Optimizing liver disease screening and surveillance in remote Indigenous Australian communities: the SSOLID study...

Recognising and acting on the connection to Country as a determinant of Indigenous peoples' well-being is necessary to improve health inequities. Indigenous Australians experience a greater burden of chronic liver disease and poorer outcomes due to ongoing impacts of colonisation across determinants of health. This is exacerbated by a gradient in health outcomes based on remoteness, lack of specialist healthcare services and barriers to access. Our research aims to explore better ways to provide chronic liver disease screening and surveillance for very remote Indigenous Australian communities using non-invasive technologies On-Country.

Using an innovative combination of Indigenous and Quantitative research methodologies, this project involves 11 communities across four very remote sites in South Australia and Western Australia. The study comprises three parts: (1) site engagement with Aboriginal health services and remote communities; (2) a 12-month liver check (screening) phase and (3) a 24-month liver monitoring (surveillance) phase. The liver monitoring phase will use a stepped-wedge randomised controlled trial design where sites will have usual hepatocellular carcinoma (HCC) monitoring for a period of between 6 and 18 months and then On-Country monitoring for a period of between 6 and 18 months depending on treatment-sequence allocation. Recommended HCC monitoring involves 6 monthly liver ultrasounds and serum alpha-fetoprotein as per the site's usual care processes, where participants travel to regional centres for liver ultrasound. On-Country monitoring will involve liver ultrasound and serum tumour markers provided On-Country every 6 months. The primary outcome is the difference in adherence to surveillance On-Country compared with usual care. In addition to statistical and health economic methods, yarning circles have been incorporated to explore participant experiences, their knowledge of liver disease and views about the On-Country monitoring.

This study was granted ethics approval from the relevant national and state Aboriginal Health Research Ethics Committees. Findings will be reported to all participants and will be disseminated to the broader community and local health services. Translation of outcomes will be supported by key Indigenous Australian and healthcare stakeholders, including peak health bodies and consumer groups. Dissemination with the academic community will be through peer-reviewed publications and presentations at relevant conferences.

ACTRN12625000256471.