The C No More Project: Community corrections Nurse-led Model of care to Eliminate hepatitis C

Open to students

People completing community corrections orders share common risk factors for hepatitis C transmission with people in prison, a group with known high hepatitis C prevalence. However, they represent a much larger population not currently targeted by hepatitis C treatment programs. This study will offer free hepatitis C testing and treatment to people in community corrections and assess the effectiveness of the model of care.

Objective

We aim to implement and evaluate a nurse and peer partnership-led mobile model of hepatitis C care. The model will utilise point-of-care testing and rapid DAA treatment initiation for people with criminal legal system involvement at selected sites in Victoria.

Timeline

2023–⁠2026.

Approach

A mobile, medically equipped van staffed by a hepatitis specialist nurse and peer support worker will park adjacent to metropolitan community corrections facilities. The service will offer hepatitis C testing for individuals attending these sites. Participants will be tested for current hepatitis C infection using point-of-care fingerstick testing, which returns a result in ~60 mins.

All participants with current hepatitis C infection will be offered a clinical assessment and DAA therapy in line with current Australian guidelines.

Following completion of DAA therapy, participants will be offered hepatitis C RNA PCR testing to confirm cure.

Hepatitis C information and education will be initiated with anyone having contact with the clinic team. This includes harm reduction strategies where appropriate.

Phase two (May 2025 –April 2026) will offer vaccinations and introduce screening for sexually transmitted infections.

Community impact

We will use a mixed-methods design to assess the service. This will utilise qualitative, sociodemographic, clinical and operational data to evaluate the acceptability, feasibility, effectiveness and cost-effectiveness of the mobile model of care.

This study will:

provide convenient, accessible testing and treatment for a group that face barriers accessing healthcare with an opportunity to engage/re-engage in hepatitis C care
test the feasibility and acceptability of rapid point-of-care hepatitis C testing in a non-traditional, non-clinical setting
provide ‘proof of concept’ evidence of feasibility, acceptability and effectiveness for scaling up the model of care
provide cost-per-treatment episode data to compare the model’s cost against existing primary care and in-prison hepatitis services
estimate the cost-effectiveness of the C No More model of care.

Student opportunities

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Exploring accessibility and acceptability of mobile STI service provision for women who use/inject drugs

Dedicated services that improve access to blood-borne virus (BBV) and sexually transmissible infections (STI) care for people who inject drugs are urgently needed but little is known about the gender-specific needs of women. As investments are made to develop new models of BBV/STI care that optimise engagement for ‘hard-to-reach’ reach populations, it is critical we ensure that these services reduce personal, structural and social access barriers for women and achieve acceptability and trust.

We are currently implementing and evaluating an innovative peer- and nurse-led model of HCV/STI care delivered through a mobile clinic van that operates adjacent to community corrections offices across Melbourne.

This study will seek to (1) identify the critical elements of mobile service design, delivery and operationalision that shape acceptability and
accessibility of HCV/STI care in this mobile setting for women who inject drugs; and (2) explore the needs and preferences regarding BBV/STI testing and linkage to care among women who inject drugs and other underserved women.

We will use respondent-driven sampling to recruit and interview ~20 women who inject drugs and/or are involved in the criminal justice system into this study. Interview transcripts will be analysed using reflexive thematic analysis. Findings will inform recommendations for gender-specific service design and/or advocacy for addressing access barriers.