study recruiting people with or at risk of HCV infection from AHS and partnering health services. Participants are screened for HCV infection using point-of-care testing (anti-HCV antibody and/or HCV RNA). Participants who test HCV positive receive a community-based disease assessment and treatment work-up including non-invasive liver fibrosis assessment (Fibroscan or APRI) and linkage to care. This “test and treat” strategy aims to increase HCV diagnosis and testing, enhance scale-up of DAA therapy and reduce HCV prevalence and incidence in the participating Aboriginal communities. Participants people with or at risk of HCV infection will be followed long term to look at HCV incidence, treatment uptake and outcomes, reinfection and HCV prevalence.
The results from this study will inform national and international clinical recommendations guiding the management of HCV infection among Aboriginal people in Australia and other international Indigenous populations. Collectively, the results from this project will transform fundamental outcomes in the practice of clinical medicine, public health and health policy.
This is the first prospective cohort study evaluating a hepatitis C “test and treat” intervention among Aboriginal people. Comparable studies are likely to be impossible outside Australia, given that many countries have major restrictions on DAA treatment access based on disease stage and drug use. By embedding HCV testing and management within Aboriginal Community Controlled Health Services (ACCHS), we will deliver safe, effective HCV care and ensure Aboriginal community control and ownership of this health issue.
The SCALE-C project will create systems that will transfer skills and knowledge between SCALE-C project team members, ACCHS staff and Aboriginal communities, establishing a learning environment to ensure the technical and cultural aspects of the project will be shared between members and will be conducted in a manner consistent with the ethical conduct of research within Aboriginal communities.
- National Health and Medical Research Council (NHMRC) Project Grant