A very inspiring presentation given by A/Professor Phillip Mills that cuts to the core of the problem of the sub-optimal success often seen in many indigenous health programs, being namely that of the lack of genuine community engagement in the development and implementation of these programs.

Mills described this as a sort of unconscious neglect that is a manifestation of the dominance of mainstream culture in policy and program development, and ultimately a form of institutional racism.

For any hope for this to be addressed, he gently described the urgent need for a reckoning with Australia’s colonial past and a shift in collective consciousness of the general population.

A very important message for those working with indigenous populations.

Access speaker presentations from this session via the AVHEC17 website

Phillip is a Kulkulgal Tribal Elder of Zenadth Kes and Associate Professor with the Australia Institute of Tropical Health and Medicine (JCU) and has authored and co-authored award winning research papers, chaired scientific and inter-departmental committees and sat on ministerial policy committees on Indigenous Health. Phillip led the reform in indigenising the Public Health System as Executive Manager of mainstream Hospitals and Primary Health Care whose core mainstream business was Aboriginal and Torres Strait Islander Health with the establishment of specifically tailored evidence based scientific Indigenous Health Models. The success of his work in community developed scientific health interventions, culturally acceptable health care systems and protocols, and innovative evidence based bi-cultural health practices and structures earned him an Order of Australian Award Medal. His expertise has flowed on into the Community Control Sector where the application of his work has assisted enhancing the development of more comprehensive primary health care.

Professor Rebecca Guy (Program Head and Professor, the Kirby Institute UNSW) gave a very illuminating presentation on the epidemiological mechanics of elimination programs and the areas that will need to be focused on if Australia is to achieve elimination of hepatitis C as a public health problem.

These areas were outlined as Modelling, Obtaining data at a finer geographical level, Developing better health service delivery data, Understanding barriers to assessing services, Monitoring of new cases and Improving completeness of indigenous data.

Of particular interest was the need to understand where new cases are coming from as this will help identify where our prevention strategies are failing and where we need to focus our efforts.

Notification of RNA data was suggested as a way for better identification of new cases.

Read more about other speaker presentations in this AVHEC17 session

In this presentation, Dr Nicole Allard describes a research project to examine whether an intensive follow-up and recall system improved liver cancer surveillance programs in patients with chronic hepatitis B.  On the basis of current recommendations for 6-8 monthly liver ultrasounds and AFPs, optimal screening was defined as having achieved 2 scans every 14 months, sub-optimal screening as one scan every 14 months and poor screening as less than one scan every 14 months.

The intervention consisted of nurses conducting an audit to detect patients requiring HCC surveillance within the clinic patient base, upskilling the healthcare workers in hepatitis B management, and establishing a proactive recall system consisting of a variety of strategies such as calling of patients, sending out of path forms by mail or sending out pre-appointment confirmation texts.

A participation rate of 75% was obtained in this patient cohort yet optimal screening was only achieved in 25% of patients. It was not clear what the baseline of adherence to screening schedules were like prior to the intervention, and thus it is difficult to interpret this result.

An important observation made during this study was that patients often had little understanding of their individual risk of HCC, and that this perhaps impacted on their adherence to screening schedules.

Recommendations included developing a low English literacy tool to help to explain this better to patients, implementing a community awareness program, considering the role of a liver cancer registry, and supporting the development of a more feasible method of screening.

See Nicole's presentation here.  

Fantastic final lecture of the day at the 2017 Australasian Viral Elimination Conference! Dr Jacqui Richmond really nailed it when she said that we will not eliminate hepatitis C without a whole of system approach. A very insightful lecture into the challenges in educating the workforce and the reasons why there has been such a slow uptake of new knowledge into practice. To move DAA prescribing into the community is the essential next phase towards elimination, but this will require a change in practice on the part of GPs. Jacqui used the diffusion of innovation theory to explain how this change might happen. A very thought provoking lecture.

Jacqui Richmond has worked in viral hepatitis for the last 20 years in nursing, education, research, and policy development. Jacqui currently works at the Burnet Institute, Melbourne Health and La Trobe University, where the broad focus of her work is on building the capacity of the health professional workforce to test, treat and manage the health care needs of people living with viral hepatitis.

Link to Jacqui Richmond's speaker presentation here

Link 

I'm reporting from oral abstracts from the Australasian Viral Hepatitis Elimination Conference 2017 with speakers discussing Models of Care/What are the challenges ahead for hepatitis B and C elimination? 

A wonderful world-wind tour of current models of care for upscaling chronic hepatitis C treatment, mostly based around nurse-led models of care linked in with tertiary care settings. A very promising model that appears to have had great success in accessing marginalised populations who require intensive case management. Missing from the discussion however was how General Practitioners could be incorporated into this model, or indeed exploration of a GP led model of care for clients with a reduced need for support.

A particularly interesting speaker presentation was given by Dr Carla Treloar about the development of a tool to monitor the experience of stigmatisation for those engaged in the health care system - a much neglected area of research in understanding the barriers to patients seeking access to care. Clearly, all options need to be on the table if we are to reach the aspirational targets of elimination, as it is unlikely that one-model-fits-all will be sufficient to reach all of the populations concerned.

Link to the oral abstracts and speaker presentations here