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  5. Margaret Hellard AM

Background

Infectious diseases - focus of her work

For almost two decades Margaret's work has centred around infectious diseases, preventing their transmission and identifying the impact of these infections in vulnerable populations. A researcher and clinician, her principal research interests are in the epidemiology of blood-borne viruses (BBVs) HIV, hepatitis B and hepatitis C, sexually transmitted infections, and improving the management of individuals who already have the infection. Margaret has considerable experience in undertaking community-based research involving young people, injecting drug users (IDUs) and vulnerable populations, and experience in research in tertiary care institutes. She also has considerable experience in undertaking research that used new technologies (such as SMS, Facebook) for health promotion and prevention interventions.

Translational Research

Margaret has over $73 million in competitive research grants and tenders. She was recently awarded an $11.3 million grant from the Paul Ramsay Foundation for hepatitis C elimination. She was also awarded a prestigious NHMRC Program Grant worth over $7 million. Margaret has over 440 peer reviewed publications including in high ranking journals such as the Lancet, GUT, Hepatology and Clinical Infectious Diseases. She has won prizes for her work including the Victorian Public Health Award for Program Excellence and VicHealth Award for Outstanding Achievement in Health Promotions. Margaret has considerable experience in translating research outcomes into health policy and practice. Examples include

  • Margaret's work over the past 15 years increasing knowledge and understanding of viral hepatitis transmission, testing and care has influenced policy in Australia and globally. This includes being one of a small group of advisors instrumental in WHO setting elimination targets for hepatitis B and hepatitis C. Margaret is leading implementation science research to ensure Australia meets these elimination targets
  • She had received funding worth over $14 million dollars to undertake this work including a prestigious NHMRC Program Grant and a NHMRC Partnership Grant. A key feature of this work is to increase the number of people being tested and treated for hepatitis C in community settings, in particular highly marginalised and vulnerable groups such as people who inject drugs. Margaret is also collaborating with researchers and governments including Georgia, Myanmar, Iceland, Kenya, India and the Netherlands on projects aiming to eliminate hepatitis C as a public health threat.
  • Margaret's work over the past ten years examining the role of the injecting network on hepatitis C transmission has led to the funding of the Hepatitis C Treatment and Prevention (TAP) Study. This world first study is examining the feasibility of a nurse led model of care for hepatitis C treatment of people who inject drugs in a community setting using a network-based approach.
  • The identification of high rates of hepatitis C reinfection in people who inject drugs led to changes in HCV prevention education and helped characterise T cell function, which in turn is informing HCV vaccine development.
  • Margaret has been instrumental in the development of innovative sentinel surveillance systems for blood borne viruses and sexually transmitted infections and sexually transmitted infections both in Victoria and nationally. This work has led to the Federal Government funding ACCESS, a highly innovative national surveillance program that is able to monitor changes in the incidence and prevalence of these diseases and the cascades of care. ACCESS enables governments to evaluate the impact of their programs aimed at eliminating blood borne viruses and controlling sexually transmitted infections.
  • Margaret's work, with others, on the feasibility of treating current people who inject drugs for their HCV has led to changes in the clinical management of this group and influenced the Victorian Government to fund and locate ten hepatitis C nurses in community based integrated clinics. Most recently this work has led to funding for randomised controlled study comparing community-based hepatitis C treatment with patients treated in a tertiary setting (The Prime Study).
  • Margaret's prison research and public health advocacy played an important role in the introduction of free HBV vaccine and public health nurses into Victorian Correctional Facilities and increasing the availability of HCV treatment into Victorian prisons.
  • Her development of health promotion projects using new technologies (The FaceSpace and Queer as FK projects) led the Victorian Government to fund the Victorian AIDS Council to continue the Queer as FK project on the Facebook social network site.
  • In 2000, Margaret saved Victoria over $500 million when the results of her PhD research The Water Quality Study demonstrated that Victoria's drinking water did not require filtration.

