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Peer workers with lived-living experience of illicit drug use and/or bloodborne viruses are critical in linking community with health services and programs. Despite the increasing demand for, and recognition of, the value and contributions of peer workers, the risk of workplace stigma and discrimination due to their lived-living experience remains a persistent issue. This scoping review aims to map available literature about workplace stigma and discrimination against peer workers with lived-living experience of drug use or bloodborne virus. The methods used in this scoping review were guided by the Joanna Briggs Institute methodology. A Population-Context-Concept format was used to develop search strategies conducted across four databases to assess articles for eligibility. Community representatives from Australian national and state-based peer-led Drug User Organisations provided input and expertise into all components of this review. Data was extracted and analysed from 61 articles that met the inclusion criteria. Findings were mapped against five levels the Socioecological Model of Health framework, and presented as key risk factors that either increase vulnerability to or sustain stigma and discrimination in the workplace, or protective factors that promote resilience and positive workplace experiences for peer workers. This review highlights that workplace stigma and discrimination towards peer workers takes many forms, including increased emotional labour, negative attitudes or behaviours towards peer workers from non-peer staff, disparities in working conditions between peer workers and non-peer staff, and law enforcement activities that impact peer work. Workplace stigma and discrimination experienced by peer workers can be addressed through adequate planning and the development of organisations and systems that address and acknowledge the existence of stigma and work to create safe work environments for peer workers. This includes organisational policies and training which recognises the unique emotional burdens experienced by peer work and addresses unequal employment conditions between peer- and non-peer staff, and broader societal changes around how drug use is policed.

Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care. Conclusion A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection.

Background Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. Methods Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. Results Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. Conclusions The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.

Background In Australia, only 22% of people with chronic hepatitis B (CHB) are clinically managed; and a national effort is engaging primary care workforce in providing CHB-related care. This study explored CHB-related knowledge, attitudes, barriers and support needs of general practitioners (GPs). Methods A survey was sent to a random sample of 1,000 Australian GPs in April- October 2018; 134 of 978 eligible GPs completed the questionnaire (14%). Results Respondents had high knowledge of at-risk populations (> 79%) and hepatitis B serology (82%), and most saw hepatitis B testing and monitoring as part of their work (95% and 86%, respectively). However, the survey revealed low knowledge, awareness and intention with respect to hepatitis B treatment: 23% correctly understood treatment initiation; 40% were aware that treatment for CHB could be dispensed in the community; 23% agreed that prescribing was part of their work. Lack of time was considered the greatest barrier (38%) and clear guidelines was the most important facilitator to providing care (72%). Conclusion Interventions are needed to generate interest and skills to provide CHB-related care by GPs.

Background Primary care services are recognised in consecutive national hepatitis B strategies as priority settings for clinically managing hepatitis B. In 2015, authorised general practitioners were able to prescribe hepatitis B therapy, thereby increasing access to medication that reduces hepatitis B-related mortality. The aim of this study was to identify elements supporting hepatitis B-related clinical management in primary care settings. Methods: Data from qualitative semi-structured interviews with 19 participants from primary care settings were thematically analysed. Results: Critical elements in providing clinical care in primary care settings were identified at an organisational and provider level. A supportive organisational culture included leadership, a multidisciplinary team approach, community engagement and cultural competency, while providerrelated issues included authorisation to prescribe, access to linguistic and cultural mediators and effective relationships with relevant specialist services. Discussion: The research identified practice leadership, organisational culture and a patient focus supported hepatitis B clinical management transitioning from specialist to primary care services.

Background and objective: In Australia, over a third of individuals living with chronic hepatitis B (CHB) remain undiagnosed. Evidence suggests general practitioners (GPs) can be uncertain regarding whom to test. The aim of this study was to evaluate an educational resource for improving GPs' knowledge about whom to test for CHB. Methods: Following a 2014 baseline survey that identified gaps in CHB knowledge among GPs in Victoria, an educational resource package was developed. Using a follow-up survey, the resource was evaluated by comparing the beforeand- after CHB-related knowledge. Results: Sixty-five GPs responded to both the baseline and follow-up survey. Their knowledge of populations at high risk of CHB who require testing was significantly greater following the intervention than at baseline. Discussion: Concise, clear and practical resources can support GPs when identifying whom to test for hepatitis B.

