How two doctors in a Kombi are making inroads into hard-to-reach hepatitis C populations

Hepatology

By Tessa Hoffman

23 Aug 2018

While policy makers grapple with how to tackle the next frontier in eradicating hepatitis C in Australia – treating people who are disengaged from the health system – a pair of doctors has taken the challenge into their own hands.

Since April last year, once a week two Brisbane GPs don pink Hawaiian shirts and drive to various drug and alcohol centres and drop-in centres for the homeless, where they offer on-the-spot testing and follow-up treatment out of a mobile clinic housed inside a classic VW Kombi van.

Dr Jonathon O’Loan (left) and Dr Matt Young are the founders of Kombi Clinic.

 Dr Jonathon ‘Joss’ O’Loan and Dr Matt Young came up with the idea after successfully treating patients with hepatitis C using direct-acting antivirals at a  medical centre, which also offers opioid replacement therapy, based in Brisbane’s south.

“We cleared out our cohort of hepatitis C patients and realised this stuff is pretty easy to do, the hard part is getting the patient in front of you or getting them (tested),” Dr O’Loan tells the limbic.

“Then we realised what we really need to do is bring the testing to the patients, because there is a big cohort of patients that aren’t on methadone or suboxone that don’t have regular GPs and have no chance of getting up to the tertiary hospital that charges $20 an hour for car parking and has six month waiting lists.

“We took the view this isn’t a barrier that should stop people from getting world class health care and life saving medications, so we need to break down these barriers and liberate the patients from the tyranny of hepatitis C.”

 

For this group, two major barriers are the wait time and any associated costs for treatment, says Dr O’Loan, something he could overcome by providing a service that is on-the-spot and free of charge.

Also on board the van are a phlebotomist and a nurse to operate a Fibroscan. On a first visit patients have a clinical history and blood taken, and on the second they are given their results and any prescriptions.

“A lot of these people live in the world of immediacy. For them, it has to happen right here right now and even a wait of 20 minutes is often too long, so asking a patient to wait three or six months in a gastro clinic, the impetus is not going to be there.”

But it’s the Kombi itself –  the iconic German Volkswagon van popularised in the 1960s which evokes images of carefree, happy-go-lucky travelling – that is the core reason the model is working so well, Dr O’Loan says.

“There are lots of studies that have showed patients feel really stigmatised talking to doctors and accessing hospital system to talk about hep C. So that’s the idea of the Hawaiian shirts – it’s hard to be stigmatised by someone in a Hawaiian floral shirt and the idea of the kombi.

“You automatically feel relaxed and chilled when you see a kombi, lots of people have stories about them. People will come up on the street and go ‘oh mate, great kombi’ have a chat and then that can be the segway into what we’re doing.”

Once a week, the Kombi Clinic is parked at locations across Brisbane including health department-run drug and alcohol centres, drop-in centres for the homeless, and places where people sleep rough, working in tandem with another mobile outreach van operated by Drug ARM Australasia.

“We pull up beside Drug ARM and as people are getting their coffee and their chat from them, we say do you want a free liver check hep C screen? And that’s been very successful.”

Some 200 patients were tested, between April 2017 and June 2018, with three quarters of those who tested positive returning for a script, he says.

The doctors don’t keep track of cure rates, Dr O’Loan says that would be very difficult to accurately do.

“The point of view we take is for many of these patients, this is the only way they are going to get medication.

“Some gastroenterologists say you should wait until they are in stable accommodation or wait until they give up alcohol or IV drug use, which is a fair call except many of these situations are years or decades in the making, so the idea to wait, they may not have another 10 years, they may develop cirrhosis in that time

“Another point is that hepatitis C is an infectious disease, if we target patients who are actively using and actively sharing we decrease the amount of transmission of the virus.”

The program has won support from Hepatitis Queensland, QML Pathology and a $10,000 Westfield Local Heroes grant.

On the back of local success, Dr O’Loan hopes to see the program go national.

“The world of hep C is largely driven by people who inject drugs and use drugs and that’s a hard target audience to reach. It makes sense to take the treatment to the patient and tailor medical services to the population you are trying to treat.

“Matt and I talk about seven Kombis from seven (capital) cities… we all treat along the way and meet at Uluru have a big ‘Rock Hep C’ concert.

“More Kombis around Australia can only be a good thing.”

If you are interested in finding out more Dr O’Loan can be contacted by phone (07) 3714 9093 or by email: [email protected]

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