Most significant publications

  • C Seaman, C Morgan, J Howell, Y Xiao, W Spearman, M Sonderup, O Lesi, M Andersson, M Hellard, N Scott* (equal senior author) Use of the controlled-temperature chain and compact prefilled auto-disable devices to reach 2030 hepatitis B birth dose vaccination targets in low and middle-income countries: A modelling and cost-optimization study. In press Lancet Global Health Accepted April 2020
  • A Pedrana, J Howell, N Scott, S Schroeder, C Kuschel, J Lazarus, R Atun, R Baptista Leite, E t'Hoen, S Hutchinson, L Aufegger, R Peck, A Sohn, T Swan, M Thursz, O Lies, M Sharma, J Thwaites, D Wilson M Hellard. Global hepatitis C elimination: an investment framework. In press – Lancet Gastro Hepatology Accepted January 2020
  • N Scott, C Kuschell, A Pedrana, S Schroeder, J Howell, A Thompson, D Wilson*, M Hellard. A model of the economic benefits of global hepatitis C elimination: an investment case In press – Lancet Gastro Hepatology Accepted January 2020
  • Scott N, Sacks-Davis R, Wade AJ, Stoove M, Pedrana A, Doyle JS, Thompson AJ, Wilson DP, Hellard M. Australia needs to increase testing to achieve hepatitis C elimination. Med J Aust. May 2020;212(8):365-70.
  • A Wade, J Doyle, E Gane, C Stedman, B Draper, D Iser, S Roberts, W Kemp, D Petrie, N Scott, P Higgs, P Agius, J Roney, L Stothers, A Thompson*, M Hellard. Outcomes of treatment for hepatitis C in primary care compared to hospital-based care: a randomised controlled trial in people who inject drugs Clinical Infectious Diseases 2020;70:9:1900-1906
  • J Howell, H Chan, J Feld, M Hellard, A Thompson. Closing the stable door after the horse has bolted - should we be treating people with immune-tolerant chronic hepatitis B to prevent hepatocellular carcinoma? Gastroenterology Feb 20 2020
  • A Bowring, F Ampt, S Schwartz, M Stoové, S Luchters, S Baral, M Hellard, Pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind J Int AIDS Soc. Feb 2020;23(2):e25442
  • CW Spearman, G Dusheiko , M Hellard, Mark Sonderup. The Lancet Seminar: Hepatitis C. Lancet. 2019;394(10207):1451-66
  • M Traeger, V Cornelisse, J Asselin, B Price, N Roth, J Willcox, BK Tee, CK Fairley, C Chang, J Armishaw, O Vujovic2 M Penn, P Cundill, G Forgan-Smith, John Gall, Claire Pickett, L Lal, Anne Mak, T Spelman, L Nguyen, D Murphy, K Ryan, C El-Hayek, M West, S Ruth, C Batrouney, J Lockwood, J Hoy, M Hellard, M Stoové, E Wright, for the PrEPX Study Team. Association of HIV Pre-exposure Prophylaxis with Incidence of Sexually Transmitted Infections among Individuals at High Risk of HIV Infection JAMA. JAMA. 2019;321(14):1380-1390. doi:10.1001/jama.2019.2947
  • G Cooke, I Andrieux-Meyer, T Applegate, R Atun, J Burry, H Cheinquer, G Dusheiko, J Feld, C Gore, M Griswold, S Hamid, M Hellard, J LIn Hou, J Howell, J Jia, N Kravchenko, J Lazarus, M Lemoine, O Lesi, L Maistat, B McMahon, H Razavi, T Roberts, B Simmons, M Sonderup, B Taylor, D Thomas, I Waked, J Ward, S Wiktor Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission The Lancet Gastroenterology and Hepatology 2019:4:135-184 http://dx.doi.org/10.1016/S2468-1253(18)

Qualifications

  • 2001: FAFPHM, Australasian Faculty of Public Health Medicine
  • 2000: PhD, Department of Epidemiology and Preventive Medicine, Monash University
  • 1996: FRACP, Royal Australasian College of Physicians
  • 1986: MBBS, Monash University

