( A report back from Dr Joss O’Loan - Kombi Clinic: It's the End of the Road for Hep C - Treating Hepatitis C in General Practice Forum)

There was no doubt that Joss O’Loan’s presentation about the Kombi Clinic stole the attention of the whole Hepatitis C forum. It was very entertaining. Two dedicated doctors, one nurse and a phlebotomist allocating one session per week to go on a mobile clinic to do hepatitis C testing and treatment, reaching out to people who need it the most. They recognise the hot spots where there are people that need to be screened eg. Alchohol, Tobacco and other drugs (ATOD) clinics. Their target is to increase the detection rates among high risk groups by increasing access to medical services. They have their own mobile Firboscan which makes the process a whole lot easier. 

The project was started after recognising barriers to treatment. The main patient factors for not getting treated were the chaotic lifestyle of the target population who find it hard to organise themselves to get to the doctor and to attend multiple appointments to get treated. The second problem was the fear of having to have blood tests as many of the target population have difficult IV access. Having an experienced phlebotomist and doctors who are experienced in doing a femoral puncture ensure they never miss an opportunity to take blood. The fears among the people about having to face the judgemental attitude of hospital staff and the experience of major side effects with interferon therapy were also taken into account when they started this project.  

A lot of GP’s only have very few patients with Hep C and the attitude of GPs have sometimes affected the patient getting treated as it may be seen as a self-inflicted issue. The biggest barrier for GPs is the lack of knowledge about the DAA treatment with many GPs not being comfortable with initiating treatment themselves. 

The Kombi Clinic have been able to improve patient compliance by making the follow up process available at their door step. This project has simplified hepatitis C treatment and found an answer to the burning issues around the testing, treating and the monitoring. They have achieved higher success rates and have broken down the common barriers to treatment access.