While the Zika virus (ZIKV) is not endemic in Australia, it continues to be prevalent in many neighbouring countries in the Indo-Pacific region. It poses significant public health concerns due to its association with severe outcomes, including Guillain-Barre syndrome and congenital malformations such as microcephaly. Although vector-borne transmission is the primary route, sexual transmission has been documented, raising the possibility of unrecognised and underreported infections.

We report the details of 2 cases of ZIKV infection diagnosed in the Northern Territory of Australia. The first case was a male traveller who contracted the virus in Timor-Leste and the second, his female partner in Australia. We believe this represents the first reported incidence of sexually transmitted ZIKV infection acquired in Australia.

The investigation emphasizes the importance of obtaining detailed patient histories, including sexual histories, to improve detection and understanding of ZIKV transmission. It also highlights the challenges of diagnosing ZIKV due to its nonspecific symptoms and the necessity of public health education regarding ZIKV transmission and prevention strategies. Clinicians need to be aware of the symptoms, geographic distribution and transmission modes of infectious diseases like ZIKV in returned travellers, as well as the potential implications for their contacts. Heightened awareness is important to ensure early detection, appropriate management, and counselling to prevent transmission.

Context
Trachoma is the world’s leading infectious cause of preventable blindness. Australia remains the only high-income country with endemic trachoma, found in remote First Nations communities in western and central jurisdictions. In 2022 Australia reached World Health Organization (WHO) benchmarks for elimination as a public health problem (EPHP): trachomatous inflammation-follicular (active trachoma) prevalence <5% in children and trichiasis (severe advanced disease) prevalence ‘unknown to the health system’ <0.2% in adults, within formerly endemic jurisdictions. 2024 was the final year of monitoring against these benchmarks, before being eligible to apply for EPHP validation.
Methods
WHO grading criteria was used to classify trachoma in children aged 5–9 years by trained graders. Trichiasis rates are derived from public health surveillance, visiting optometry services, and Adult Health assessments (715 checks). Jurisdictions also submit data on implementation of the SAFE strategy for trachoma control: Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvements to reduce transmission and prevent reinfection.
Results
In 2024, 86 at-risk communities were screened for trachoma. Overall trachoma prevalence was 2.1% in the Northern Territory, 1.3% in Western Australia and 0% in South Australia. Several communities still report hyper-endemic trachoma (>20% prevalence). In total, 1,674 doses of antibiotics were administered in 25 communities to treat active infection. Trichiasis in screened persons aged 15+ years was 0.04%, with six surgical interventions.
Conclusion
Australia has met criteria for EPHP validation; however, systemic efforts are needed to prevent recrudescence. Ownership by and accountability to First Nations people must underpin post-EPHP strategies developed. Surveillance and control will need to be maintained in at-risk communities and may include the use of biomarker assessments in partnership with ACCHOs and primary care. Focusing on improving social and environmental determinants of health, changing focus from “SAFE” to “EFAS”, will be critical to maintaining elimination status.

Statement on First Nations-focused research
This presentation will be delivered by the National Trachoma Surveillance and Reporting Unit, funded by the Australian Government to collate and analyse trachoma prevalence and control data submitted annually by states/territory health departments, ACCHOs, primary care providers and others that undertake delivery of the SAFE strategy.

Background
Trachoma is the leading infectious cause of blindness worldwide. Australia is the only high-income country with endemic trachoma. This presentation reviews trachoma prevention and control activities in Western Australia (WA) and their implications for sustainable trachoma elimination.

Methods
A statewide approach to trachoma control, consistent with the Communicable Disease Network Australia’s Guidelines for the public health management of trachoma (2006), was established in Western Australia (WA) in 2006. Implementation of these guidelines involves trachoma prevalence and control activity data being collected and reported to the National Trachoma Surveillance and Research Unit.