Appointments

  • 2017: Deputy Director (Programs), Burnet Institute
  • 2013: Associate Director, Burnet Institute
  • 2012: Adjunct Professor, Monash University, DEPM.
  • 2011: Head, Hepatitis Services, Infectious Disease Unit, Alfred Hospital, Victoria, Australia
  • 2009: NHMRC Senior Research Fellow
  • 2008: Honorary Senior Fellow, Nossal Institute, University of Melbourne, Victoria, Australia
  • 2006: Honorary Associate Professor, Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
  • 2002-2006: Honorary Senior Lecturer, Department of Epidemiology and Preventive Medicine, Monash University, Australia
  • 2002: Head of the Epidemiology and Social Research Unit (now Centre for Population Health) at Burnet Institute, Melbourne, Victoria, Australia
  • 2001-2009: Infectious Diseases Physician, Royal Melbourne Hospital, Victoria, Australia
  • 2000-2002: Senior Research Fellow, Department of Epidemiology and Preventive Medicine, Monash University, Australia
  • 1996: Infectious Diseases Physician, Alfred Hospital, Melbourne, Australia

Awards

  • 2019: Member of the Order of Australia (AM) ‘for significant service to medicine as an infectious diseases and public health physician and research scientist’.
  • 2010: Burnet Institute Frank Fenner Award: Recognised for her outstanding leadership, innovation and contribution to the fields of research and public health
  • 2005: Victorian Public Health Award, Program excellence winner for HIV sentinel surveillance
  • 2005: VicHealth Award for Outstanding Achievement in Health Promotions (studies over $75,000) for The epidemiology and control of chlamydia infection in Victoria
  • 2005: VicHealth Award for Outstanding Achievement in Health Promotions (studies less than $15,000) for Uncontested possessions and key positions
  • 2005: Frank Fenner Award for Advanced Research in Infectious Diseases
  • 2004: NHMRC Career Development Award
  • 2004: VicHealth Senior Research Fellowship
  • 2001: Australasian Society of Infectious Diseases, Aztra Zeneca Travel Award
  • 2000: Inaugural Graham Rouch Award, Victorian Branch of the Australasian Faculty of Public Health Medicine
  • 2000: Young Water Scientist of the Year
  • 2000: Victorian Public Health Award for Research Excellence
  • 2000: NHMRC Clinical Research Fellowship
  • 1998: NHMRC Clinical Research Fellowship

Positions

  • Red Cross Blood Bank Australia – Chair, Expert Review Panel on Injecting Drug User Donation Policy
  • Advisory Committee to Justice Health on Hepatitis C Care and Treatment Victoria
  • WHO Advisor –Think tank to develop strategies to eliminate hepatitis B and C
  • WHO Advisor – Hepatitis C Surveillance and Screening
  • WHO Temporary Advisor - WHO Consultation on Strategic use of ARVs
  • WHO Temporary Advisor – WHO Consultation on Hepatitis C Modelling
  • Communicable Diseases Network of Australia National Strategies BBV/STI Subcommittee
  • InC3 – International Collaboration of Incidence Hepatitis C in Injection Drug users (coordinating committee).
  • Australian Hepatitis Councils Health Reference Group
  • Victorian Department of Health Advisory Committee on BBVs and STIs
  • ASHM Viral Hepatitis Clinical Oversight Committee

Reports + Policy Briefs

2022 (8)

2021 (11)

2020 (1)

Reports and other work

  • A systematic review of immediate HCV RNA testing following HCV Antibody compared with HCV RNA testing at time of assessment for HCV therapy.

    The World Health organization estimates that between 130 and 150 million people are chronically infected with hepatitis C virus (HCV) worldwide (World Health Organisation, 2012, Woodall et al., 1994). People with untreated HCV are at increased risk of liver cirrhosis, hepatocellular carcinoma, and liver-related mortality (Villano et al., 1997). HCV RNA testing, which generally follows a positive anti-HCV antibody test in a clinical setting, allows the detection of current HCV infection, thus indicating individuals for treatment and care options (Rongey et al., 2009, Scott et al., 2006, Piasecki et al., 2004). This review investigates the optimal time at which to perform HCV RNA tests in order to establish the presence of current infection, and to reduce morbidity and mortality associated with HCV infection.

