KOMBI CLINIC CASE STUDY
Australia has laid the foundation for the elimination of hepatitis C virus (HCV) as a public health threat with strong political commitment based on high levels of screening and diagnosis, unrestricted access to direct-acting antiviral (DAA) therapy and a diverse range of models of care.1-3 However, case finding and linkage to care in populations that are hard to reach, or who have been disenfranchised from health systems remains difficult and has emerged as a major road block to finalising elimination.4
Reaching out to those in need
Based in Brisbane, Australia, the Kombi Mobile HCV Clinic represents a unique approach to increasing detection rates and education by improving free access to medical services to members of the community who are at higher risk of contracting HCV. The initiative was started after recognising the barriers to treatment faced by patients attending a suburban GP clinic. The chaotic lifestyle of the target population was identified as the main barrier to attendance and treatment. For example, patients can find it hard to get to the clinic and to attend the multiple appointments required for treatment initiation. The second barrier faced by many patients was the fear of having blood tests performed, as many of the target population have difficult intravenous access.
Each week, the Kombi Mobile Clinic, equipped with a Fibroscan device, two dedicated GPs, one nurse and one experienced phlebotomist visit and undertake screening, education and treatment services at:
- alcohol/mental health facilities,
- community centres,
- rough sleeping locations,
- homeless shelters,
- halfway houses,
- music festivals, and
- other relevant public events.
The Kombi van creates a source of discussion and gets people talking to the GPs, which creates an opportunity to ask if those people have been tested and/or treated for HCV. On the first visit, the team can take a clinical history, perform a Fibroscan and have blood samples taken. On the second visit (approximately 4 weeks later), test results can be reviewed, and education provided; treatment can be prescribed if necessary and follow-up visits arranged. Patients who require treatment can collect their prescriptions from a local pharmacy, where a $20 grocery voucher is also provided as an added incentive.
The Clinic has already demonstrated that bringing medical services into the community can increase treatment uptake and improve health outcomes for people living with HCV.5 In 2019, the Kombi Clinic screened 914 people for HCV and other blood-borne infections and initiated treatment in more than 140 patients. Of the patients who have completed treatment to date, 96.6% have obtained a sustained viral response at 12 weeks.
In summary, expanding access for HCV treatment in hard to reach or disenfranchised settings requires a continuous effort to overcome practical challenges. The Kombi Clinic represents a unique approach to dealing with equitable access to care and demonstrates that it is possible to make HCV testing and treatment a simple two-step process that can be provided in non-traditional settings.
The Kombi Mobile HCV Clinic has received partial funding from Gilead Sciences.
- Dore GJ and Hajarizadeh B. Infect Dis Clin N Am 2018;32;269-79.
- Australian recommendations for the management of hepatitis C virus infection: a consensus statement (September 2018). Available at: http://www.hepcguidelines.org.au/ (accessed Feb 2020)
- Pharmaceutical Benefits Scheme. General statement for drugs for the treatment of hepatitis C. Available at: http://www.pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c (Accessed Feb 2020).
- Klein MB. Journal of the International AIDS Society 2019, 22:e25360.
- O’Loan J. International Conference on Hepatitis Care in Substance Users 2019; 11-13 September 2019; Montreal, Canada
IHQ/LVD/2020-02//0007 • Date of Preparation: March 2020