1. Coordinator, Harm Minimisation & Hepatitis Programs South Eastern Sydney Local Health District Hepatitis and the holy grail Gary Gahan

2. Experiences may be universal but context is everything

4. “Nothing is original. Steal from anywhere that resonates with inspiration or fuels your imagination … And don’t bother concealing your thievery – celebrate it if you feel like it. In any case, always remember what Jean-Luc Godard said: “It’s not where you take things from – it’s where you take them to.“ Jim Jarmusch

5. 90,000 residents in NSW living with hepatitis C Nearly 10 infections reported every day in NSW 2% of people with HCV start treatment in any year Within 3-5 years, new interferon-free treatments will be available that have cure rates of above 90%, simplified dosing schedules and reduced side effects NSW Context

6. Huge pool of infectivity Huge potential pool of people wanting treatment Huge network of GPs but negligible number of specialist prescribers Limited capacity to adequately assess need in community settings NSW Context

7. Bricks and mortar Highly specialised Configured to manage the mainstream Linkages to external health care providers primarily through pre/post treatment communication with GPs Expensive Growing demands and limited capacity to expand beyond current capacity Current Model

8. 1.Integrated care 2.Equitable care 3.Accessible care The Holy Grail

9. 1.Build the capacity of primary health care services to monitor and manage people living with hepatitis 2. Free up specialist public liver clinics to focus on seeing people most in need of specialist attention 3.Focus on those with advanced liver disease or other complex health issues The Holy Grail

10. A couple of case studies Reaching for the Grail

11. The lora project

12. The Liver Outreach Australia (LORA) Program is a nurse led model of care for the assessment and treatment of people with chronic hepatitis C. Aims to provide high quality clinical care in areas with little health infrastructure The program provides 3 year funding for a Clinical Nurse Consultant, a portable FibroScan machine and teleconferencing equipment. The LORA Program is sponsored by Janssen-Cilag Pty Limited, but is being implemented under the guidance of an independent Steering Committee Lora

13. HCV notifications rates in line with NSW averages Large geographic region with dispersed population including CALD and Aboriginal communities Higher levels of disadvantaged than the NSW population One Fibroscan machine across the region Why Nowra ?

14. Undertake education, screening and counseling of high-risk patients. Assess extent of liver injury through a mobile Fibroscan Work collaboratively with primary health care providers to establish a management plan. Follow up of treated patients in the community Facilitate access of patients to existing allied health services such as dietician, social worker and drug and alcohol services What does Lora do?

15. HepCheck 1 - 2 - 3

16. The Challenge Significant number of people affected by hepatitis & homelessness in the Inner City of Sydney Limited capacity to adequately assess liver damage in community settings Treatment is complex and confined to a small number of specialist health services Hepatitis is not a priority issue for many people with the condition Preventing illness and promoting good health among people subject to homelessness is a shared responsibility across multiple services

17. Growing consensus that this is a health issue that needs addressing A comprehensive network of specialist homelessness services in regular contact with people effected by hepatitis Existing clinical capacity within a number of these services Specialist health services with demonstrated capacity and commitment to working with homeless populations Strong partnerships with community based organisations such as Hepatitis NSW and NUAA The Context

18. HepCheck 1-2-3 will deliver a set of integrated projects across multiple services that results in: 1. better access to specialist hepatitis assessment and clinical care for people affected by homelessness 2. better integration of hepatitis health programs within existing specialist homelessness services 3. better coordination and support for the homeless sector to enable hem to respond to the liver health needs of their clients The vision

19. HepCheck

20. Build on existing strengths Show leadership Skill up your workforce Communicate and highlight your achievements Build real partnerships Engage with your communities of interest Find ways to share resources Innovate and solve problems together Get connected Get some quick wins and then move onto the trickier issues Capacity Building Framework

21. Steal from anywhere that resonates with inspiration or fuels your imagination

22. Thank you! Any Questions? Gary Gahan Coordinator, Harm Minimisation & Hepatitis C Programs HIV/AIDS & Related Programs Unit t: (02) 9382 8616 m: 0402 241 288 I gary.gahan@sesiahs.health.nsw.gov.au