BackgroundDiagnosis is essential for engagement in care for chronic hepatitis B (CHB) and chronic hepatitis C (CHC), however, many Australians remain undiagnosed, especially for CHB. Primary care represents an important setting for testing, and this study sought to examine coverage in a large representative cohort of patients.MethodsWe analysed retrospective data from the electronic medical records of active patients visiting 566 primary care clinics in Victoria, Australia. Pathology records were assessed to identify the proportion of patients with a record of CHB/CHC serology testing based on risk factors identified in national guidelines (ethnicity, Indigenous status, history of injecting drug use, diagnosed HIV, and/or indications of liver disease).ResultsOf 1,593,774 patients, 393,948 (24.7%) had an indication for testing for CHB and/or CHC, of which 150,821 (38.3%) had evidence of testing. This proportion was highest in patients with HIV (65.6%) or injecting drug use history (60.0%), and lowest for those whose Indigenous status/ethnicity indicated testing (38.2%) or with elevated liver enzymes (39.1%). The proportion with evidence of testing was only moderate among those with a cirrhosis diagnosis (48.6%) or probable cirrhosis based on laboratory testing (50.6%).ConclusionsThis analysis demonstrated considerable gaps in testing for CHB and CHC in a large population of patients, including many with evidence of cirrhosis, suggesting higher risk of adverse outcomes. Primary care practices should be supported to comprehensively offer testing for viral hepatitis, particularly where there is evidence of liver disease, and these findings should be used to guide future interventions.

Background and objectiveIn Australia, over a third of individuals living with chronic hepatitis B (CHB) remain undiagnosed. Evidence suggests general practitioners (GPs) can be uncertain regarding whom to test. The aim of this study was to evaluate an educational resource for improving GPs' knowledge about whom to test for CHB.MethodsFollowing a 2014 baseline survey that identified gaps in CHB knowledge among GPs in Victoria, an educational resource package was developed. Using a follow-up survey, the resource was evaluated by comparing the before-and-after CHB-related knowledge.ResultsSixty-five GPs responded to both the baseline and follow-up survey. Their knowledge of populations at high risk of CHB who require testing was significantly greater following the intervention than at baseline.DiscussionConcise, clear and practical resources can support GPs when identifying whom to test for hepatitis B.

IntroductionType 1 diabetes (T1D) is associated with changes in brain structure, cognition, mental health, and functional outcomes. While these changes have been linked to dysregulated glycaemic control, findings are inconsistent, and their long-term impact remains unclear. Most evidence comes from cross-sectional or short-term longitudinal studies, limiting insights into causal associations. To address this, we aim to study individuals with T1D approximately 30 years after onset to assess how early dysglycaemic insults during neurodevelopment influence cognitive and functional outcomes in mid-adulthood.Methods and analysisThis protocol paper outlines an observational, case/control, cross-sectional/longitudinal and descriptive study that follows up the original Royal Children’s Hospital (RCH) Diabetes Cohort Study. The initial study recruited children in Australia diagnosed with T1D between 1990 and 1992, conducting five waves of data collection. We now introduce the Cognition and Longitudinal Assessments of Risk Factors over 30 Years (CLARiFY) Diabetes Complications Study to assess brain, cognition and functional outcomes in mid-adulthood, approximately 30 years post-T1D onset. Both T1D participants from the original cohort and healthy controls will participate in semistructured interviews, neuroimaging and cognitive testing. T1D participants will also undergo complications screening. Data from this study and previous waves will be used to (Aim 1) explore cross-sectional and longitudinal impacts of T1D on brain health over 30 years. Linear regression will analyse cross-sectional outcomes, and multivariate analysis will assess cognitive variables jointly. Longitudinal outcomes will be examined using linear mixed-effects regression for IQ patterns, with secondary outcomes analysed via generalised linear models. Additionally, linear mixed-effects regression (Aim 2) will identify T1D-related metabolic factors affecting brain outcomes, with covariate selection informed by the construction of directed acyclic graphs (DAGs).Ethics and disseminationThe study was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC 35 240F and 2019.065). The research findings will be disseminated through peer-reviewed publications, conference presentations, and print and social media. Participants will receive a summary of the study findings on its completion.