Policymaker Perspectives on the Role of Health Systems in Sustainable Hepatitis C Point-Of-Care Testing in Australia

Point-of-care testing for hepatitis C virus (HCV) offers multiple benefits to key populations and healthcare providers, but it has not achieved widespread implementation. This analysis investigates the impact of the health system on the sustainability of point-of-care HCV testing in Australia. Between September 2023 and January 2024, in-depth, semi-structured interviews were conducted with people involved in HCV policymaking in Australia. Data were coded using WHO's Health System Building Blocks framework (i.e., Health Workforce, Health System Financing, Medical Technologies, Leadership and Governance). Thematic analysis examined how the health system supports and hinders the long-term sustainability of HCV point-of-care testing. There were 29 participants working in seven Australian jurisdictions or nationally: 13 from departments of health, six from community-led organisations, five from local health services, and five from pathology. The analysis demonstrates the interrelations between Building Blocks, but governance was consistently foregrounded across each theme. For Health Workforce, the community approach to models of care in Australia bolstered support for HCV testing outside of traditional healthcare settings. For Health System Financing, sustainability was threatened by a lack of long-term funding mechanisms for point-of-care testing. For Leadership and Governance, state and national HCV elimination targets were seen as important to drive point-of-care testing at the local level, especially when they were reflected in services' key performance indicators. Integration into existing health system structures, sustainable funding mechanisms, and strengthened governance frameworks are needed to sustain HCV point-of-care testing in Australia. Study findings are critical to inform a long-term testing strategy in Australia and internationally.