Funders:

Australian Centre for Disease Control (CDC)
National Health and Medical Research Council (NHMRC)
Department of Health and Aged Care

Investigators:

Prof Jane Davies
Ms Sarah Mariyalawuy Bukulatjpi
Dr Christine Connors
Dr Joshua Davis
A/Prof Jess Howell
Prof Robert Batey
Prof Benjamin Cowie
Dr Josh Hanson
Prof Gail Matthews
Prof Louise Maple-Brown
Dr Paula Binks
Dr Kelly Hosking
Mr George Garambaka Gurruwiwi
Ms Roslyn Dhurrkay
Dr Belinda Greenwood-Smith
Dr Nicole Allard
Dr Karen Fuller
Ms Jessica Michaels
Dr Lou Sanderson
Mr Phillip Merrdi Wilson
Ms Teresa De Santis
Ms Emily Vintour-Cesar
Kelly-Anne Stuart-Carter
Amanda McAtamney
Dr John Boffa
Jaclyn Tate-Baker
Dr Sean Taylor
Prof Steven Tong
Prof Anna Ralph
Dr Vicki Krause

Partner Organisations:

ASHM
Cairns and Hinterland Hospital and Health Service
Cancer Council Australia
Central Australian Aboriginal Congress
Danila Dilba Health Services
Hepatitis Australia
Hepatitis B Voices Australia
Katherine West Health Board Aboriginal Corporation
Mala’la Health Service Aboriginal Corporation
Marthakal Homelands Health Service
Menzies School of Health Research
Miwatj Health Aboriginal Corporation
NACCHO
Northern Territory Government, NT Health
NT AIDS and Hepatitis Council (NTAHC)
Red Lily Health Board Aboriginal Corporation
Sunrise Health Service Aboriginal Corporation
Wurli-Wurlinjang Health Service
 

Aims:

Objectives: 

• Enhance the Hep B PAST model to include broader liver disease, including Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD) and cirrhosis
• Enable timely identification and entry into HCC surveillance for people at risk, including those with MASLD-cirrhosis
• Strengthen and embed culturally safe liver disease workforce training (Managing Hep B course and S100 prescriber training)
• Translate and expand the Hep B Story App into additional First Nations languages
• Evaluate the feasibility and impact of HBV point-of-care (PoC) viral load testing in remote settings
• Strengthen and enhance one-stop-shop liver clinics, including Liver Ultrasound Screening for HCC (LUSH) point-of-care ultrasound
• Undertake ultrasound audit and continuous quality improvement (CQI) activities
• Expand the Hep B Hub to support coordinated, data-driven care
• Evaluate outcomes across the cascade of care using epidemiological, clinical, and qualitative methods
• Expand the Hep B PAST Plus program into Far North Queensland 

Summary:

Hep B PAST Plus builds on the success of the Hep B PAST program to enhance and expand a culturally safe, community-partnered model of care for liver disease across northern Australia. While originally focused on chronic hepatitis B (CHB), the program now responds to the growing burden of liver disease by incorporating conditions such as MASLD, cirrhosis, and hepatocellular carcinoma (HCC).

The program strengthens delivery of “one-stop-shop” liver clinics on country, incorporating innovations such as point-of-care HBV viral load testing, LUSH point-of-care ultrasound, and systematic ultrasound audit processes. It also embeds workforce development through accredited training, including the Managing Hepatitis B course and S100 prescriber training, alongside health literacy initiatives such as the Hep B Story App translation into additional First Nations languages.

Hep B PAST Plus uses participatory action research and continuous quality improvement approaches, working in partnership with First Nations communities, health services, and stakeholders. A comprehensive evaluation framework combines epidemiological data, clinical outcomes, and qualitative insights to assess impact across the cascade of care and inform national policy and practice.

Implications for policy and practice:

• Demonstrates a scalable, culturally safe model of care for liver disease in First Nations communities
• Supports national hepatitis B and liver cancer strategies and WHO elimination targets
• Expands care models to address emerging liver disease burdens, including MASLD
• Provides evidence for integrating point-of-care diagnostics and ultrasound into remote care
• Strengthens workforce capability through accredited training pathways
• Informs best practice approaches to community engagement, co-design, and participatory research
• *Our research has found:  
• The Hep B PAST model significantly improves the hepatitis B cascade of care in participating communities
• Culturally safe, co-designed workforce training leads to sustained improvements in clinical practice
• One-stop-shop liver clinics improve access to HCC surveillance, diagnosis, and treatment in remote settings
• Point-of-care testing has strong potential to improve engagement, reduce delays, and support real-time decision making
• Expanding care to include MASLD and cirrhosis is essential given the rising burden of metabolic disease
• Health literacy tools, such as the Hep B Story App in First Nations languages, improve understanding and engagement in care
• Linking clinical care with CQI and surveillance data strengthens system-level impact and sustainability

Chief Investigator:

Professor Jane Davies

Project Managers:

Contact info:

Project dates:

Hep B PAST Plus is delivered in partnership with health services and First Nations communities across northern Australia. Participation occurs through local primary health care services, Aboriginal Community Controlled Health Organisations (ACCHOs), and partner organisations.

Community members may be invited to attend liver health assessments through locally delivered “one-stop-shop” clinics. These may include screening for hepatitis B, MASLD, and liver fibrosis, as well as access to ultrasound and other non-invasive assessments.

Primary health care staff are invited to participate in workforce training, including the Managing Hepatitis B course and S100 prescriber training.

