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