Initial promotion and recruitment

To initiate the program, the Aboriginal Deadly Liver Mob worker and Needle and Syringe Program (NSP) workers can talk with Aboriginal NSP clients about the Deadly Liver Mob program to explain that it will be starting soon. A small number of NSP clients were approached by Deadly Liver Mob workers and invited to be a ‘seed’ client. A ‘seed’ is a person who meets the program criteria for participation. They can be identified by the Deadly Liver Mob program staff, referred by NSP staff, self-referred or referred by another agency. The Aboriginal Deadly Liver Mob worker will explain how the program works by walking potential participants through the program flow chart. Seed clients are taken through the program, including testing, and then act as recruiters by spreading word about the program. These clients receive voucher incentives for their participation in each stage.

Aboriginal Elders in the local community may also be invited to go through the program, including education, screening and results. Even though Aboriginal Elders fall outside of the target population (as sexual health targets a younger audience) and may not meet the eligibility criteria for participation, this group is crucial to getting feedback on cultural appropriateness and acceptability. Additionally, if Elders respond positively to the program and understand its importance, this is an effective way to spread the word about the program through Aboriginal networks. In future Deadly Liver Mob sites, Elders should be approached early in the implementation as they may have important feedback on the delivery. Each site would need to decide whether to provide payment or vouchers for the time of Elders to go through the program, and they may choose only to go through certain aspects e.g. education rather than screening.

New Deadly Liver Mob sites should attempt to engage with the local Aboriginal Community Controlled Health Services (ACCHS) and any other relevant local Aboriginal and other organisations. Deadly Liver Mob staff can liaise with other relevant services to explain the program to staff. These services can include opiate substitution treatment clinics, probation and parole services, housing services etc. When talking about the Deadly Liver Mob program in these services, the program was positioned as inviting all Aboriginal people to undertake education and health screening. No specific mention of injecting drug use was made.

Briefing to other services can be verbal without printed promotional material.

The Deadly Liver Mob program combines health promotion and education delivered by Aboriginal health workers, a peer referral model and payment incentives to improve engagement, testing and treatment of bloodborne viruses and sexually transmissible infections.

The program is for Aboriginal people and is delivered by Aboriginal people

Aboriginal people who are eligible to participate in the program are those that:

Are aged 16 years or above (as people this age are entitled to use both Needle and Syringe Program and sexual health services without parental consent).
Identify as Aboriginal (Deadly Liver Mob workers should undertake screening of clients at enrolment using local protocols for establishing Aboriginal identity).
Have injected drugs or currently inject drugs.
At risk of hepatitis C including any of the following: people with a prison history, people who have ever had an unsafe tattoo, and people who live with someone who injects drugs and/or has hepatitis C.

The following criteria are taken from Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) as ‘working criteria’ for confirmation of Aboriginal or Torres Strait Islander heritage:

Being of Aboriginal or Torres Strait Islander descent, and
Identifying as an Aboriginal or Torres Strait Islander person, and
Being accepted as such by the community in which you live, or formerly lived.

Aboriginality should be determined by the local Deadly Liver Mob workers and in accordance with community principles. If the Deadly Liver Mob program runs for more than a year, some sites also instituted a ‘catch up’ education session for people at risk to reinforce education messages and to promote re-screening for those who continue to have risks for hepatitis C. More frequent education and screening may be important to provide to people who have been incarcerated given the lack of Needle and Syringe Program provision in prison.

Promotion of the Deadly Liver Mob program did occur in prison health clinics with specific details of Deadly Liver Mob sites and days of operation as a way to connect people recently released with the program.

Refer to troubleshooting for advice on non-Aboriginal partners of Aboriginal clients.