Results
In 2006, trachoma was endemic in about 50 communities and towns in the four WA regions, with <15,000 people at risk of the disease; prevalence in these locations was 23%. By 2024, trachoma prevalence had reduced to less than 5% and was limited to six communities in two regions. Recognising that home is the most influential environment for children and family health, partnerships between WA Health’s Environmental Health Directorate, local Shires and the State Housing Authority within the Department of Communities have enabled what started as Safe Bathroom checks by Aboriginal environmental health practitioners to transform into Healthy Homes Assessments. These assessments facilitate and prioritise repairs and maintenance of health hardware. Many schools in trachoma-endemic communities implement face-washing, nose-blowing, uniform laundering, and teeth-brushing programs. The 715 health-check includes trichiasis screening.

Conclusions
Over the past 18 years, trachoma control in WA has shifted from an emphasis on community-based screening and antibiotic treatment (often community-wide) to supporting behaviours and environmental conditions that protect people from trachoma and other infective and post-infective conditions such as otitis media, skin infections, post-streptococcal glomerulonephritis and rheumatic fever/heart disease.
Future challenges include maintaining environmental health improvements and health hardware, normalising facial cleanliness and accessing technologies suitable for trachoma surveillance after certification of trachoma elimination.

The results presented are not research findings; they were generated in the course of delivering a public health program overseen by the WA Trachoma Reference Group which comprises a variety of government, non-government, and Aboriginal Community Controlled Organisations including Aboriginal Health Council of WA and Aboriginal Community Controlled Health Services.

Background/Approach:
As Australia works towards its 2030 hepatitis C (HCV) elimination goal, the increasing challenge of identifying new cases highlights the need to strengthen care pathways. Ensuring both historical and new diagnoses are linked to care and that treatment is initiated post-diagnosis will be critical. Funded through an NHMRC Partnership Grant, Connect C aims to foster the sustainable use of HCV notifications data held by health departments to link those diagnosed with HCV to treatment. To achieve this, Connect C prioritises the building of linkages between health departments, community organisations, and healthcare and laboratory service stakeholders through in-person and online forums to inform community-accepted care models initiated from HCV notifications data.

Analysis/Argument:
Diverse perspectives from our stakeholder engagement emphasises the need for enhanced data sharing between government and health services to mobilise a broad workforce in supporting person-centred care pathways. A coordinated, system-wide approach to improve data visibility is required. Effective collaboration among stakeholders, including health authorities, community organisations, and peer support, is key to addressing barriers such as a lack of awareness of treatment options, stigma, poor access to healthcare and insufficient social support. Individuals who are not engaged in treatment can be identified and prioritised for care through better linkage of notifications data and other administrative health data.

Conclusions/Applications:
Utilising HCV notifications data, tailored treatment pathways and integrated peer support, can optimise acceptable pathways to HCV treatment, and re-engage individuals lost to care. Collaboration between health services and community organisations, including peer organisations, is key to mobilising sector resources to improve care pathways, enhancing retention in care, reducing the number of people living with HCV, improving health outcomes, and preventing transmission. This approach can help to accelerate progress towards HCV elimination by 2030, reducing HCV as a public health threat.

Introduction
Hepatitis B virus (HBV) remains a public health challenge, with chronic HBV infection leading to advanced liver disease complications including decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC). Prevention of HBV-related DC and HCC relies on effective interventions, particularly antiviral therapy, with late HBV diagnosis a missed opportunity for their earlier introduction. This study investigates factors associated with late HBV diagnosis in a large, metropolitan area of Sydney, Australia.

Methods
This population-based cohort study used linked data, consisting of all HBV notifications in New South Wales linked to hepatitis C virus notifications and hospital admission data. DC and HCC diagnosis was based on first hospitalization for each event. Late diagnosis was defined as HBV notification at or within two years of DC or HCC diagnoses. Cross-tabulation and unadjusted and adjusted logistic regression analyses were performed to assess the association of late diagnosis with demographic, temporal, geographic, and clinical factors.

Results
Between 2002 and March 2022, 10,910 individuals in SESLHD were notified with HBV, with 296 (3%) diagnosed with DC or HCC. Late diagnosis occurred in 102 (34%) of these individuals and was more common in females (43%) versus males (31%), individuals born between 1945 and 1964 (55%), and those born in West/South Asia (43%). Female sex was independently associated with late HBV diagnosis (adjusted odds ratio [aOR] 1.92, 95%CI 1.08-3.42). Trends towards associations with late HBV diagnosis were observed for birth cohort (≥1965) (aOR 2.02, 95% CI 0.85-4.82), overseas birth (aOR 1.92, 95% CI 0.96–4.01), alcohol use disorder (aOR 2.72, 95% CI 0.86–8.96), and year of DC or HCC diagnosis (aOR 0.57, 95% CI 0.28–1.16 2016-2021 vs 2001-2008).