    A systematic review of immediate HCV RNA testing following HCV Antibody compared with HCV RNA testing at time of assessment for HCV therapy.
  • Overview of viral hepatitis treatment research in China. (WHO Report).

    China is confronted with a significant challenge in managing a substantial population afflicted with hepatitis B virus (HBV) and hepatitis C virus (HCV). An estimated 93 million individuals live with chronic hepatitis B, while 7 million individuals contend with chronic hepatitis C in China. Moreover, every year, approximately 300,000 deaths are attributed to hepatitis-related diseases in the country.

    Overview of viral hepatitis treatment research in China. (WHO Report).
  • The Optimise Study: A rapid survey examining frequency, impacts of long COVID and associated concerns. (PUBLIC HEALTH REPORT)

    Long COVID is estimated to be costing the Australian economy $3.6 billion annually.1 Partly because of the variation in the definition of long COVID

    The Optimise Study: A rapid survey examining frequency, impacts of long COVID and associated concerns. (PUBLIC HEALTH REPORT)
  • A systematic review of the effectiveness of antiviral treatment compared with no treatment for chronic HCV infection.

    Hepatitis C virus (HCV) infection affects more than 3% of the global population and poses a high economic burden (El Khoury et al., 2012, Georgel et al., 2010). Between 130 and 150 million people are chronically infected with hepatitis C, and it is a major cause of hepatocellular carcinoma and liver cirrhosis (Georgel et al., 2010, Coffin et al., 2012). Approved treatments include interferon-alpha (IFN), ribavirin (RBV), and HCV NS3 protease inhibitors. Other classes of agents including additional interferons and direct-acting antiviral agents (DAAs) have been studied for effectiveness and tolerability. The purpose of this rapid review is to assess the effectiveness of HCV anti-viral treatment (IFN, PEG-IFN, RBV) in terms of treatment response, adverse events, quality of life, morbidity, and mortality.

    A systematic review of the effectiveness of antiviral treatment compared with no treatment for chronic HCV infection.
  • Know COVID-19: Estimating risks associated with early reopening in Victoria

    In this study, we use Covasim to estimate the risk of Victoria experiencing a third COVID-19 epidemic wave if Stage 4 restrictions were eased on the 14th September 2020 or two weeks later on the 28th September.

    Know COVID-19: Estimating risks associated with early reopening in Victoria
  • Modelling the Victorian roadmap (PUBLIC HEALTH REPORT)

    COVID-19 mathematical modelling of the Victoria roadmap 2021.

    Modelling the Victorian roadmap (PUBLIC HEALTH REPORT)
  • The Optimise Study: COVID-19 worry and perceptions about infection and potential severity. (PUBLiC HEALTH REPORT)

    This report evaluates the impact of the COVID-19 pandemic on participants’ lives: their main concerns, risk perception, and confidence in the State and Federal Governments’ responses to the COVID-19 pandemic. This report focusses on trends over the past six months (between September 2021 and February 2022).

    The Optimise Study: COVID-19 worry and perceptions about infection and potential severity. (PUBLiC HEALTH REPORT)
  • The Optimise Study: Social networks and mixing patterns

    This report focuses on: Average overall contacts between October 2020 and March 2021, Average contacts per setting, over time, The impact of contacts on mood and the influence of people's social network on attitudes toward vaccination.

    The Optimise Study: Social networks and mixing patterns
  • 2019: Australia’s progress towards hepatitis C elimination annual report

    Hepatitis C poses a significant public health concern in Australia, with over 170,000 individuals estimated to be living with chronic hepatitis C infection as of the beginning of 2017. Until the availability of direct-acting antivirals (DAAs) for all Medicare-eligible Australians with hepatitis C infection on March 1st, 2016, there was a growing population of individuals living with hepatitis C. This trend was accompanied by an increasing burden of liver disease, rising rates of liver cancer, and premature deaths attributed to long-term hepatitis C infection.

    2019: Australia’s progress towards hepatitis C elimination annual report
  • 2024: Australia’s progress towards hepatitis C elimination annual report

    2024: Australia’s progress towards hepatitis C elimination annual report
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