As part of the evaluation, participants and health care staff may be invited to take part in questionnaires, interviews, or other feedback activities. Participation is voluntary and helps improve the program and future models of care.
 

1. Martin, G. E., Hosking, K., Banz, K., Gargan, C., Stewart, G., Greenwood-Smith, B., Ramsay, P., Tate-Baker, J., Connors, C., Binks, P., McKinnon, M., Manchikanti, P., Gurruwiwi, G. G., Allard, N., Qama, A., Michaels, J., Vintour-Cesar, E., Batey, R., Marshall, C., Nihill, P., Fernandes, T. A., Fuller, K., Tong, S. Y. C., Boettiger, D., Cowie, B., Davis, J. S., Bukulatjpi, S. M., Davies, J., & the Hep B PAST Partnership. (2025). Disease progression and treatment need in sub-genotype C4 hepatitis B infection: A retrospective cohort study in the Northern Territory, Australia. BMC Infectious Diseases, 25(1), 881. https://doi.org/10.1186/s12879-025-11213-w
2. Sullivan, R., Bukulatjpi, S., Binks, P., Hosking, K., Nundhirribala, P., Vintour-Cesar, E., McKinnon, M., Gurruwiwi, G., Green, A., Davis, J., & Davies, J. (2024). “They feel shame sometime, but that is why we need to talk to them…we need to tell them how important it is not to feel shame”: Hepatitis B-related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce. Archives of Public Health, 82, Article 82. https://doi.org/10.1186/s13690-024-01389-z
3. Howell, J., Combo, T., Binks, P., Bragg, K., Bukulatjpi, S., Campbell, K., Clark, P. J., Carroll, M., Davies, J., de Santis, T., Muller, K. R., Nguyen, B., Olynyk, J. K., Shackel, N., Valery, P. C., Wigg, A. J., George, J., & Roberts, S. K. (2024). Overcoming disparities in hepatocellular carcinoma outcomes in First Nations Australians: A strategic plan for action. Medical Journal of Australia, 221(5), 230–235. https://doi.org/10.5694/mja2.52395
4. Hosking, K., Binks, P., de Santis, T., Wilson, P., et al. (2024). Evaluating a novel model of hepatitis B care, Hep B PAST, in the Northern Territory of Australia: Results from a prospective, population-based study. The Lancet Regional Health – Western Pacific, 48, 101116. https://doi.org/10.1016/j.lanwpc.2024.101116
5. Binks, P., Venkatesan, S., Everitt, A., Gurruwiwi, G. G., Dhurrkay, R. G., Bukulatjpi, S. M., Ross, C., Alley, T., Hosking, K., Vintour-Cesar, E., McKinnon, M., Sullivan, R., Davis, J. S., Hefler, M., & Davies, J. (2024). An evaluation and refinement of the “Hep B Story” app, tailored to meet the community’s cultural needs. BMC Health Services Research, 24, 710. https://doi.org/10.1186/s12913-024-11149-y
6. Binks, P., Gurruwiwi, G. G., Dhurrkay, R. G., Bukulatjpi, S. M., Ross, C., Hosking, K., Tate-Baker, J., Marshall, C., McKinnon, M., Vintour-Cesar, E., Sullivan, R. P., Davis, J. S., Hefler, M., & Davies, J. (2024). “Talking about something no one wants to talk about”: Navigating hepatitis B-related work in remote Australian Aboriginal communities: A decade of learning and growth. Discover Health Systems, 3, Article 13. https://doi.org/10.1007/s44250-024-00075-9
7. Binks, P., Ross, C., Gurruwiwi, G. G., Wurrawilya, S., Alley, T., Bukulatjpi, S. M., Vintour-Cesar, E., Hosking, K., Davis, J. S., Hefler, M., & Davies, J. (2024). Adapting and translating the “Hep B Story” app the right way: A transferable toolkit to develop health resources with, and for, Aboriginal people. Health Promotion Journal of Australia, 35(1). https://doi.org/10.1002/hpja.858
8. Hosking, K., de Santis, T., Vintour-Cesar, E., Wilson, P. M., Bunn, L., Gurruwiwi, G. G., Wurrawilya, S., Bukulatjpi, S. M., Nelson, S., Ross, C., Stuart-Carter, K.-A., Ngurruwuthun, T., Dhagapan, A., Binks, P., Sullivan, R., Ward, L., Schroder, P., Tate-Baker, J., Davis, J. S., & Davies, J. (2024). “Putting the power back into community”: A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia’s Northern Territory. PLOS ONE, 19(1), e0288577. https://doi.org/10.1371/journal.pone.0288577
9. Hosking, K., de Santis, T., Vintour-Cesar, E., Wilson, P. M., Bunn, L., Gurruwiwi, G. G., Wurrawilya, S., Bukulatjpi, S. M., Nelson, S., Ross, C., Binks, P., Schroder, P., Davis, J. S., Taylor, S., Connors, C., & Davies, J. (2023). “The most culturally safe training I’ve ever had”: The co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia. Research Square (preprint). https://doi.org/10.21203/rs.3.rs-2830413/v1
10. Hanson, J., Radlof, S., Littlejohn, M., Hempenstall, A., Edwards, R., Nakata, Y., Gregson, S., Hayes, R., Smith, S., McKinnon, M., Binks, P., Tong, S. Y. C., Davies, J., & Davis, J. S. (2023). Hepatitis B genotypes in Aboriginal and Torres Strait Islander Australians: Correlation with clinical course and implications for management.

Hep B Story App
ASHM Hepatitis B S100 Prescriber Training
4th National Hepatitis B Strategy 2023-2030