Conclusion
A third of people with HBV-related advanced liver disease complications are diagnosed late, reducing opportunities for effective interventions. Strategies to enhance earlier HBV diagnosis are required to reduce HBV disease burden and advance HBV elimination efforts. Strategies should aim to reach groups most affected, while also ensuring equity for groups at higher risk, such as women. These findings underscore the importance of localised data and benefits of data linkage.

Hepatitis C causes significant morbidity and mortality, particularly in drug, alcohol and mental health service populations. Screening remains suboptimal in these settings, particularly in regional areas. According to modelled estimates, Shepparton has the highest hepatitis C prevalence in regional Victoria, and nearly the lowest treatment rates.

A large proportion of undiagnosed people with hepatitis C in the Goulburn Valley region are likely to attend drug, alcohol or mental health services in Shepparton. We implemented an intervention to improve hepatitis C screening at the central service for these patients in Shepparton, the Goulburn Valley Health (GVH) Joint Addiction Medicine and Mental Health Service. This included clinical guidelines promoting universal screening, intensive staff education, integrated screening prompts, advocacy from service leaders, and a streamlined referral process to the local Nurse Practitioner-led hepatitis clinic.

We audited screening rates at the GVH mental health inpatient service and drug and alcohol outpatient service before and after the intervention. 404 patients were included over 9 months. Hepatitis C screening rates increased significantly from 6.6% pre-intervention to 27.9% post-intervention. Antibody-positive patients were referred to the hepatitis Nurse Practitioner for assessment and treatment.

This was a pragmatic audit of an intervention, and its limitations must be considered. However, the evidence suggests that the intervention was effective in increasing screening rates. Significant work remains to ensure the intervention is sustainable, grows to become more universal, and achieves successful follow-through of antibody-positive patients through to treatment and cure.

We are now expanding the program to include Shepparton’s major needle syringe exchange program, and partnering with research organisations. Our strategy will be to combine three initiatives: 1) Universal screening, 2) Point-of-care hepatitis C testing, and 3) Financial incentives. We believe this strategy will further improve screening rates and follow-through to cure.

Increasing the proportion of hepatitis B and C (HBV and HCV) cases linked into care (LIC) is integral to eliminating these conditions in Australia. Cultural brokerage can be an effective way to engage with culturally and linguistically diverse (CALD) populations affected by HBV and HCV. To our knowledge, this has not been previously undertaken in Australia.

Using a mixed-methods retrospective cohort study, the South East Public Health Unit (SEPHU) sought to determine whether culturally-responsive management by a Cultural Liaison Officer (CLO) improved public health outcomes and consumer experiences for HBV and HCV cases.

Health undertaking notifications were used to identify cases of HBV and HCV from CALD communities. Rates of LIC, offering treatment, and provision of recommendations for HBV vaccination of close contacts were assessed. Data were compared prior to the introduction of the CLO (September 2022 to October 2023) and after CLO commencement (November 2023 to October 2024). Semi-structured interviews were undertaken to gauge consumer experience of working with the CLO.

205 HBV and 39 HCV cases were followed up during the study period. A significant association was seen between the introduction of the CLO and the proportion of HBV cases followed up until LIC (from 51.9% prior to CLO involvement to 97.9% , Chi2 = 27.7, p<0.001); known to be offered treatment (increased 6.4%, Chi2 = 19.6, p=0.001); and contacts being offered the HBV vaccine (increased 29.6%, Chi2 = 11.25, p=0.001). There were no significant associations regarding HCV cases.

Interviews identified three main themes regarding the cases’ experiences with the CLO: self-perception; family and community; and institutions - demonstrating the beneficial contributions of the CLO.

Utilising a CLO was associated with improved public health follow-up of CALD cases with HBV. Cultural brokerage should be considered for future public health management of conditions, particularly where CALD communities are overrepresented.